Joint Dislocations in the Hand

A dislocation occurs when the bones of a joint are forced out of their normal position. In the hand, the PIP joint (the middle joint of the finger) is the most commonly dislocated joint, accounting for the majority of finger dislocations seen in sports. The MCP (knuckle) joints and DIP joints are less frequently dislocated. Thumb MCP dislocations also occur and may involve the ulnar collateral ligament (see Skier's Thumb page).

PIP Dislocations

Dorsal PIP dislocation (most common): The middle phalanx dislocates dorsally (toward the back of the hand) relative to the proximal phalanx, typically from axial load combined with hyperextension — a "jammed finger." Dorsal dislocations involve injury to the volar plate, the thick ligamentous structure on the palm side of the PIP joint that prevents hyperextension.

• Stable (Type I) dorsal dislocation: Volar plate avulsion without significant collateral ligament injury; reduced and clinically stable; treated with buddy taping and early range of motion.
• Unstable (Type II/III) dorsal dislocation with volar plate disruption: More significant injury; requires post-reduction stability testing through range of motion; may need extension block splinting if unstable in extension.
• Fracture-dislocation (Type III): Volar lip fracture of the middle phalanx with dorsal subluxation. The size of the volar fragment determines stability — fragments involving >30–40% of the articular surface are often unstable and may require surgery.

Volar PIP dislocation (less common): The middle phalanx displaces volarly (toward the palm), injuring the central slip of the extensor tendon. If the central slip is disrupted, untreated volar PIP dislocation can lead to a boutonnière deformity — a progressive flexion contracture at the PIP. Requires prolonged extension splinting at the PIP joint (6 weeks) and careful follow-up.

Rotatory (lateral) dislocation: The condyle of the proximal phalanx buttonholes through the extensor mechanism — often irreducible by closed means and requires surgical reduction.

Reduction Technique

Most PIP dislocations can be reduced (put back in place) in an emergency or clinical setting using a hematoma block (local anesthetic into the fracture/joint) followed by:

• Longitudinal traction with slight accentuation of the deformity, then reduction by reversing the mechanism
• Confirmation of reduction with X-rays in two planes
• Post-reduction stability testing through range of motion

Treatment options

Frequently Asked Questions