Holly is a 12year old schoolgirl who injured her finger playing netball.She had attended A and E and then received an appointment with an Orthopaedic hand surgeon, who diagnosed a partial rupture to the volar plate (a soft structure which stabilises the middle joint of the finger).  He did not feel that surgery was necessary and referred Holly for ‘Hand therapy’.

 

Holly stated that her finger had been stubbed on the ball and forced backwards.  Holly presented with a stiff, swollen and painful  index finger, which she could not straighten or bend fully at the middle joint.  The palmar aspect of the finger was particularly painful.  Upon the initial treatment Holly was shown how to bend her finger in order to maintain it’s mobility, but also how to avoid fully straightening the finger in order to protect the damaged tissue.  A small thermoplastic splint was applied to the finger in order to protect Holly’s finger.  Holly was taught to remove this for exercises.  The finger was also taped to control the swelling.

 

Holly was reviewed again 6 weeks later.  The pain was less severe and mobility much improved.  The middle joint remained slightly thickened but the swelling was now under control.  Holly was taught how to fully straighten the affected finger and how to strengthen the finger against the resistance of rubber bands, gradually increasing the amount of resistance.  Holly was advised on gradually weaning herself off the protective splint, but to continue to wear this in risky situations eg. netball for a further 4 weeks.  Holly was not given another appointment but told that she could ring and book in for another appointment if necessary.  She did not need to do this and was subsequently discharged.