I Jammed My Finger…How Do I Know If It’s Broken?
⌚️ read time: 5 minutes
I’m always amused by the way various injury patterns change with the seasons. In the heat of summer, it will be months between seeing a thumb ulnar collateral ligament injury (commonly called Skier’s thumb).
But in January? I might see four or five a week.
Summer in Colorado means mountain biking and rock climbing. As well as softball leagues, trampolines, dog walks, and pick-up basketball games.
And what does that mean for me? Summertime is ‘jammed finger’ season.
You know the feeling. That ball catches your finger in just the wrong way. Or you collide with your kid on the trampoline. Cue the Advil and the ice packs.
But often the hard part is knowing what to do next. These injuries all hurt at the moment, but the question remains…do I need to see a doctor?
Today I will provide some quick tips** so you know what to look out for and what the downsides could be if you skip that trip to the doctor.
**Disclaimer: Remember, this page does not constitute medical treatment or advice. The only way to know for sure if your finger has sustained long-term damage is to see a doctor, get an x-ray, and develop a plan. There are a few very serious, permanent consequences of a ‘jammed finger’ depending on your injury pattern, so do not delay in seeking care.
Trajectory is Key
No matter the injury, the first couple of days will be defined by pain and swelling. The key is to focus on the trajectory.
By day 3 or 4 after the injury, what is the trajectory of your symptoms? Are they worsening? Staying the same? Improving?
If your symptoms (pain, swelling, motion) are significantly improving by day 3 or 4 after the injury, you might not need to see a doctor.
That being said, if you were originally improving after 3-4 days, but you start to worsen again by day 7-10, please get yourself evaluated.
Crooked Fingers
Do not pass go. If at any point your finger was dislocated or crooked in any way, please stop reading this article and get to a doctor.
Even if you or your friend ‘popped it back in.’ While many of these injuries will not need additional treatment, there are a subset of fractures that come with dislocations that are very serious, difficult to detect early on, and nearly impossible to treat if a couple of weeks pass by without recognition.
We’re talking about permanent disability to your finger. Painful arthritis, stiffness, or an inability to ever straighten the finger again. What’s worse is that these issues have no reliable surgical fixes.
Please do not delay.
Normal finger
Subtle, but very serious ‘jammed finger’ injury
How do I treat my sprained finger?
The biggest misconception around finger injuries is the use of that little blue foam aluminum splint you see everywhere. Finger injuries typically do not benefit from being splinted. If your finger injury is considered a ‘stable’ injury, it actually benefits from movement right away.
And if it’s unstable? It needs way more than a blue foam splint.
Most of these jamming finger injuries are actually sprains of what we call the collateral ligaments. There are two ligaments per knuckle, and they run one on either side. These get stretched or even torn when you jam your finger.
As soon as the ligaments start healing, they heal with contracting scar tissue. That means the ligament will shorten as it heals.
If you don’t get that finger moving right away, the collateral ligaments will shorten so much that you won’t be able to fully bend your finger. And that means you can’t make a fist, grip objects, or generate strength.
Immediate finger movement is essential to regain your hand function — otherwise, you are in for many months of pain, swelling, and stiffness as you try to slowly work it out.
And the hard truth is, sometimes the stiffness can be permanent.
But how do I know if my injury is serious?
I know you’re not going to like this. But the reality is, there is no magic way to know without an x-ray (see x-rays above). Ideally, this is coupled with an evaluation by a hand specialist, but even a quick urgent care x-ray is better than nothing. Please do your future self a huge favor and get an answer early on.
The green light to immediately move your finger relies on three things:
An x-ray demonstrating that you don’t have a surgical fracture
A gentle examination of the ligaments to determine that they are not completely torn and unstable
An examination of your flexor and extensor tendons to ensure they did not rupture from the bone
I don’t know the numbers off the top of my head, but I would guess over 90% of these injuries that come into my office would meet the above criteria. It is common to have little chip fractures associated with these injuries — so don’t panic if your urgent care provider tells you ‘fracture.’
It is far less common to have larger unstable fractures or tendon disruptions that require surgery.
Similarly, it is actually quite difficult to tear the collateral ligaments to the point where the joint becomes unstable. Not impossible, but this is rare.
This all goes back to my first point.
If you do happen to have a rare unstable fracture or unstable collateral ligament injury, your injury will almost certainly not be improving over the first 3 to 4 days. Or you will notice a deformity. An unstable finger is a very painful, swollen condition that is difficult to ignore.
And yet every couple of months I meet some poor soul who managed to ignore a serious injury and now has a finger that is highly dysfunctional.
Putting it all together
So what’s the takeaway? Here’s a framework for how I think about it.
Don’t use a finger splint 24/7. Start gentle motion immediately.
In a world where you don’t have access to x-ray from your couch, you either have one of two injuries:
A stable injury
Or an unstable injury
If stable (the more likely case), you don’t need a splint. In fact, a splint will set you behind on your motion and significantly prolong your path back to a normal finger.
They’re okay to use part-time for rest and recovery. But not 24/7.
Start gently moving that finger through its full range of motion as soon as possible. If you physically can’t bend or straighten the finger, get to a doctor right away to rule out tendon injury or a missed dislocation.
And if your injury is unstable? Well, splint or not, this will be a painful, swollen finger that does not improve on its own. It won’t tolerate motion in any form, even if you feel like you typically have a high pain tolerance.
You know what to do. Off to the hand surgeon.
An important caveat:
If you go to an emergency room or urgent care where they pop your finger back in place (a maneuver called a reduction) and then put you in a splint, please do not remove that splint.
Whether you were given clear instructions or not, you should make sure you are in front of a hand specialist within 3 to 4 days of this happening. Do not sit in a splint for two weeks before seeing a hand specialist. That is too long to wait.
Takeaways:
Many jammed fingers do not need medical care. The problem is, subtle injuries that are missed early on can lead to devastating consequences.
If your jammed finger isn’t significantly improving within a few days of injury, please get to a doctor for an x-ray right away.
Contrary to our natural intuition, most injured fingers do better with immediate movement, rather than prolonged splinting. Your x-ray is your green light to move, move, move!
A finger jam is an incredibly common condition that I see nearly every day in my office.
While the vast majority will heal on their own, there is a subset of injuries that must be identified early to be able to achieve full recovery. Because these injuries can have lasting consequences, if you have any doubt about your finger, it is best to see a specialist sooner rather than later for appropriate treatment.
