Intermetacarpal Sprain

The intermetacarpal ligaments run between the knuckles, at the base of the fingers. These ligaments are vulnerable to sprain and injury, in which the ligament becomes over stretched or torn. Intermetacarpal sprains are classified into 3 categories. Grade 1 sprains cause pain, but the tendon is not lengthened. Grade 2 sprains include a lengthened ligament, due to the ligament being stretched or partially ruptured. With grade 2 sprains there is still function, although function may be decreased. Grade 3 sprains include a complete tear of the ligament, and the joint usually displays a loss of function.

SYMPTOMS

  • Severe pain at the time of injury.

  • Often, a feeling of popping or tearing inside the hand.

  • Tenderness and inflammation at the knuckles.

  • Bruising within a couple days of injury.

  • Impaired ability to use the hand.

CAUSES

This condition occurs when the intermeatacarpal ligaments are subjected to a greater stress than they can handle. This causes the ligaments to become stretched or torn.

RISK INCREASES WITH:

  • Previous hand injury.

  • Fighting sports (boxing, wrestling, martial arts).

  • Sports in which you could fall on an outstretched hand (soccer, basketball, volleyball).

  • Other sports with repeated hand trauma (water polo, gymnastics).

  • Poor hand strength and flexibility.

  • Inadequate or poorly fitted protective equipment.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain appropriate conditioning:

  • Hand flexibility.

  • Muscle strength and endurance.

  • Applying tape, protective strapping, or a brace may help prevent injury.

  • Provide the hand with support during sports and practice activities, for 6 to 12 months following injury.

PROGNOSIS

With proper treatment, healing should occur without impairment. The length of healing varies from 2 to 12 weeks, depending on the severity of injury.

RELATED COMPLICATIONS

  • Longer healing time, if activities are resumed too soon.

  • Recurring symptoms or repeated injury, resulting in a chronic problem.

  • Injury to other nearby structures (bone, cartilage, tendon).

  • Arthritis of the knuckle (intermetacarpal) joint, with repeated sprains.

  • Prolonged disability (sometimes).

  • Hand and finger stiffness or weakness.

TREATMENT

Treatment first involves ice and medicine, to reduce pain and inflammation. An elastic compression bandage may be worn, to reduce discomfort and to protect the area. Depending on the severity of injury, you may be required to restrain the area with a cast, splint, or brace. After the ligament has been allowed to heal, strengthening and stretching exercises may be needed, to regain strength and a full range of motion. Exercises may be completed at home or with a therapist. Surgery is rarely needed.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Stronger pain relievers may be prescribed, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms remain or get worse, despite treatment for longer than 2 to 4 weeks.

  • You experience pain, numbness, discoloration, or coldness in the hand or fingers.

  • You develop blue, gray, or dark fingernails.

  • Any of the following occur after surgery: increased pain, swelling, redness, drainage of fluids, bleeding in the affected area, or signs of infection, including fever.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)