Finger injuries

Last updated: October 11, 2023

Summarytoggle arrow icon

Finger injuries are often caused by blunt or penetrating trauma and include tendon injuries, phalangeal fractures, nail bed injuries, dislocations, and amputations. A thorough assessment of the injured finger and hand is necessary to determine appropriate management. Examination of the injured finger includes visual inspection for cuts and deformities, assessment of capillary refill, evaluation of sensory function, and testing active range of motion (ROM) and strength against resistance. X-rays are used to assess for fractures and/or foreign bodies. Rarely, MRI or ultrasound may be used to assess ligament or tendon injuries.

Tendon injuries can be closed or open. Open injuries are most commonly caused by a laceration and typically require surgical repair; closed injuries are usually caused by forced extension or flexion of the phalangeal joints and often occur while exercising or playing sports. All closed flexor tendon injuries require surgical repair, but most closed extensor tendon injuries can be managed conservatively with splinting. Long-term complications of closed flexor tendon injuries include joint contractures and chronic deformities. Dislocations at the metacarpophalangeal joint can be simple or complex. Simple dislocations can be managed in the outpatient setting with closed reduction and splinting; complex dislocations require specialist intervention. Management of phalangeal fractures is determined by fracture location and characteristics. If initiated promptly, most fractures can be successfully managed with immobilization and early outpatient follow-up. Traumatic amputation of all or part of the finger requires urgent consultation with hand surgery to preserve viable tissue. Crush injuries from blunt trauma are often associated with open fractures and usually require surgical consultation. Management of nail injuries may include repair of nail bed lacerations and drainage of any associated subungual hematomas. Finger swelling, whether traumatic or atraumatic, can lead to ring entrapment and secondary ischemia. Conservative methods of ring removal (e.g., lubrication of the finger) can be attempted if there is no evidence of vascular compromise, but immediate removal with ring cutters is required if there are signs of ischemia.

See also “High-pressure injection injuries” and “Bite wounds.”

Management approachtoggle arrow icon

Consult hand surgery urgently for patients with amputations, high-pressure injection injuries, evidence of neurovascular compromise, and/or wounds that are large, grossly contaminated, or involve a crush injury. [1]

Diagnosticstoggle arrow icon

Most soft tissue finger injuries are diagnosed clinically. X-rays are typically used to identify fractures and dislocations, while advanced imaging can help identify occult fractures or support the diagnosis of soft tissue injuries when the diagnosis is uncertain.

Clinical evaluation of finger injuries

Identify injuries that require urgent specialist consultation, surgical repair, or closed reduction prior to imaging, e.g., neurovascular injury, open fractures, and tendon lacerations.

Always evaluate the innervation and blood supply of the entire hand and compare injured fingers to those on the contralateral hand.

Digital tendon integrity testing

Routinely evaluate all of the following muscle tendons with active ROM and against resistance in patients with hand and finger injuries. Consider evaluating other muscles (e.g., thenar muscles, hypothenar muscles, lumbricals, interossei) on a case-by-case basis.


A true lateral view of the affected finger without superposition of the other fingers is necessary to rule out a fracture.

Tendon and ligament injuriestoggle arrow icon


Overview of closed tendon and ligament injuries of the digits [1][2]
Description Etiology Clinical features Definitive management
Jersey finger
  • Hyperextension of a flexed DIP joint (forced extension)
  • All patients: operative treatment
Mallet finger
  • Loss of DIP extension
Boutonniere deformity
Gamekeeper's thumb (Skier's thumb)
  • Tear of the ulnar collateral ligament (UCL)

Closed tendon injuriestoggle arrow icon

Jersey finger [1][2]

Jersey finger is often misdiagnosed as a sprain and therefore undertreated.

Mallet finger [1][2]

Boutonniere deformity [1][2]

Boutonniere deformity commonly manifests 7–14 days after the original injury. [2]

Complications [1][2]

Tendon lacerationstoggle arrow icon

Clinical features [1][2]

  • Overlying skin injury
  • Complete laceration: inability to flex or extend the finger distal to the injury
  • Partial tendon laceration: any of the following findings may be present
    • Normal active ROM but an inability to flex or extend the finger against resistance
    • Painful but intact ability to flex or extend the finger against resistance
    • Pain-free finger ROM and strength

Signs and symptoms of a partial tendon laceration may be masked by the function of uninjured tendons; maintain a high index of suspicion for a tendon injury in patients with a hand laceration.

Management [1][2]

Initial management

Reevaluate patients with a suspected tendon injury after 2–3 days if there is no evidence of injury on initial examination. [2][4]

Definitive treatment

  • Complete laceration: surgical repair
    • Flexor tendon: Operative repair is typically performed within 12–24 hours.
    • Extensor tendon: Surgical repair may be delayed up to 7 days.
  • Partial laceration: immobilization or surgical repair depending on injury characteristics

Ligament injuriestoggle arrow icon

Gamekeeper's thumb (Skier's thumb) [1][2][5]

Finger sprain [1][2][6]

Initial evaluation


Dislocationstoggle arrow icon

Metacarpophalangeal dislocations [1][7]

Interphalangeal dislocations [1][8]

Upper extremity interphalangeal joints (IP joints) include the DIP and PIP joints of the fingers and the IP joint of the thumb.


Reduction of dorsal IP dislocation

Phalangeal fracturestoggle arrow icon

The majority of finger fractures can be managed with immobilization with a splint, but some fractures require urgent surgical intervention.

Clinical features

Management [1][2][9]

Distal phalangeal fractures

Do not attempt reduction of comminuted tuft fractures.

Middle phalangeal fractures

Proximal phalangeal fractures

In most cases, fingers should be immobilized in the position of function: 50–90° of MCP flexion and 15–20° of IP joint flexion. Immobilization of the entire finger in extension is usually avoided. [2]

In proximal and middle phalanx fractures, if rotational malalignment persists after reduction, refer to hand surgery; rotational malalignment is never acceptable. [2]


  • Nonunion
  • Delayed union
  • Fingertip numbness
  • Hypersensitivity

Crush injuriestoggle arrow icon

  • Definition
    • Local tissue injury caused by traumatic compression of the finger
    • Injuries may include:
  • Clinical features
    • Injury may be more extensive than is evident on the surface [2]
    • Swelling
    • Pallor
    • Bleeding (often minimal)
  • Diagnostics: X-rays are indicated in all patients to assess for fracture.
  • Management [2]
  • Complications

Crush injuries of the finger often involve tuft fractures.

Amputationstoggle arrow icon

Initial approach

Remember to provide tetanus prophylaxis if indicated.

Distal amputation [1][2]

Proximal amputation [2][10]

Do not allow the amputated part of the finger to come into direct contact with ice, as this can cause further damage.

Nail injuriestoggle arrow icon

Nail plate and nail bed injuries [11][12]

  • Definition: disruption of the continuity of the nail bed; typically caused by traumatic injury
  • Clinical features
  • Treatment [2]

Gauze that has adhered to an injured nail bed or fingertip can be removed by soaking the finger in a solution of 1% lidocaine for 20 minutes. [2]

Nail avulsion [11][12]

Subungual hematoma [13]

Adherent nails do not need to be removed to repair a nail bed laceration or drain a subungual hematoma. [7]

Ring-related injuriestoggle arrow icon

Ring entrapment

Ring removal


  • Patient reports pain or inability to remove the ring
  • Dusky or cool finger
  • Anticipated swelling (e.g., in systemic inflammatory state, hand injury)

Rings should be removed from injured fingers to prevent entrapment due to swelling or deformity. [2]

Procedural steps [1][14]

  • Prior to removal: Attempt to reduce swelling.
  • Manual removal can be attempted if there are no open wounds or signs of ischemia; techniques include:
    • Lubricate the finger and apply distal traction to the ring.
    • Slide the finger of a surgical glove underneath the ring and use the glove to apply distal traction to the ring.
    • Insert rubber bands under the ring with a hemostat and apply distal traction to the rubber bands.
  • Ring cutters should be used immediately if the finger appears ischemic.
    • Slide the curved finger guard of the ring cutter between the ring and the skin.
    • Engage the cutting blade (unit may be manual or motorized).
    • Limit blade rotation to 30-second intervals to prevent overheating the ring, as this can burn surrounding skin.

Standard ring cutters will cut gold, plastic, platinum, silver, stainless steel, and titanium; vice-grip pliers are required to crack tungsten, natural stone, and ceramic rings.

Postprocedural care [14]

  • Provide tetanus prophylaxis if skin integrity is compromised.
  • Refer to hand surgery if there is neurological or vascular compromise.
  • Instruct the patient not to place rings on the finger until the edema resolves.


Referencestoggle arrow icon

  1. Roberts JR. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. Elsevier ; 2018
  2. Tos P, Titolo P, Chirila NL, Catalano F, Artiaco S. Surgical treatment of acute fingernail injuries. J Orthop Traumatol. 2011; 13 (2): p.57-62.doi: 10.1007/s10195-011-0161-z . | Open in Read by QxMD
  3. Sherman SC. Simon's Emergency Orthopedics, 8th edition. McGraw Hill Professional ; 2018
  4. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine 10th edition- Concepts and Clinical Practice E-Book. Elsevier Health Sciences ; 2022
  5. Wang QC, Johnson BA. Fingertip injuries.. Am Fam Physician. 2001; 63 (10): p.1961-6.
  6. Eiff MP, Hatch RL. Fracture Management for Primary Care and Emergency Medicine. Elsevier ; 2019
  7. Clavero JA, Alomar X, Monill JM et al. MR Imaging of Ligament and Tendon Injuries of the Fingers. Radiographics. 2002; 22 (2): p.237–256.
  8. Welman T, Popova D, Vamadeva S, Pahal G. Management of amputated digits. Br J Hosp Med. 2020; 81 (11): p.1-8.doi: 10.12968/hmed.2020.0087 . | Open in Read by QxMD
  9. Reichman EF. Reichman's Emergency Medicine Procedures, 3rd Edition. McGraw Hill Professional ; 2018
  10. Antoniou SA, Mavridis D, Kontouli KM, et al. EAES rapid guideline: appendicitis in the elderly. Surg Endosc. 2021; 35 (7): p.3233-3243.doi: 10.1007/s00464-021-08524-9 . | Open in Read by QxMD
  11. Leggit JC, Meko CJ. Acute finger injuries: part II. Fractures, dislocations, and thumb injuries.. Am Fam Physician. 2006; 73 (5): p.827-34.
  12. Eddy M. Hands, fingers, thumbs - assessment and management of common hand injuries in general practice.. Aust Fam Physician. 2012; 41 (4): p.202-9.
  13. Mahajan M, Rhemrev SJ. Rupture of the ulnar collateral ligament of the thumb – a review. Int J Emerg Med. 2013; 6 (1).doi: 10.1186/1865-1380-6-31 . | Open in Read by QxMD
  14. Leggit JC, Meko CJ. Acute finger injuries: part I. Tendons and ligaments.. Am Fam Physician. 2006; 73 (5): p.810-6.

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