How to Treat a Dislocated Knuckle
A dislocated knuckle can be a very, very painful and occur commonly through injuries that cause trauma to the hand - such as falling off a swing, tree, children fighting and twisting hands. This kind of injury most commonly occurs in the middle knuckle of any of the fingers, but more rarely in the thumb. While Bruce Willis can show his bravery by resetting his own dislocated joints in the movie Die Hard, this is certainly not something one should try at home! Immediate medical attention should be sought if any of the fingers become dislocated.
When do These Injuries Occur?
Most commonly, during benign activities such as playing sports. Basketballs and baseballs are notorious for this kind of injury as they strike the tip of a finger and push the finger down forcefully towards the direction of the hand, causing the middle joint to dislocate. Fingers can often get caught in sports equipment such as pads or jerseys and be pulled in the 'wrong' direction, causing a dislocation. Falling off sports equipment or playground equipment such as 'monkey bars' or high bars is often a cause of a dislocated knuckle too.
What Are the Symptoms?
They can be very obvious, with swollen fingers, crooked fingers and very painful fingers. It won't be possible to bend the fingers back into the 'right' position if they are dislocated without medical attention so seek it immediately. Fingers may also appear pale or blue and there may be numbness and tingling in lieu of pain. Pain is generally a milder dislocation, tingling indicates a much more severe injury as nerves and blood vessels may have been frayed. If there is any break in the skin or a wound, this warrants immediate medical attention, probably a 9-1-1 call. Do not under any circumstances delay with seeking medical attention as this could cause permanent disfiguration, disability or to a lesser extent a complicated healing and rehealing procedure (which means doctors must break things to heal them correctly!).
What Happens at the E.R.?
Generally, a physical examination is what takes place first. The doctor will look at the finger that was injured and may ask for cooperation on locating the type of pain and location of pain, by gently massaging or squeezing the finger. The doctor will also in most circumstances order an x-ray of the hand to attempt to locate any fractures or ligament tears and confirm the dislocation. Jewelry such as rings should be removed immediately at home with soap as a lubricant if needed. The doctor will always remove jewelry anyway, but at the hospital it may require a ring cutter. Applying an ice pack to the injured finger is also highly recommended while still at home and elevating the hand to a position higher than the heart. This will help immensely when one arrives at the doctor's.
Die Hard Doctors
The doctor will realign the fingers using standard procedure they learn in school. A local anesthetic is usually applied to the finger through an injection so no pain is felt. This is not just important for the comfort of the patient, but pain often causes involuntary movements which may lead to further complications as the finger is jerked out of control of the doctor trying to realign the dislocated knuckle. Medication may also be applied orally, by injection or even through IV to reduce pain. Finally, the injured finger is usually placed in a protective splint or bandaged to the finger next to it (a procedure called 'buddy taping'). A second x-ray may be ordered to confirm that the realignment of fingers has occurred correctly and any broken bones that may not have shown up on the first x-ray are located the second time.
Post-Treatment Steps
A regime of ice-pack application every few hours for 20-30m must be followed for a few days after treatment until pain and swelling have subsided. Fingers must be elevated on pillows while sleeping or sitting. This reduces pain or swelling too. Further medication may be prescribed and a specialist will have to be consulted a week or two after the initial treatment. All in all, the process for complete healing is 3-6 weeks.