Hand Dislocations 

Introduction
Hand dislocations occur when a force causes the bones in the fingers or wrist to move out of position.  Sports, falls, job-related injuries, and motor vehicle crashes are the most common causes of hand dislocations.  Symptoms can include deformity, extreme pain, loss of motion, and loss of sensation.  The bones may spontaneously return to position, or they may need to be realigned by a doctor with or without surgery

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Anatomy

Your hand consists of five digits including four fingers and a thumb.  The bones in your fingers are called phalanges.  You have three phalanges in each finger and two in your thumb.  The hand above the fingers is made up of five metacarpal bones.  Several small bones make up your wrist.

Two interphalangeal (IP) joints separate the phalanges on your fingers.  Your thumb has one IP joint.  The IP joints allow you to bend and straighten your fingers.  Your knuckles are the metacarpophalangeal (MCP) joints.  The MCP joints allow your fingers and thumbs to move up and down and from side to side.  The carpometacarpal (CMC) joints are located between your hand and wrist.

Your hand bones are connected together by strong ligaments.  Your muscles are attached to your bones by tendons.  The tendons and muscles power your hand joints and enable them to move.  Your hands also contain blood vessels, nerves, connective tissues, and fat.

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Causes
Hand dislocations cause the bones in the hand to move out of their normal position.  The bones may spontaneously return to position, or they may need to be realigned by a doctor.  A hand dislocation may also injure the ligaments, tendons, blood vessels, nerves, and connective tissues. 
 
Hand dislocations are most commonly caused by injuries during sports, such as football, basketball, and baseball.  IP joint dislocations occur most frequently during sports.  Falls on an outstretched hand are most likely to cause MCP and CMC joint dislocations.  Job-related injuries and motor vehicle crashes can also cause hand dislocations.

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Symptoms
A hand dislocation causes pain at the time of injury.  Your hand will be extremely painful when you attempt to move it.  You may not be able to or may have difficulty moving your hand.  Your hand may bruise, swell, or feel numb.  Displaced bones may cause your hand to look odd or crooked.

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Diagnosis
Your doctor can identify a hand dislocation by reviewing your medical history and examining your hand.  You should tell your doctor about your symptoms and how your injury occurred.  T X-rays will be used to identify the dislocation and possible associated fractures.

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Surgery
Open reduction surgery is used for joints that cannot be realigned with closed reduction methods.  In many cases, ligaments or tendons are trapped in the joint and obstruct closed reduction attempts.  Open reduction surgery is used to remove the trapped tissues and realign the joints.

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Treatment
Some joint dislocations may correct themselves spontaneously.  Other joints may need to be moved back in place by a doctor in a procedure called a closed reduction.  The procedure is termed “closed” because the skin on the hand does not need to be surgically opened to realign the joints.
 
Surgery may be necessary for joint dislocations that cannot be treated with closed methods.  These are called complex dislocations.  Splinting and therapy usually follows closed or open reduction of hand dislocations.  Splinting is used to keep your hand in the proper position while it heals.  Dynamic splinting may be used in cases when significant stiffness has developed after injury and treatment.  As the initial goals of range of motion are achieved, additional exercises will be added to improve strength.  You will gradually be transitioned to a home exercise program as you improve, and the need for a therapist's help diminishes.

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Recovery
The recovery process is different for everyone and depends on many factors including the location of your dislocation, the extent of your injury, and the type of treatment you received.  Recovery can take many weeks.  Your doctor will let you know what to expect.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.