Finger Dislocations and Sprains in Basketball: More Than Just ‘Buddy Taping It’
The finger gets hit by the ball, bends the wrong way, and the instinct is to pull it straight and tape it to the next finger. In some cases that’s fine. In others, it creates a problem that will show up again in three weeks.
Finger injuries are the most frequently dismissed injury in basketball, partly because they happen so often. But knowing which structures are involved changes whether a player needs two days off or two months.
What Can Be Damaged
The most commonly injured joint is the proximal interphalangeal (PIP) joint, the middle joint of each finger. The supporting structures at this joint include:
The volar plate: a fibrocartilaginous plate on the palm side of the joint that prevents hyperextension. It is the most commonly injured structure in a dorsal PIP dislocation.
The collateral ligaments: the radial and ulnar collateral ligaments on each side of the joint, stabilising it against sideways forces.
The central slip of the extensor tendon: runs over the dorsal (back) surface of the PIP joint. If this is torn and missed, the result over 2-3 weeks is a boutonniere deformity, where the middle joint can no longer straighten and the finger curls.
The central slip injury is the one that gets missed most often. It presents with PIP joint pain and swelling after an injury, sometimes with only mild extension weakness initially. Without correct splinting, it progresses.
Grading and Imaging
Simple dislocation (no fracture, stable after reduction): Can often be managed conservatively with buddy taping and early movement.
Fracture-dislocation: If there is a fragment off the volar plate or a significant fracture at the base of the middle phalanx, stability of the joint is compromised. X-ray is required when there is significant swelling, inability to bend the finger, or any bony tenderness.
Central slip injury: Requires 6 weeks of PIP joint extension splinting to prevent boutonniere deformity. Missing this is the most common management error.
Treatment
For simple PIP sprains with intact extensor mechanism: buddy taping to the adjacent finger, early active movement, and progressive loading over 2-4 weeks.
For volar plate injuries: extension block splinting at 30 degrees for 2-3 weeks, then progressive extension.
For central slip injuries: full extension splinting of the PIP joint for 6 weeks, with DIP joint mobilisation kept active throughout.
For fracture-dislocations: surgical consultation if more than 30-40% of the articular surface is involved or the joint is unstable after reduction.
Strapping for Return to Play
Return to basketball with a buddy tape or custom thermoplastic ring splint is standard practice for most finger injuries. The key is that the tape should protect the joint without completely immobilising it, since prolonged immobilisation causes joint stiffness that can persist for months.
Correct buddy taping technique, strapping through the middle phalanx of both fingers with some spacing, is a practical skill that any team coach or trainer benefits from learning.
Want to understand this injury at a deeper anatomical level? The Club Physio’s online anatomy course breaks down the structures, biomechanics, and load patterns behind the most common sports injuries. Built for athletes and therapists alike. [Explore the course at theclubphysio.com.au]
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