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Dislocations
Sudden pain, swelling and an oddly positioned finger or joint after a fall or sporting knock? A dislocation may be the cause. This page explains what a dislocation is, how it’s assessed and treated, and when surgery may be needed.
What is it?
A dislocation is an injury where the two bones that meet at a joint become separated, so that they no longer sit together properly. In the fingers and hand it commonly happens during sport, and it is not unusual for the joint to be put back into place (reduced) on the field by an athlete, trainer or coach before you are seen by a doctor, or in the emergency department or urgent care centre before you see a hand surgeon.
At a glance
What is it?
An injury where the two bones meeting at a joint become separated and no longer sit together
Common symptoms
Pain, swelling and an abnormally positioned joint, often with reduced movement
Who it affects
Most often the result of a sporting injury, such as a blow to the finger, or a fall onto the hand
Is it serious?
Usually treatable without surgery, but needs prompt assessment to avoid lasting instability or stiffness
Treatment options
Reduction, splinting, buddy-strapping and hand therapy; surgery is needed in some cases
First step
Reduction of the joint, followed by an X-ray to check for any associated fracture
Causes and risk factors
- A blow to the finger during sport
- A fall onto an outstretched hand or finger
- Direct trauma to the joint
- Injury to the ligaments that hold the joint together, such as the volar plate or collateral ligaments
Dislocations are commonly a sporting injury. The force of the injury stretches or tears the ligaments that hold the joint together, including the volar plate (the ligament on the front of the joint) and the collateral ligaments at the sides. If the skin overlying the joint is also torn, the injury is described as an “open” dislocation, which carries a significant risk of infection.
Symptoms and how dislocations present
At the time of injury the joint may look visibly out of position. Finger joints are often reduced in a hospital emergency department under local anaesthetic; it is good practice to have an X-ray both before and after the joint is relocated so that any fracture can be identified.
After the joint is put back into place, the stability of the ligaments is checked to see whether the finger bends abnormally to the side. A small avulsion fracture, where a stretched ligament pulls off a tiny fragment of bone, is often seen at the front of the joint and is usually a sign of a volar plate injury.
Swelling can persist for weeks to months after a dislocation. This is not unusual, given the amount of bleeding into the joint and bruising of the ligaments and soft tissues that occurs with this type of injury.
How are dislocations diagnosed?
Dislocations are usually diagnosed from your history and an examination, supported by X-rays taken before and after the joint is reduced. This confirms the joint is correctly positioned and identifies any associated fracture.
Dr Tomlinson will also examine the stability of the ligaments around the joint, as injury to the collateral ligaments or volar plate affects how the injury is managed. If the skin over the joint has torn, this is assessed and treated as an open injury, as it carries a risk of infection.
Treatment options for dislocations
Most dislocations are treated without surgery once the joint has been reduced. Treatment typically includes managing swelling, splinting, buddy-strapping to a neighbouring finger, and a specific exercise programme to regain movement. A careful balance of stillness (splinting) and movement (finger exercises) is important – too little movement can lead to stiffness, and too little support can lead to ongoing instability.
Surgery may be recommended when the volar plate is completely torn and difficult to splint effectively, when the collateral ligaments and volar plate are both significantly disrupted so the joint does not sit fully in position after reduction, or when the dislocation is open. Open dislocations require antibiotics and surgical washout of the joint, with any injured ligaments repaired at the same time.
When to see a hand surgeon
See a hand surgeon if a dislocated joint cannot be reduced in the emergency department, if the skin over the joint has torn (an open dislocation), if the joint still does not sit fully in position on the X-ray taken after reduction, if the finger remains unstable once the swelling has settled, or if a significant fracture accompanies the dislocation. Prompt assessment gives you more treatment options.
What to expect at your appointment
At your appointment, Dr Tomlinson will take a history of your injury and examine the affected joint, including its stability and range of movement. She will review any X-rays taken at the time of injury, or arrange further imaging if needed. Together you will discuss whether splinting and hand therapy, or surgical repair, is the right approach for your injury, so you can make an informed decision about what to do next.
Related conditions and treatments
Dislocations often occur alongside other hand and wrist injuries. A small avulsion fracture is common at the site of a dislocation, and more significant fractures sometimes occur at the same time, which usually needs surgery to hold the bones in position while they heal – see our fractures page for more information. Ligament injuries, such as damage to the volar plate, collateral ligaments or the TFCC at the wrist, frequently accompany a dislocation – see our ligaments page for more information.