Back Pain Doctor
Finger Sprains
A finger sprain occurs when the ligaments supporting a finger joint are stretched or torn. It typically happens when a force bends the finger backwards or sideways, or jams it on the end — a fall onto an outstretched hand, or catching a ball awkwardly in cricket, netball, basketball or football. Most sprains involve the PIP joint in the middle of the finger, which is also the joint that takes longest to recover.
Assessment focuses on where the tenderness sits, how the joint moves, and whether it is stable. A joint that feels loose when tested suggests a complete ligament tear. The other priority is excluding a fracture or dislocation, which are not uncommonly mistaken for sprains — X-ray is the appropriate first-line image where there is significant swelling, deformity, bony tenderness or suspected instability. Advanced imaging is rarely needed and is reserved for clarifying instability or an injury that is not adding up clinically.
First-line care is usually relative rest, ice, light compression and elevation for the first day or two with simple analgesia, followed by early protected movement. Moderate sprains are often briefly immobilised and then buddy-strapped, which supports the joint while allowing the movement that prevents stiffness. Guided stretching and hand therapy help restore range of motion. Severe injuries — a complete tear, an unstable joint, or an avulsion fracture where the ligament has pulled a fragment of bone away — need referral for consideration of surgical repair. Ignoring a sprained finger in the hope it settles risks chronic stiffness, instability and later arthritis, so persistent symptoms should be reviewed rather than tolerated.
Common symptoms
- Pain, swelling and tenderness around a finger joint
- Bruising over the injured knuckle
- Stiffness, with difficulty making a fist or straightening the finger
- A joint that feels loose or unstable after a severe injury
Commonly seen in
Thirteen options we can consider for finger sprains, and where each one fits.
We work through these in order. Most people improve with the first two or three stages, and the later options exist for problems that are still there after that. Listing a treatment here does not mean it is right for you — the evidence, likely benefit, risks, cost and alternatives are all weighed against your diagnosis at consultation.
Start here — getting the diagnosis and the plan right
Nothing further along the pathway works as well without this, and for many people it is enough on its own.
Diagnosis, education and progressive rehabilitation Working out what is driving the pain, explaining what your imaging does and does not mean, and building a graded loading plan you can actually follow. Core care
What it involves
Assessment to identify the likely pain source, an explanation of what the diagnosis means, adjustment of the loads that aggravate it, and a progressive strength and conditioning plan — with weight management where that is clinically relevant.
What the evidence shows
Early controlled loading and graded return to activity are the best-supported management for acute soft-tissue injury.
Where it fits for you
The whole plan for most acute injuries, with a clear timeline for getting back to what you do.
Settling pain enough to rehabilitate
Short-term pain control, used to open a window for the loading work rather than as a treatment in its own right.
Dry needling and trigger point therapy A fine needle into a tender band of muscle, with nothing injected. Only if relevant
What it involves
A fine needle is placed into a tender band of muscle, with nothing injected. Often done in the same visit as your assessment.
What the evidence shows
Not indicated in the acute phase.
Where it fits for you
May help later if protective muscle pain persists.
Wet needling (trigger point injection) The same target as dry needling, with a small volume of dilute dextrose solution injected. Only if relevant
What it involves
The needle is placed into the tender muscle band and a small volume of 5% dextrose with 0.04% lignocaine is injected. Often more comfortable than dry needling, and usable where the tender area sits deeper.
What the evidence shows
Low-quality evidence and no acute-phase role.
Where it fits for you
Rarely relevant.
Ultrasound-guided injections Guidance means we can see the needle reach the target. What goes into the needle depends on the diagnosis. Only if relevant
What it involves
The injection is performed under ultrasound so the needle can be watched into the target structure. What is injected is decided by the diagnosis — and corticosteroid is used sparingly, for the reasons set out below.
What the evidence shows
Injection is generally avoided in acute injury, where healing tissue needs load rather than suppression.
Where it fits for you
Considered only for a specific complication identified on assessment.
V-ACTOR vibration therapy (vibration therapy) Low-frequency vibration applied over tender muscle. Not a shockwave, despite sharing the machine. Only if relevant
What it involves
A vibration handpiece is moved over the tender muscle and fascia for a few minutes. It runs from the same STORZ MASTERPULS icon console as radial shockwave but is a separate handpiece delivering a different, gentler form of energy. No needles, no anaesthetic, no downtime.
What the evidence shows
Vibration is not appropriate over a fresh injury.
Where it fits for you
Considered only once the acute phase has passed and tender, guarded muscle is limiting movement.
Energy-based treatment — no needles, no downtime
Delivered in the clinic over a short course of sessions. Often the next step when rehabilitation has stalled.
Radial or focused shockwave? Read the overviewRadial shockwave (radial pressure wave) Broad treatment across tender muscle and fascia, close to the surface. Only if relevant
What it involves
A handpiece is moved over the tender tissue while ballistic pressure pulses are delivered, using a transmitter head chosen for the tissue — including heads shaped for fascia and for the muscle either side of the spine. The pulse is strongest at the skin and weakens with depth, so this is mainly a myofascial treatment, though it can reach deeper in some areas. No anaesthetic, no downtime, usually a course of sessions about a week apart.
What the evidence shows
Shockwave is a treatment for persistent problems, not fresh injury.
Where it fits for you
Only once pain persists well beyond the expected healing time, and then for the tender muscle and fascia rather than the injured structure.
Focused shockwave (ESWT) A true shock wave converging at depth — for tendon, joint, ligament and bone. Only if relevant
What it involves
A focused system generates an acoustic shock wave that converges at a focal point set at a defined depth, concentrating the energy where the target is. This is the form we use for tendon, joint, ligament and bone. Typically four to six sessions about a week apart, no anaesthetic and no formal downtime.
What the evidence shows
Same — the evidence base is in chronic presentations.
Where it fits for you
Considered only once the problem has become persistent and a tendon, ligament or attachment is the target.
EMTT (magnetotransduction therapy) High-energy magnetic pulses applied over the area. Painless, no contact. Evidence mixed
What it involves
You sit with the applicator positioned over the area for a short session. Painless, no gel or contact required, and usually delivered as a course — commonly alongside shockwave.
What the evidence shows
Evidence in acute injury is early.
Where it fits for you
Not routinely offered at this stage.
Injection options where pain persists
All ultrasound-guided. Each carries a real cost and a genuinely uncertain benefit, so we go through the numbers with you before you decide.
Platelet-rich plasma (PRP) Your own blood, concentrated and injected under ultrasound guidance. Evidence mixed
What it involves
Blood is taken from your arm, spun to concentrate the platelets, and injected into the target under ultrasound guidance in the same appointment.
What the evidence shows
Trials in acute muscle and ligament injury have largely not shown faster return to sport than rehabilitation alone.
Where it fits for you
Not recommended routinely, and we will explain why if you have been offered it elsewhere.
Prolotherapy (dextrose) A course of dextrose injections into and around the structure and its attachments. Only if relevant
What it involves
Hypertonic dextrose is injected at the tender ligament and tendon attachments, and into the joint where relevant, usually as a series of treatments a few weeks apart.
What the evidence shows
No established role in acute injury.
Where it fits for you
Considered only for persistent ligament laxity-related pain later on.
Viscosupplementation (hyaluronic acid) A gel-like injection into an arthritic joint. Widely used, and genuinely contested. Not used here
What it involves
One or a short series of hyaluronic acid injections into the joint under ultrasound guidance.
What the evidence shows
No role in acute soft-tissue injury.
Where it fits for you
Not offered for this problem.
If the nerves are part of the picture
Burning pain, hypersensitive skin, or pain that does not behave like joint or tendon pain. Relevant for a minority of people, and worth checking for.
Lyftogt perineural therapy (perineural injection therapy) A series of small dilute dextrose injections just under the skin, over tender superficial nerves. Only if relevant
What it involves
Small injections of low-concentration dextrose, usually 5%, placed just beneath the skin along tender superficial nerves. Given as a series of short sessions.
What the evidence shows
Low-quality evidence, and not an acute-phase treatment.
Where it fits for you
Occasionally relevant if nerve-type pain persists after the injury settles.
Ultrasound-guided nerve hydrodissection Fluid placed around a nerve to free it from the surrounding tissue. Only if relevant
What it involves
Under ultrasound, fluid is placed in the plane around the nerve to separate it from the tissue that is tethering or compressing it.
What the evidence shows
Not an acute injury treatment.
Where it fits for you
Only if a nerve becomes involved as the injury heals.
This is general information only and suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of the uncertainty, the expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.
Corticosteroid injection is not a stage of this pathway.
Cortisone reliably reduces pain in the short term, and that can be genuinely useful when pain is stopping you sleeping or moving enough to rehabilitate. Beyond that window the picture changes. Evidence in tendon problems suggests early relief can be followed by worse outcomes at a year than exercise alone, and repeated injections into a joint have been associated with cartilage loss. It does not repair anything.
So we do not build treatment plans around it. Where an injection is the right call, we discuss what is being injected and why, keep the number low, and pair it with the loading work that changes the longer-term course.
When we would still consider it
- Pain severe enough to block rehabilitation
- A clear inflammatory or bursal target on imaging
- A specific short-term goal — a trip, a procedure, a return to work
- Diagnostic use, where the response tells us where the pain is coming from
Frequently asked questions
How do I know it is not broken?
What is buddy strapping and how long do I wear it?
Why is my finger still swollen months later?
Ready for a clearer plan for your back or musculoskeletal pain?
Book an assessment with Dr Joshua Hatch.
Your assessment focuses on understanding the likely source of your pain and the most appropriate non-surgical options for your diagnosis, with the aim of reducing pain and improving function.
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