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Complications of PIP fractures and How You can Avoid Them

pip fracture

Hand fractures are no fun. And especially if you have sustained or suffered from fractures of these PIPs. These are your middle knuckles, I like to call them. And there’s a lot of variation in terms of did you fracture it, but it’s pretty stable and you didn’t need surgery, or you fractured it and you needed surgery. You might have fractured it and dislocated, which is probably one of the worst hand injuries that you could suffer from. Here are some complications that I’m gonna share with you.

The 5 Complications of PIP fractures

There’s five main complications and I wanna share them with you because if I share with you what those complications are, maybe you can avoid them, right? So I’m just gonna name them off and I’m gonna tell you a little bit more about them.

1. One of the biggest complications after a PIP fracture is stiffness. These joints are just always so stiff. There’s stiffness. You can have a lot of pain due to the stiffness. Your tendons could get stuck. So it’s called tendon adherence. And so if those get stuck, then your fingers don’t move well and then therefore they become painful and stiff.

You can develop a trigger finger and you can develop different types of tendonitis if you continue to have various stubborn stiffness. So let’s go over them a little bit. So, stiffness, why do these joints get so stiff? Well, these joints, we have what’s called collateral ligaments. There are ligaments on the side of the fingers, and those ligaments are always stiff, whether it’s straight or whether it bends. It’s what holds our joints together and allows us to move in the way we move. Because they’re stiff in both directions after a fracture or injury to this knuckle, they tend to be even more stiff. So one of the biggest complications is stiffness. The other reason why they tend to be so stiff is because if you look at the natural attitude of your hand, just naturally if you weren’t doing anything, they’re always slightly bent and each finger is more bent than the next, right? So this small finger tends to be a little bit more bent than say the index finger, but because they’re slightly bent, they get stuck in that bent position. I’ve made another video, go check those videos out where I talk about how you can really move those knuckles so you can avoid the stiffness.

2. The second biggest complication is pain. So once they get stiff, your finger can become really painful, but it’s not just the finger. The whole hand can become painful because we have what’s called little muscles in our hand. They’re called intrinsic muscles. And those can get really tight and out of balance with the other muscles called extrinsic muscles. They’re the muscles that start outside of your hand that come into your hand that actually are the big muscles that move the fingers and allow them to bend down and allow them to open up. So because of, you know, just the structures of the hand alone, you can create after a fracture, an imbalance of how the muscles work. And because of that, that can cause you pain. So one of the ways to get out of it is to actually work through the imbalances and make sure your hand’s moving in the way it’s supposed to move.

3. The third thing that can cause complications, this tends to be more for people who’ve had surgery, but you can have this problem even if you didn’t have surgery, which means like your tendons got tethered, or got stuck down, and got scarred down somehow. So again, the tendons that move your fingers, the ones that pull them down, might get stuck right about here because there’s so many little structures. And if there’s any scarring, if there’s a lot of swelling, it could scar down those tendons and make it really hard to move. So you have tendons on the side that bend your knuckles down, but you also have tendons on the backside that help you to open them up. And these tendons can get stuck too. And they especially can get stuck in the little knuckle. It’s just because they’re very small. So if you think about it, there’s a big tendon that opens your fingers, but down into the fingers they get smaller and smaller. It’s just like if you took your big old ponytail and you divided it into smaller ponytail, smaller ponytail you’d have less and less and less, So that’s what happens in these tendons. They tend to be smaller, they tend to be weaker, they don’t have their own muscles. And so and it’s a complicated system so they tend to get stuck down. And once you get stuck down, it can be really hard to move. So that’s one of the complications that you want to avoid. Getting to hand therapy fast is a really critical thing. And working with the right hand therapist can also be the critical thing to avoiding complications like tendon adhesions.

4. The fourth complication that I see after a PIP fracture are what’s developed a trigger finger. Because you’re trying so hard to make a fist and you’re constantly working in this middle range, you can develop what’s called a trigger finger. So a trigger finger is essentially like your tendons are down here. And then we have what’s called a pulley system and it holds our tendons down. We have a pulley system here and here. And what happens is because of the injury, your tendons can get swollen, the whole area gets swollen and you develop what’s like a little like a nodule basically on that tendon. And then every single time you make a fist that little ball goes down and it rubs and then every time you open it has to go the opposite way. So if you imagine two things, just rubbing and rubbing and rubbing together creates a lot of friction. That friction creates more scar tissue and it causes a lot more pain. So that is called a trigger finger. For some people, they can feel the clicking, they can feel like their finger gets stuck and then they have to pull it up. Either way trigger fingers after a PIP fracture can cause even more pain on top of that problem. So it’s a big complication that if you don’t fix it is gonna require injections or surgery. And if you’re trying to avoid more problems with your hand you wanna make sure that you’re exercising in a way that doesn’t cause you to have a trigger finger or to make your trigger finger worse.

5. The last complication I wanna talk about are different types of tendonitis. Tendonitises just means you have an irritation at the tendon. So when your hands don’t move really well, you can develop wrist tendonitis, you can develop elbow tendonitis because you’re constantly trying to work and then you’re working your hand with your arm completely out of balance.

Those are the five complications: stiffness, pain, scar adhesion, trigger finger, and tendonitis. These often can occur after a PIP fracture. And it’s important, like I always tell people to call my office or they ask me specifically when they come in with their issues. These are the complications that we’re trying to avoid because if you can avoid it, you can reduce the time in therapy, Reduce time in therapy, reduce the pain and suffering because these injuries can be really stubborn. So you want to reduce the pain and suffering that you have by, you know, reducing all of these complications.

How to Avoid Complications?

Seek Immediate Medical Attention: At the first sign of a finger injury, consult a healthcare professional. Early diagnosis and treatment are crucial to prevent complications.

Follow Professional Advice: Adhere strictly to the treatment plan provided by your healthcare provider. This may include immobilization, medication, and other therapies.

Proper Immobilization: Ensure that the fracture is correctly splinted or casted. This helps in maintaining proper alignment of the bone for healing. However, over-immobilization should be avoided to prevent joint stiffness.

Gentle Mobilization: Once your healthcare provider approves, begin gentle exercises to maintain joint mobility. This is crucial to prevent stiffness and maintain range of motion.

Physical Therapy: Engaging in physical therapy is key to recovering strength and flexibility. A physical therapist can guide you through exercises that are safe and effective for your specific condition.

By following these steps, you can significantly reduce the risk of complications from a PIP fracture and promote a more successful recovery.

So if you have any further questions, I don’t give personal medical advice because I just don’t know what’s going on specifically with your injury. But if this video helped you and you have further questions, leave them below because then I can create more videos like this to help you figure out what to do next. Okay? If you are in the Miami area I’ll include the link to my clinic so you can come and ask us more questions and make a decision about what you need to do to get rid of your hand pain. If you live somewhere else and you’re looking for what’s possible for me? Because I hear that a lot. What’s possible? Can I still fix this? What should I do? Really honestly, these injuries look so small, but they can be really complex. So even if you go once to your local certified hand therapist to find out where you are, truly what you can do, that can be really helpful just to get clarity in terms of what to do next. Then you can ask them about these types of complications and what might be going on with you.

My name is Hoang, I’m an occupational therapist and certified hand therapist. And we see these types of fractures all the time in our practice. We see them at different stages, So sometimes we see them new, sometimes we see them old, and sometimes we see them chronic. So depending on like what part of the journey you’re on, it’s important to get the right kind of help so that you can get rid of it, so you don’t need another surgery, so you don’t have a first surgery to begin with, so you don’t continue to suffer with hand pain over years and years and years.

CLICK HERE! to learn more about PIP Rehab

About Hoang Tran – an expert in physical & occupational therapy  

Hoang Tran is a Miami certified hand therapist , the owner of Hands-on Therapy Services and the author of the book “The Hands-On Approach”. She loves helping people with hand, neck and shoulder problems because she knows how bad and debilitating they can get if not addressed and treated properly (once and for all!). 

The aim of her occupational therapy practice is to bring patients back to full functionality, without pills, injections or surgery. Occupational and Physical Therapy are both offered at Hands-On Therapy by our experienced therapists who provide a comprehensive approach to your care. 

If you or someone you know is living with:

Carpal Tunnel Syndrome

Mallet Finger

Trigger Finger Or Trigger Thumb

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