The hand is composed of many different bones, muscles, and ligaments that allow for a large amount of movement and dexterity. There are 3 major types of bones in the hand itself, including:
- Phalanges – The phalanges of the hand are the group of small bones that comprise the bony core of the digits of the hand. Even though the phalanges are small in size, they are classified as ‘long bones’ because of their structural characteristics; each phalanx consists of a shaft, distal head, and a proximal base.
- Metacarpal bones – A metacarpus is a group of five bones of the hand between the phalanges and the carpus. Even though the metacarpal bones are small, they are classified as long bones since they have structural characteristics of long bones; each metacarpal bone consists of a shaft, distal head, and a wide proximal base.
- Carpal bones – The carpus is the anatomical term for the wrist which connects the radius and ulna of the forearm with the metacarpal bones of the hand. It is comprised of eight individual carpal bones that are seated in two neat rows of four. The proximal row of carpal bones, as seen in a lateral to medial direction on the palmar surface, include the scaphoid bone, lunate bone, triquetral bone, and pisiform bone.
A dislocated knuckle occurs when there is a dislocation in the long bones of the palm, which doctors call the metacarpals. Generally, a finger dislocation is a joint injury in which the finger bones move apart or sideways so the ends of the bones are no longer aligned normally. Finger dislocations typically occur when the finger is bent backwards beyond its normal limit of motion. The metacarpophalangeal joints are in the knuckles, located where the fingers meet the rest of the hand. These joints connect the metacarpal bones in the palm with the first row of phalanges in the finger. Because these joints are very stable, metacarpophalangeal joint dislocations are less common than the other two types. When knuckle dislocations occur, they are usually dislocations of either the index finger or little finger (pinky).
Causes & Symptoms
One of the most common causes of a dislocated knuckle happens when a person strikes a solid object with his or her hands closed (similar to a boxer’s fracture). Patients who sustain a dislocated knuckle commonly complain of pain and swelling at the base of the small finger. A deformed appearing knuckle is also a common sign of its dislocation. There is also often a bump over the back of the palm just below the small finger knuckle.
The knuckle itself may look sunken in, or absent. The best way to see the deformity is by making a fist with both hands and comparing the appearance of the backs of your hands. The hand with a dislocated knuckle will have a different shape to the outer side of the hand. In the early stages after the injury, the deformity of the hand may be hard to discern, as swelling can make the side of the hand look deformed.
Generally, knuckle dislocations are traumatic and due to injury. Therefore, they can be due to a fall, or a knuckle being hit with an object, like trying to punch a hard wall. In children whose skeleton has not fully developed, knuckle dislocations are less common, because the ligaments tend to be stronger than the bone. Although, a fracture of the phalanx growth plate is a more likely injury.
Other common causes of a dislocated knuckle are involved in sports injuries. For instance, trying to tackle in a football match can increase your risk of injuring your knuckle. A dislocated knuckle can also occur when you put out your hand to break a fall. The impact from the fall can push your fingers beyond their regular range of motion and out of their joints, thus injuring the knuckle as well. A crushing blow to your knuckle, like closing a door on your hand, can also cause bones to separate from the joint. Additionally, some people are born with weaker ligaments which can lead to an increased chance of dislocating the knuckle.
Signs and symptoms of a dislocated knuckle include the following:
- Pain on the outer side of the hand.
- Difficulty forming a fist.
- Swelling and bruising.
- Deformity of the hand.
- Tenderness over the small finger knuckle.
Who gets a Dislocated Knuckle?
Certain risk factors can increase your chances of knuckle dislocations, such as:
- Sports – Athletes who play contact sports, such as boxing, martial arts, football, basketball, hockey, and rugby are at higher risk for knuckle dislocations.
- Occupational labor – People who work in occupations that require climbing ladders or stairs are at an increased risk of dislocating their knuckles due to the chance of falling.
- Age – Elders aged 50 and up are prone to experiencing a dislocated knuckle due to general wear and tear, including osteoporosis (decreased bone density).
- Hard surface – You are more susceptible to injuring your knuckle if you either punch or trip and land on your hands on a hard surface, such as steel or concrete.
How Does it Affect You? How Serious is it?
Knuckle dislocations can damage many structures within the injured finger, including the joint surfaces of the bone, the volar plate, ligaments, and tendons. Acute complications include an inability to reduce dislocation and associated fractures. These may require surgery to repair the finger. Unfortunately, repairing your finger can come with additional complications along the way, such as the following:
- Persistent hand pain – Some patients tend to continue to have persistent hand pain after surgery. When this occurs, your doctor will work with you to create a treatment plan, which may include additional physiotherapy, cognitive behavioral therapy, or medicines to help you recover regularly.
- Nerve or blood vessel damage – During surgery, there is a slight chance that the nerves, veins, or tissue around your knee can be damaged. Damaged nerves or blood vessels can cause numbness, pain, or lower blood flow around the finger where your knuckle is damaged.
- Blood clots – Because a repair affects the way blood flows around your affected finger, it can increase your risk of developing blood clots. In rare cases, blood clots can cause serious complications.
Recommended Treatment & Rehabilitation
During a diagnosis of a dislocated knuckle, your doctor will ask you what happened to cause the injury and they will perform a physical exam afterward. They will look for factors, such as:
- Decreased ability to move the hand.
- Unequal temperatures between the injured and uninsured hands.
Swelling and discoloration are common with dislocations. This is because of direct trauma to the bone and surrounding muscles, ligaments, tendons, nerves, and blood vessels. Next, your doctor will ask you to make a fist to check your ability to move your hand.
This helps determine the extent of the injury, as well as the type of treatment that may be required. The doctor may also be able to determine if a ligament has been torn. Torn ligaments will not appear on standard X-rays. If they suspect a fracture, they will use an X-ray of your hand to check.
Normally, the X-rays look at the hand from three different directions. Getting images from different angles makes it easier for the doctor to see possible fractures. They should be able to see if there’s a break and if so, tell what type it is. Oftentimes, the doctor may order more X-rays, with special views to look for hard-to-find fractures.
Depending on how the injury occurred, it is possible the X-rays will show an object (also known as a foreign body) in your hand. Foreign bodies that may appear on X-rays are glass, bone, metal, and stones. This could occur if the injury came from punching another person in the mouth, being bitten by an animal, having something go through your knuckle, and being cut with a sharp object.
If a dislocated knuckle is detected, the primary goals of treatment are to immobilize the hand to permit proper healing and to alleviate the pain associated with fractures. In order to properly immobilize most broken bones, the splint should immobilize the joints above and below the site of the injury. In the case of a dislocated knuckle, however, different types of splints may be used. One type of splint may extend from the fingers, with the fingertips exposed to the forearm near the elbow.
Another type of splint that has been shown to be effective for some knuckle dislocations of the little finger is to buddy-tape the ring finger and little finger together. The doctor will decide what type of splint will treat the patient’s fracture.
When a dislocated knuckle occurs, it is possible for a portion of the metacarpal bone to move out of regular alignment. This is known as angulation. The amount of angulation will determine what type of treatment is required to ensure a better recovery. Any degree of angulation in the second or third metacarpal bones is considered abnormal and requires referral to a hand specialist for possible surgical repair.
Because dislocated bones can cause an extreme amount of pain, pain management is an important aspect of treating knuckle dislocations. Pain management is best accomplished with anti-inflammatory medications and pain relievers. Acetaminophen or ibuprofen typically provides good pain relief with few side effects.
Soon after your knuckle dislocation heals, it is common to experience loss of hand strength, loss of grip strength, and reduced motion and ability to move the finger and wrist. A physiotherapist can provide hands-on techniques to help improve motion and residual pain, as well as teach patients exercises to improve grip strength, wrist strength, and motion of the fingers and wrist. Along with the hand, the strength of other muscles, such as those around the elbow and shoulder, can be affected since the activity of the injured arm is limited with the hand injury.
Therefore, below are a few safe hand exercises for you to try and help recover from your knuckle injury More rapidly. These exercises will slowly help reduce further symptoms linked to your dislocated knuckle:
Place a small towel roll on a table. Afterward, with your palm facing down, grab the towel. Squeeze it for about 6 seconds, then slowly straighten your fingers to release the towel. Repeat this exercise 8-12 times a day.
Radial and ulnar deviation
First, grasp a water bottle with your affected hand. If you do not have something to hold on to, make a fist instead. With your elbow on a table, slowly bend your wrist upward. Then, lower your wrist back to where you started. Repeat this method 8-12 times a day.
Pronation and supination stretch
Grasp a pen, pencil, or stick, and wrap your hand around it. If you do not have something to hold on to, make a fist instead. Then, lift your arm so that your elbow is at your side, bent at a 90-degree angle. Slowly turn your forearm as far as you can back and forth in each direction. Your hand should face up and then down. Hold each position for at least 15-30 seconds until you feel a stretch in your forearm. Repeat this method 2-4 times a day.
Alternative & Homeopathic Treatment
Some homeopathic treatments for a dislocated knuckle can increase a huge amount of support for the recovery of this specific injury. The overall goals of caring for an injured knuckle are to minimize pain, swelling, and the risk of infection of any open cuts. Some of these treatments include the following:
- Immobilization – Immobilizing your hand will help prevent further injure from another dislocation. You can do this by holding the injured hand in the uninjured hand.
- Ice and elevation – One of the most recommended approaches to reduce pain and swelling is to apply an ice pack to the injured area. If ice isn’t available, placing a towel soaked in cold water on the injured hand will work as well. Furthermore, elevating the injured hand will also help reduce swelling.
- Clean and treat your cuts – An open cut suggests an open fracture. This type of break is at higher risk for infection and poor healing. All cuts should be washed with soap and water and then covered with a clean bandage right away.