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Interphalangeal Collateral Ligament Sprain

Ovid: 5-Minute Sports Medicine Consult, The

Interphalangeal Collateral Ligament Sprain
Matt Roth
  • Injury to a collateral ligament at the interphalangeal joint of the finger, usually the proximal interphalangeal joint (PIP):
    • 1st degree: Pain, but no laxity with stress
    • 2nd degree: Pain and laxity but firm endpoint with stress
    • 3rd degree: Pain and loss of firm endpoint with stress
  • Mechanisms: Abduction or adduction force applied to the finger, usually while extended
  • Synonym(s): Mild injuries: Jammed finger
  • 1st- and 2nd-degree sprain much more common than 3rd-degree sprain
  • Index finger most often affected
  • Radial collateral ligament (RCL) more often affected than ulnar collateral ligament (UCL)
Risk Factors
  • Ball-handling and contact sports: Football, basketball, volleyball, wrestling
  • Prior injury or dislocation of the PIP joint
  • Finger struck by player or ball during play
  • Axial trauma causing forced ulnar or radial deviation of joint
  • Usually presents acutely in 1st few weeks but may become chronic
Physical Exam
  • Pain and swelling over lateral aspects of PIP joint
  • Decreased range of motion (ROM) secondary to pain and swelling
  • Instability in more severe injuries
  • Confirm neurovascular integrity, especially with on-field assessment.
  • Ensure that maximum tenderness is over lateral aspects and not dorsal (suggestive of central slip injury, which can have significant consequences if missed).
  • Stability is best evaluated for with the metacarpophalangeal (MCP) joint kept in 90 degrees of flexion and the PIP joint stressed in both extension and 20–30 degrees of flexion (1)[C].
  • Compare with uninjured fingers.
  • Use gentle force to avoid overstressing joint and extending partial tear into a complete tear.
  • Instability with lateral stress (opening beyond 20 degrees or lack of firm endpoint) suggests loss of integrity.
  • Assess function of flexor and extensor tendons by isolating MCP, PIP, and distal interphalangeal (DIP) joints separately to rule out tendon injury.
  • Loss of active ROM may be due to either pain or volar plate/central slip injury, so digital block may be necessary to test ROM (2)[C].
Diagnostic Tests & Interpretation
  • Plain radiographs are generally not required for 1st-degree injuries but may be considered for 2nd- or 3rd-degree injuries or to rule out additional bone injury.
  • Minimum requirement of posteroanterior, true lateral, and oblique radiographs of involved fingers (2)[C]
  • May be associated with avulsion fracture at ligamentous insertion
  • Look for dorsal subluxation to suggest instability
  • US is an emerging diagnostic tool in the evaluation of finger ligament integrity (1)[C].
Differential Diagnosis
  • Phalangeal fracture
  • IP dislocation
  • Central slip injury
  • Volar plate injury
  • Often associated with one or more of above


Ongoing Care
Follow-Up Recommendations
  • Follow up in 1–2 wks for reevaluation of laxity.
  • Refer significant fractures for possible ORIF (2)[C].
  • If uncertain of possible central slip/volar plate injury, refer to surgeon or follow up in 7–10 days for reevaluation (2)[C].
  • Chronic disability may be seen in athletes with delayed presentation or multiple dislocations (2)[C].
  • Chronic symptoms may respond to extended splinting and “buddy taping” with protected ROM exercises for several weeks to months (2)[C].
  • Surgical repair may be indicated if disability and instability persist after a sufficient trial of conservative treatment (2)[C].
Patient Education
Advise patients that some persistent deformity may be noted after injury has healed.
1. Leggit JC, Meko CJ. Acute finger injuries: part I. Tendons and ligaments. Am Fam Physician. 2006;73:810–816.
2. Freiberg A, Pollard BA, Macdonald MR, et al. Management of proximal interphalangeal joint injuries. Hand Clin. 2006;22:235–242.
3. Morgan WJ, Slowman LS. Acute hand and wrist injuries in athletes: evaluation and management. J Am Acad Orthop Surg. 2001;9:389–400.
Additional Reading
Alexy C, De Carlo M. Rehabilitation and use of protective devices in hand and wrist injuries. Clin Sports Med. 1998;17:635–655.
Palmer RE. Joint injuries of the hand in athletes. Clin Sports Med. 1998;17:513–531.
842.13 Sprain of interphalangeal (joint) of hand

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