Combat Arts Finger Injuries Overview
Typically those in the combat arts wear gloves in some martial arts. However, in training camp and actual fights, the fingers are vulnerable. The bones are small, held together by thin ligaments. It’s easy to tear a ligament, dislocate a finger, or fracture the fingers like a professional MMA fighter.
Finger Injury Causes
MMA fighter Harvey Park is reported to have suffered a gruesome finger injury in a fight, with the bone breaking through the skin, and to have carried on and won. Reports like that are inconsistent with each other and no medical record sits behind them, so take the detail loosely. Take the lesson seriously though: bone through the skin is an open fracture, and that is an emergency. Stop, cover it, and get to an emergency department. Fighting on invites infection of the bone and can cost you the finger.
While grappling or performing moves in several martial arts like judo and BJJ, the fingers play an important role in gripping. Sudden flexion and extension injuries can cause tendon avulsion injuries. If weapons are involved then, lacerations and amputations are common. Crush injuries are also common when a heavy object or weight is dropped on the fingers. Ringside, these injuries are accidental.
Finger Injury Symptoms
Types of Finger Injuries
The injuries in the fingers are usually classified based on the type of injury. Many fighters continue to train despite the pain while splinting injured fingers. This spells disaster as it limits the mobility of the finger and prevents healing. However, injuries to fingertips heal quickly because of the excellent blood supply. Finger injuries must be promptly identified and treated. Some common injuries include Crush injury, Amputation, and Mallet Finger.
Splintered an Injured Finger & Still Experiencing Pain During Training?
Related Injuries
Crush injuries take place due to compressive forces, and they can be open or closed. Objects or people falling on the hand can crush the fingers. That can involve fractures, nail bed damage, tendon injury, and damage to the nerves and vessels running down each side of the digit. Where the fingertip itself is lost, surgeons grade it by how much tissue has gone — Allen's classification of fingertip amputations runs from Type 1 (pulp only), through Type 2 (pulp and nail bed) and Type 3 (partial loss of the distal phalanx), to Type 4 (loss proximal to the lunula).
Symptoms
Causes
A crush injury happens when the finger is compressed — trapped under a heavy weapon, an opponent landing awkwardly on the digits, or even a bare-knuckle punching action crushing the fingertip. There are no muscle bellies in the fingers, so what gets damaged is skin, nail bed, bone, tendon, and the nerve and artery on each side. Compartment syndrome of the hand is an uncommon complication rather than a usual one, but it is serious enough to watch for after any significant crush.
To learn how Crush injury is diagnosed Click Here
This is a closed tendon injury seen in contact and high-velocity sports, most often while rolling. The fingertip gets caught in a gi, or takes a ball or a strike square on the end, and the tip is driven into bend while you are holding it straight. That forced flexion of an extended fingertip is the mechanism: it tears the terminal extensor tendon, or rips a flake of bone off with it. The tip then droops and you cannot straighten it.
Mallet finger injuries happen when the extensor tendon is torn. The tendons on the back of the hand that straighten the fingers are the extensor tendons, and they connect muscle to bone. Each finger has three joints: the metacarpophalangeal joint (MCPJ), where the finger meets its metacarpal in the hand; the proximal interphalangeal joint (PIPJ) in the middle; and the distal interphalangeal joint (DIPJ) out at the fingertip. Mallet finger is an injury of that last joint. Commonly, rolling or striking moves in BJJ or grappling cause a violent flexion of the DIPJ, or lacerate the back of the finger over it.
To learn how Mallet Finger are diagnosed Click Here
Any direct blow or a crush injury to the distal finger can damage the nail bed. As blood enters the space it exerts more pressure. Nailbed avulsions can be associated with subungual hematomas, fractures of the finger, or avulsion of the finger joint. In martial arts, nail injuries take place due to sudden moves.
Sometimes, simply hooking a finger into an opponent’s gi can cause a nailbed to get avulsed if he jerks away or the movement is sudden and forceful. A crush injury where the finger is crushed under an opponent or a finger fracture due to a fall can also cause a nail bed injury.
To learn how Nailbed Injuries are diagnosed Click Here
Common Injuries
You can read more about common finger injuries such as lacerations and dislocations in our Common Injuries section.
Finger Injury Diagnosis
The diagnosis of finger injuries is done through various tests and a thorough physical exam. While imaging forms the cornerstone of diagnosing finger injuries, nerve conduction tests are also integral to testing the functions of nerves innervating the finger.
Injury Specific Diagnosis
Physical Exam
After inspecting hand dominance, whether the wound is dirty or clean, reviewing tetanus status and time since injury, the doctor examines the injury. He will compare it to the normal contralateral hand. Any abnormal positioning of the hand is noted. The capillary refill exam is done on the nail bed. The blood flow to the finger is observed through this test. The finger is tested via moving 2 point discrimination. The fingers are tested for active and passive range of motion. Doctors will also check for joint instability and hematomas.
Imaging
X-rays are usually diagnostic. The affected digits will require plain films in AP and lateral views. X-rays of the entire hand must be taken. X-rays of the opposite hand are also taken for comparative studies.
Lab Tests
CBC is dome to monitor blood loss. The coagulation profile is checked. Unless surgery is needed, no other blood tests are required.
To learn how a Crush injury is treated Click Here
Physical Exam
Doctors will ask all those in the combat arts about hand dominance, their occupation, the time of injury, how the injury occurred, any associated injuries and when was their last meal. This will influence the treatment and the management of the amputated finger.
On physical exam, they will check the level of amputation, which structures are involved, whether the nerves and blood vessels are affected and to what extent. They must assess whether the amputated part is suitable for replanting.
The Sebastian and Chung classification sorts finger amputations by level, splitting them into distal and proximal groups using the lunula, the insertion of flexor digitorum profundus, and the neck of the middle phalanx as landmarks. The level matters, because it drives whether replantation is worth attempting and what function can realistically be expected afterwards.
Imaging
X-rays of the affected finger and amputated part are done. This assesses bony injuries, bone quality and it will determine treatment through bony fixation.
Lab Tests
CBC has to be done to assess for blood loss. Coagulation studies are done for those on anticoagulants.
To learn how Amputation is treated Click Here
The physical exam must observe DIPJ flexion at rest. The fingers are all examined but this one sign is diagnostic. That is the inability to straighten or extend the DIPJ during the range of motion tests. It is conclusive for the mallet finger. Persistent tenderness and swelling near the DIPJ are also indicative. Doctors will isolate the DIPJ to accurately diagnose a mallet finger.
This is mostly a clinical diagnosis. X-rays are done to assess bony injuries. An anterior-posterior (AP), lateral, and oblique views are ordered. The X-ray centers at the DIPJ of the affected finger. These views are important as they classify the mallet finger category. It's essential to differentiate a bone injury from a tendon mallet injury as the treatments will differ. The lateral view is the best for assessing any avulsion fractures. This view can also check for the palmar subluxation of the phalanx. Rarely, ultrasound is also used to view the tendons.
Blood tests are not required unless part of the pre-operative clearance. The type of treatment will determine the necessity of blood tests.
To learn how Mallet Finger is treated Click Here
The physical examination of the nailbed is done where there is appropriate lighting to visualize the injury carefully. An assessment can be made based on the history but a physical exam may reveal hematomas or hidden fractures. The doctors look for lacerations, closed or open fractures, and any associated amputations of the fingertip.
Evaluation should include assessing the finger. The associated finger is examined for sensation, the range of motion at the interphalangeal joints, and capillary refill. If injuries to the bones, joints or soft tissue is suspected in addition to the nailbed, then X-rays of the affected finger and hand with two or three views are done.
No lab tests are required to diagnose injuries to the nailbed.
To learn how Nailbed injuries are treated Click Here
Common Diagnoses
In our Common Diagnoses section, find out about how doctors use various imaging tests, nerve conduction studies, and other tests to diagnose finger injuries.
Finger Injury Treatment
The treatment of various finger injuries depends on the type of injuries. Crush and amputation injuries are critical in the first 12 hours and the emergent treatment is crucial. Other avulsion injuries will require surgical repair. Rehabilitation also forms a major part of therapy as early flexibility is promoted instead of immobilization.
Source: Nina Lishchuk, Standard License, via Shutterstock
Prolonged immobilization tends to limit joint mobility. Fingers have a good blood supply, which helps them heal and helps them fight infection — but the skin is thin, mat and cage wounds are rarely clean, and the tendon sheaths and joints sit close to the surface, so an infected finger can get serious fast. All finger injuries must be followed up and watched for the signs: spreading redness, pain that climbs instead of settling, pus, or fever.
Injury Specific Treatment
Emergency
Emergency treatment depends entirely on the type of injury. Severe crush injuries involving a mangled limb will require a team approach from hand surgeons, orthopedic doctors, and rehabilitation medicine. Advanced Trauma life support (ATLS) and vitals signs check are administered. First aid is done if possible ringside. The injury is irrigated and examined. Larger trauma with lacerations and avulsion will need surgical repair.
Medical
Medical treatment of a crush injury depends on what is damaged underneath the skin. The finger is X-rayed, and open wounds are cleaned and irrigated, with tetanus cover and antibiotics where the skin is broken. A painful blood blister under the nail can be drained by a clinician to relieve the pressure — do not drill, burn or cut a nail yourself. Nail bed lacerations are repaired. Closed fractures of the phalanx are usually splinted, while unstable fractures and those running into a joint surface need surgical fixation, done under a digital nerve block with repair of the soft tissue. Swelling is managed with elevation, and the digital nerves, arteries and the circulation in the tip are all checked. Motion is started as early as the injury allows, because stiffness is the usual long-term cost of a crush.
Home
A splint stays on for as long as your doctor says, judged on how the bone looks on X-ray — not until the pain stops. Pain settles long before a fracture unites. Antibiotics are not automatic either; they are for open or contaminated wounds, and that is a doctor's call. Some transverse fractures need weekly X-rays to check the position has not slipped. Watch the hand for compartment syndrome: pain far worse than the injury should cause, pain when someone gently straightens the finger, a tight, shiny, swollen hand, and numbness or tingling. That is a surgical emergency — go to an emergency department immediately, and loosen any tight tape, ring, splint or dressing on the way. It is released surgically in hospital; left alone it kills muscle and can cost you the hand.
Emergency
Once a finger amputation has occurred it is vital to get emergency care straight away. As a rough guide, a detached fingertip tolerates something like 12 hours warm and up to about 24 hours cooled — and amputations closer to the hand, which contain muscle, tolerate far less than that, a matter of hours rather than half a day. The amputated part must be wrapped in normal saline-soaked gauze, sealed in a plastic bag or box, and that sealed bag placed in iced water. There must be no direct contact with ice.
Direct contact with ice will damage the tissue and kill the viable amputated part. If the amputation is larger and closer to the body, the presence of muscle will hasten the death of the tissue. Irreversible changes in muscle take place after 6 hours without blood supply.
Medical
The first step is the first aid provided in the ED. With the preserve amputated part, tetanus vaccination is given and antibiotics are started pre-emptively.
Replantation is done in healthy fighters with clear amputation, thumb amputation, multiple finger amputations, amputations at or close to the palm, and single finger amputation that are zone I.
Replantation is not done in the case of single-digit injury through zone II, smokers, in severe crush injuries, mangled limbs, heavily contaminated injuries, segmental injuries, prolonged warm ischemia time, those with simultaneous avulsion injuries, in fighters where the amputated part is not preserved properly, previous surgery to affected finger and ‘red line' or 'red ribbon' sign seen in vessels during surgery. This sign indicates the level of injury to the vessels.
In the operating theater, the amputated part must be assessed. Its suitability for replanting is examined. All structures are dissected and identified. This is particularly for the neurovascular bundle. If there are no suitable blood vessels, then replantation is canceled.
There is an order for repair in replantation:
First, the bone is fixed to allow repair of soft tissue. This is followed by the repair of the extensor and flexor tendons.
Nerve repair and arterial anastomosis follow. If suitable veins are present, then venous anastomosis is undertaken
To fix the bone, two Kirschner wires or plates are used. Sometimes, the bone is shortened before fixation. This allows closure of the soft tissues and repair of neurovascular structures.
Home
The post-operative management is equally important to ensure rapid healing. The fighter must maintain adequate hydration and circulation volume due to previous blood loss. Pain control is advised with NSAIDs.
Keep the affected limb raised and warm. Check the color and temperature of the replanted digit. The doctor will teach you how to monitor capillary refill in the finger. Do not change any dressings for the first 48 to 72 hours. This will ensure minimal manipulation of the repair.
For artery-only replants doctors may make stab incision to the amputated tip. Apply heparin-soaked gauze to allow venous drainage. Another controversial method is to use leeches instead. This treatment is halted once the finger looks pink with a normal capillary refill. It indicates that the veins have been drained.
Some fighters may require further surgery like bone grafting, tenolysis, or tendon transfer. Return to contact after a replant is measured in many months, not a couple of them: bone union, tendon glide and nerve regrowth all run longer than that, and sensation can keep improving past a year. Your surgeon clears you, not the calendar — going back early risks the replant you just spent two operations saving. Functional recovery is better in distal injuries than proximal, and movement and power are better in distal amputations as well. Start rehabilitation as advised post-injury.
Most fighters on discovering an injury or hearing a pop in their fingers on the mat, tape their fingers and continue to fight on. However, imaging must be done to determine the type of injury and then further treatment.
If there are no large articular disruptions or subluxation, conservative treatment with a splint is enough. There are no universal guidelines on splint type or on night orthotic wear. The fighter can be prescribed a Stax splint or an aluminum foam splint, and it holds the DIP joint in full extension — straight, not bent back. Do not force the joint into hyperextension: it blanches the thin skin over the top of the joint and that skin can break down. The PIP joint is left free to move. Splinting runs continuously for 6-8 weeks.
Following that, there is progressive flexion physical therapy at six weeks.
Avoid hyperextending the DIPJ and freely move the PIPJ.
Open injuries need cleaning in the OR and surgical repair. Surgery is advised for fighters who have large bone fragments, those with joint mal-alignment, those with Acute Type II and III injuries, fighters who have inadequate DIP joint extension after splinting, and for fighters who seek treatment months after injury.
Surgical techniques could involve closed reduction with percutaneous pinning (CRPP), open reduction and internal fixation (ORIF), and reconstruction of the torn tendon.
Keep the splint on at all times, including in the shower. If the fingertip is allowed to droop even once, the healing tendon ends pull apart again and the clock effectively restarts — which is why the splint stays on for the full 6-8 weeks. Prevent any flexion of the injured joint. If the splint has to come off to dry the skin, keep the finger pressed straight against a flat surface while you do it, or have a clinician change it.
The injury must be thoroughly cleaned with minimal debridement of both the nail bed and nail root. A doctor will reposition and anatomically repair significantly disrupted nail beds and nail roots. If this is not done accurately and immediately, nailbed growth is affected leading to deformed nails.
Close approximation of the nail bed preserves the skin folds surrounding the nail margins. Any adhesions between the eponychium, nail bed, and root are prevented by replacing the nail or gauze packing to maintain the space.
Even if there is partial nail avulsion or the surrounding nail fold has been disrupted, then nail has to be removed. If there are associated lacerations of the nail bed blunt removal of the nail is necessary. The nail bed is then closed with absorbable sutures. The nail is replaced to allow new nail growth and the nail fold space is maintained with gauze packing.
Some doctors may just apply Vaseline gauze after repair and allow it to separate on its own. A plaster volar splint rounded at the end can protect the fingertip. Elevate the finger and check the injury in three days with a dressing change. Sutures in the nail or the gauze packing under the eponychium are removed in two weeks.
Common Treatments
Doctors treat finger injuries through a variety of ways including, physical therapy, grafts, medications, and surgery. You can read more about it in our Common Treatments section.
