okay top three upper extremity conditions you don’t want to leave untreated. First of all all three things I’m going to mention are going to potentially masquerade as sprains times when you feel like you just tweaked your shoulder or tweaked your wrist or maybe it hurts a little bit you’re going to let it just get better on its own. I’ve seen many patients over the course of my career who come into me many months after the sprain only to find out that you have a fracture or a complete tear or a fracture dislocation.

So let me go through the list.

Acute Rotator Cuff Tears

acute rotator cuff tears now what is that that’s your rotator cuff that helps you elevate your arm. It hurts usually right over here if you injure it but if you have an acute rotator cuff tear from an injury whether it’s a dirt bike football basketball weekend warrior stuff that is something that you really want to know about as soon as possible.

The problem here is that if you have an acute tear and it’s retracted like I tell people like it’s like a garage door spring boink it pulls way away from the bone that is something we can repair right away. If it’s left untreated maybe say for 4 to 6 months that becomes increasingly harder to reattach. It starts to scar in, the muscle starts to get lazy fibrotic less elastic and all of a sudden now it’s going to be less likely that the Tenon is going to be repairable. You’ll end up potentially having a higher Reta rate from a surgery.

By the way when your rotator cuff is torn like that you’re going to have continued pain for a while so that’s really important to go see a doctor get a careful evaluation. And I usually will MRI patients with acute shoulder injuries like that right away, rule out that tear because you never know and you never want to miss that.

Scaphoid Fracture

okay number two scaphoid fractures. Now a lot of people who sprain their wrists probably never make it into my office. There are a subset of people who sprain their wrists who actually broke their scaphoid. The scaphoid is a small bean-shaped bone in the wrist and it’s a very important bone and when it’s broken the problem is it doesn’t have a great blood supply and so it takes a lot of time to heal and it requires immobilization right away.

So there are a lot of people who think they just tweak their wrist and the pain maybe gets better but never quite goes away and may come into me say four or 6 months after the wrist sprain and we get an x-ray and next thing you find out oh this was a break and it hasn’t healed and you’ve gone on to what’s called a scoid nonunion.

That is a harder thing to treat than an acute scoid fracture that sometimes can be even just treated in a cast. A scaphoid non-union definitely needs surgery. It needs sometimes bone graft; it might need other types of reconstructive considerations. Even with surgery sometimes it has a harder time to heal.

So really important if you sprain your wrist and it’s lasting more than a week or two come in get an x-ray get it checked out. You never want to miss a scaphoid fracture.

Finger Sprain

and number three a finger sprain. Now a lot of patients jam their fingers whether it’s playing basketball if they fall wrestling whatever the situation might be. If you have a sprain of your finger right in this finger joint here this pip joint every so often I’ll see patients who come in late where they have a fracture dislocation. Well not only is it broken but the joint is dislocated and when that happens that is something that when found early could be treated in a more limited often surgical way sometimes nonoperatively but sometimes surgically.

But if I find it late it’s going to require a more complex longer operation to reconstruct that joint getting it closer to normal. So if you jam your finger and haven’t reestablished all your motion within a week or two very important to come into my office get it checked out make sure nothing worse happened with respect to the joint the bone and you know worst case is the best case you came in wasted your time and found that everything’s normal.

So you know I highly recommend if anything’s lingering early in the process come in get an x-ray get it checked out and you know the worst case is the best case which is everything’s fine and there’s nothing to worry about. The best case is also sometimes the worst case but it’s also a good case because you found an injury that’s severe early in the process and so in order to treat a severe problem earlier always better than finding it late.

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The human fingers and thumb are intricate structures that are vital to almost everything we do. When a finger fracture or thumb injury occurs, the impacts can be detrimental and far-reaching.

If you have sustained an injury to your fingers or thumb and are experiencing ongoing pain or other symptoms like swelling or limited range of motion, a fracture or ligament tear may be the cause. Below, we’ve provided an overview of finger fractures and thumb UCL (and RCL) ruptures, including their causes, symptoms, treatment options, and recovery:

Understanding Finger Fractures

Phalanges are the small bones that make up the fingers and thumb. Each finger has three phalanges—the distal phalanx (fingertip), middle phalanx, and proximal phalanx (closest to the hand)—while the thumb has only a distal and proximal phalanx. The phalanges are connected to each other by interphalangeal joints and to the long hand bones (metacarpals) by the metacarpophalangeal joint (MP), which may also be injured when a finger fracture occurs.

Phalangeal fractures in adults most often involve the distal phalanx. In children, injuries to the growth plate of the small finger are most common.

Causes and Symptoms of Finger Fractures

The most common causes of phalanx fractures are:

• The fingers being hit by a fast-moving object, such as a ball
• Breaking a fall with the hand
• Slamming the fingers, such as in a drawer or door
• Accidents with tools (hammers, power tools, etc.)
• Traumatic, high-impact events such as a car accident

Common symptoms of phalanx fractures include:

• Pain and tenderness
• Swelling of one or more fingers
• Bruising and/or redness
• Limited range of motion or stiffness
• Deformity

Exploring Thumb UCL Ligament Tears

The ulnar collateral ligament (UCL) is a strong ligament located at the base of the thumb in the webspace between the thumb and index finger. Supported by the radial collateral ligament (RCL), it provides stability to the thumb and is critical for movements such as gripping and pinching.

Each finger also has a UCL and RCL at the metacarpophalangeal joints, but the thumb UCL is the most commonly injured or torn. UCL injuries are involved in up to 86% of all injuries to the base of the thumb, while RCL injuries are less common.

An acute UCL injury is sometimes referred to as Skier’s Thumb, while a chronic UCL injury is sometimes referred to as Gamekeeper’s Thumb.

Causes and Symptoms of UCL Tears

UCL and RCL tears typically occur when overwhelming stress is placed in either the radial or lateral direction at the finger or thumb joint.

Gamekeeper’s Thumb occurs when the ulnar collateral ligament of the thumb is ruptured, allowing the thumb to deviate beyond its normal anatomic endpoint. This may or may not involve an avulsion of the bone, meaning a small fleck of bone pulled off with the ligament. Sometimes, a Stener Lesion will occur, in which the ligament becomes displaced above the adductor aponeurosis and will not heal without surgery.

Common symptoms of UCL and RCL tears include:

• Pain at the base of the thumb that worsens with movement
• Tenderness
• Swelling and/or bruising
• Weakened ability or inability to grasp or pinch
• Wrist pain (sometimes referred from the thumb)

Diagnosis and Imaging Techniques

Phalanx fractures are diagnosed through a thorough physical examination followed by X-rays. If a UCL tear is suspected, a physical examination may be followed by stress-view X-rays to check for widening at the location of the tear. An MRI is the most definitive way to determine the extent and location of a UCL and/or RCL tear. MRI or CT scans may also be indicated in cases where finger fractures are complex or difficult to visualize from X-ray images.

Treatment Options: Surgical and Non-Surgical

There are a variety of finger fracture patterns, and each one calls for a specifically tailored treatment plan that also takes into account the bone involved and the severity of the fracture. In addition, attention must be given to the rotation of the fingers that may be associated with a phalangeal fracture. Some fractures can be immobilized in a cast or splint while others may need to be manipulated into proper alignment or require surgical intervention for reduction and fixation of the fracture.

Treatment for UCL or RCL tears also depends on the severity and location of the tear. While non-surgical treatment may be effective in many instances, some UCL injuries require surgical repair to heal properly.

Non-Surgical Treatment Options

If the bone or ligament is in a good position for healing, conservative management may be indicated, which consists of strict immobilization for approximately 4-6 weeks. If the injury does not respond to non-surgical treatment in this period of time, surgery may be necessary.

Phalanx CRPP

Phalanx Closed Reduction and Percutaneous Pinning (CRPP) allows phalanx fractures to be realigned and stabilized with metal wires. This usually doesn’t require any kind of incision but does involve small poke holes where the wires are inserted. The procedure is carried out in an operating room under sterile conditions and with a live X-ray that can show when the bones have been reset back to anatomic alignment.

Phalanx ORIF

Phalanx open reduction and internal fixation (ORIF) surgery is usually reserved for fractures that are in many pieces or unstable and need to be stabilized with internal hardware. It involves making an incision over the fracture and putting hardware over the bone to realign the pieces. This hardware is designed to remain inside and often does not need to be removed.

UCL and RCL Repair

If a collateral ligament fails to heal with conservative management or is displaced (known as a Stener lesion), surgical intervention may be necessary. UCL and RCL repair surgery involves making an incision over the disrupted ligament and repairing the native tissue. If a primary repair isn’t possible or the injury is chronic in nature, the ligament may be reconstructed with a tendon autograft. This procedure may involve the use of a small suture anchor in the bone to ensure a solid repair.

Recovery and Rehabilitation Guidelines

Recovery times after phalanx fracture and collateral ligament repair surgeries are estimated as follows:

• Phalanx CRPP – Patients are generally immobilized for about 4 weeks (depending on the fracture). Once the fracture has healed, the pins are removed.
• Phalanx ORIF – The bone takes approximately 4-6 weeks to heal and is kept in anatomic alignment by hardware.
• UCL and RCL Repair – Patients are typically immobilized for 4-6 weeks before beginning physical therapy to regain motion and strength. A custom removable brace may also be used temporarily for rest and comfort.

Take Action: Your Next Steps

Living with finger or thumb pain makes for ongoing challenges and frustrations and negatively impacts your quality of life. Finding a permanent solution may be as simple as seeing a specialist who can accurately diagnose and treat your injury or condition.

Schedule an Appointment With a Specialist

At Modern Orthopaedics of New Jersey, our award-winning team of world-class surgeons is always ready to diagnose and treat patients with the utmost care, skill, and professionalism. Schedule an appointment to resolve your finger or thumb pain today!