Ligament injuries of the hand

The management of associated ligament injuries of the hand is described with the treatments of respective injury types.

Here, general management principles of ligament injuries are presented.

A thorough history and physical exam are critical to properly assess hand ligament injuries. Considerations include:

• Mechanism of injury
• Location of pain and tenderness
• Presence of deformity or instability
• Loss of function

Imaging studies can aid in diagnosis and classification of ligament tears.

• Plain x-rays assess fractures and dislocations which may be associated with predictable ligament injuries. Stress views may be useful to assess laxity. Local anesthetic infiltration can facilitate stress views.
• An MRI improves a diagnosis of ligament tears and helps to classify severity. MRI with arthrography is helpful in the diagnosis of intrinsic injuries, eg, the partial scapholunate ligament rupture.
• Ultrasound allows dynamic assessment of ligament integrity and related articular movement.

Ligament injuries may be classified by location (eg, collateral ligaments, volar plate) or grade of tear (partial vs complete). Pathoanatomic classification guides treatment.

Incomplete ligament injuries often do not need specific surgical management and heal well with protective splinting and progressive rehabilitation.

In case of complete ligament injuries resulting in important instability, eg, complete scapholunate disruption or skier’s thumb, surgery could be considered.

Early protected motion is beneficial to prevent stiffness and promote healing after ligament repair. Splinting or bracing may be used initially to protect the repair.

Hand therapy focuses on controlling edema, regaining range of movement, proprioception, and later strengthening to restore function.

For details on postoperative treatment phases, see the dedicated pages in each anatomical section.

Sagittal band injuries at the MCP joint cause imbalance of the extensor tendons with subsequent subluxation. Patients report pain, catching, and instability of the affected finger.

Exam shows abnormal extensor tendon subluxation with flexion/extension. X-rays are often normal. Ultrasound may confirm diagnosis.

Partial tears can be treated with splinting and therapy. Complete tears require surgical repair or reconstruction to prevent tendon dislocation.

Shearing injuries can cause partial or complete avulsions of the volar plate, leading to instability and hyperextension of the affected interphalangeal joint.

Diagnosis is made by physical exam revealing joint laxity.

Partial tears may be treated with splinting and early motion. Complete tears may require open repair or reconstruction in case of joint instability.

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