Capsule tear on the finger

definition

Like every joint, the finger joints are also surrounded by a capsule. This can be injured by overstretching, for example by over-stretching. Mostly this happens in sports, e.g. in volleyball or basketball, when the ball hits the extended finger. Then the joint capsule on the flexor side tears. Usually you feel pain immediately and the affected area swells. If the joint is also dislocated (the head has jumped out of the socket), a misalignment is visible. In the event of a lateral kink, the side ligaments can also tear in or off.
If necessary, part of the bone can also be pulled out and the bone splintered off.

To differentiate between a capsule tear on the finger and an overstretched finger, the editors recommend the following article: Overstretched finger

Causes of a ruptured capsule on the finger

The capsules of the finger joints can withstand normal loads. The capsule and the surrounding ligament structures ensure stability when bending and stretching the finger. Movement for which the finger joint is not designed can rupture the capsule. This happens particularly often with falls in which the fingers or a finger bend backwards, or in sports such as volleyball, in which the ball pushes the extended finger backwards towards the back of the hand. At a certain point, the capsule can no longer support the stretch.
If the finger is pulled too hard, the joint can no longer cope with the elongation. Usually other structures are also injured. If blood vessels in the finger tear, it can bleed into the joint (see also: Bruise), which can lead to painful swelling and restricted mobility.
In the worst case, a finger joint can dislocate completely, which can lead to a capsule injury on the finger.
Please also read our topic: Dislocation of a finger joint

Accompanying symptoms of a capsule tear on the finger

If a capsule rupture occurs acutely in the finger, the affected joint is usually stabbing and often swollen, and a bruise may also be seen.
Because the drainage in this area no longer works properly, synovial fluid from the injured joint is deposited. Sometimes you can also hear a crack when the capsule itself ruptures. The acute permanent pain becomes worse if you continue to put pressure on the finger. In most cases, the mobility and function of the joint or finger is severely restricted, as a protective function or because structures important for movement have also been injured. If the joint itself is also injured, for example if the head of the base phalanx of the finger jumps out of the joint socket of the middle phalanx (dislocation), a misalignment can be observed.

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Which doctor treats a capsule tear on the finger?

In general, the doctor who is there first will take care of it: Perhaps a team doctor is already looking after the sports team or you go to the emergency room, where the doctor on duty will look at your finger. The specialist in the field of the musculoskeletal system is the orthopedist / trauma surgeon, who can also help in this case.
If necessary, doctors with the additional designation "sports medicine" are also familiar with this area.
If structures such as the surrounding ligaments are also injured or a bony problem has arisen, you will be referred to a hand surgeon or a hand surgery center if necessary. These doctors are specialists in the surgical treatment of hand injuries.

Diagnosis of a ruptured capsule on the finger

First, the attending physician will ask about the injury event. He is interested in what movement and under what circumstances the capsule ruptured. Then the affected finger must be looked at and clinically examined: one generally checks the blood circulation, the motor skills (mobility) and the sensitivity (the feeling) in the affected area and in the fingertip.

In order to better estimate the swelling and the range of motion, the finger is compared with that of the opposite side. Is the finger badly swollen? How far can the finger still be moved? If the doctor cannot safely rule out that the bone is also damaged, an X-ray of the finger will be taken.

For example, a torn piece of bone would be visible there. In order to better assess the damage to the capsule and the surrounding ligamentous apparatus, an MRI (= magnetic resonance imaging) image can also be made. Ligaments, soft tissues and joint effusion can be assessed particularly well on this.

What can you see on the x-ray?

The x-ray is not able to show soft tissue such as muscles, tendons, joint capsules and fluids well. For these purposes, an MRI image must be made.

However, the x-ray in the diagnosis of the capsular tear is made in order to rule out bony involvement in the injury.

The tendons of the finger often attach to bony protrusions. If the tendon is severely pulled and torn, bone fragments can also be loosened, which may have to be surgically fixed. The bone fragments are visible on the X-ray as small lightening.

Do you have a torn tendon on your finger? - Then read our article on: Tendon tear on the finger

Treatment of a ruptured capsule on the finger

The therapy is based on the damage discovered in the examination and, if necessary, in the X-ray and / or MRI. A less severe case of a capsular rupture is usually treated conservatively, i.e. not surgically. In order to give the finger enough opportunity to heal, the finger (and possibly the hand in general) should be spared, i.e. the finger is immobilized and strain on the finger should be avoided as much as possible. The finger can possibly also be tightly bandaged.

A break in sports is particularly advisable to prevent secondary injuries. In addition, the finger should be cooled to combat the swelling and reduce pain. Raising the finger can also help: fluid can flow back better and the finger hurts less. In addition, pain reliever and anti-inflammatory (anti-inflammatory) Drugs help over a short period of time, for example ibuprofen tablets. After the swelling has subsided, it is important to quickly mobilize the finger in order to prevent joint stiffness.

Treatment with a finger splint

If a noticeable restriction of movement is noticed in the course of the treatment, a splint may be necessary to stretch the scarred joint capsule, a so-called squeeze splint. This is a dynamic splint, which means that integrated spring wire clamps permanently exert force on the affected joint in the direction of the restricted movement. This force can be adjusted individually. This avoids permanent stiffening, for example this principle is also used after tendon injuries. Sometimes the splint is also combined with a bandage sleeve to better protect the affected area. However, a “normal” rigid splint can also be worn to protect and immobilize the finger. This is particularly useful in the first few days until the swelling has subsided.

Exercises to restore mobility

Before you begin to exercise the affected finger specifically, you should consult your doctor. To mobilize the connective tissue, you can carefully move the skin over the joint in circular movements to reduce the swelling, create better gliding ability and promote blood circulation. In addition, you can do grasping exercises, for example with balls or water bottles, to train your finger for everyday life again. Carefully bend and stretch the finger every now and then or close a fist, ideally, can quickly improve mobility. One should watch out for pain. In case of doubt, professional physiotherapy can help.

Treatment by taping

By professionally taping the finger (see also: Taping fingers - how does it work?) Stabilization and better distribution of force on the affected finger can be achieved. Usually the affected finger is tapped on the neighboring finger and so immobilized. However, a tape does not replace the protection of the finger during the healing process: this means that you should also take a break from exercise until the capsule rupture has healed. Taping can have a supportive effect, similar to a bandage. The healing of the capsular tear is not accelerated by taping.

When do I need surgery for a torn capsule on my finger?

A capsular tear usually heals well without surgery. If the capsule is severely injured or a bone is involved, surgery should also be considered as an option. Even if the joint is crooked and can no longer be adjusted, it must be corrected surgically, otherwise there is a risk of joint wear and tear (finger arthrosis) occurring earlier.
In the operating room, the torn capsule parts are sewn and, if necessary, re-anchored to the bone. This can be done with the help of wires or screws. If other structures such as muscles, tendons or ligaments are injured, these are also sewn. Such an operation can often also be carried out on an outpatient basis.

Time it takes for a torn capsule to heal

Complete healing takes about six weeks. During this time, exercise should be avoided and fingers should only be used cautiously in everyday life. Of course, the pace of the process can vary from person to person. In order to quickly reduce joint swelling, it is important to consistently elevate and cool the finger. In addition, as soon as the acute phase is over, it is important to carefully build up movement in order to avoid permanent stiffening of the joint. If tendons or ligaments are torn in addition to the capsule, healing may be delayed.

Read more about this: Duration of a capsule tear on the finger

When can you go about your work after a capsule rupture on your finger?

It usually takes about six weeks for the finger to heal completely and for you to be able to go about your work. Of course, this depends on the type of work and how much pressure is placed on the finger. If the finger is not heavily strained, you can work again before the six weeks are up. Reintegration may help to gradually increase working hours and stress. It is important not to put too much strain on the affected finger too soon, so as not to provoke another capsule tear. The time also depends on the severity of the injury; if bones and / or ligaments are also affected, the healing process can be further delayed.

How long are you on sick leave?

The sick leave depends on the severity of the injury, the intensity of the treatment, the patient's feeling and the type of professional activity.

Simple capsule injuries that are spared and wallpapered often do not require a long sick leave.

Physical activities or jobs that require a lot of writing may have to be suspended for several weeks. Otherwise, the activity can be resumed as soon as the person concerned does not feel any pain while performing the job.

A severe or even surgically treated capsular tear takes about 6 weeks to heal and additional weeks of rehabilitation. Physical activities must be interrupted for the entire healing process, otherwise the healing can be endangered.

What are the consequences of a capsule tear on my finger?

A capsule tear is a painful injury that usually heals without consequences. Even without treatment, the injury usually heals without complications or restriction of movement of the finger. Accompanying injuries to the tendons or finger bones, however, can also lead to pain and restricted mobility in the long term.

If small fragments of bone go undetected, the entire finger can remain painful, unstable, and stiff. In the long term, a capsule tear on the finger increases the risk of finger arthrosis of the joint.

Even uncomplicated courses can become noticeable after decades due to cartilage wear and tear. Even small, unnoticed remains of injury in the finger joint can destroy the cartilage over the years and cause osteoarthritis.
The consequences are

• Pain in the affected finger
• Restrictions on movement
• Thickening and stiffening

The affected fingers.

Capsule tear on the thumb

The thumb is in an exposed position from all fingers and is therefore more often affected by capsular tears and other injuries.

The risk of a capsule rupture increases particularly in sports in which the thumb is naturally spread apart from the other fingers. This is possible, for example, with ball sports such as basketball and volleyball, or with skiing. The typical "skier's thumb" is an injury to the capsule apparatus caused by getting stuck in the loop of the ski pole.

Since the thumb fulfills the most important functions of the hand, precise diagnostics for possible ligament and bone injuries should be carried out. In rare cases, surgery is unavoidable in the event of such accompanying injuries.

Immobilization and follow-up treatment for the thumb must also be carried out consistently and under medical supervision. By splinting and immobilizing the thumb, everyday work and all professional activities are severely restricted. A correspondingly long sick leave is often necessary. If the thumb is overstretched, there is a risk that the flexor tendons will tear. In these cases, there is a likelihood that some movement restriction will persist even after treatment. For this reason, a doctor must be consulted at an early stage if the thumb is injured.

Would you like more detailed information about the capsule tear on the thumb? - Then read our main article: Capsule tear on the thumb