Dislocations and subluxations of the hand and wrist

What do dislocation and subluxation mean?

In the event of a dislocation, the joint surfaces are no longer in contact - the joint is completely dislocated. In the case of a subluxation, there is still partial contact, but the joint is misaligned and unstable. Both injuries affect the surrounding capsular-ligamentous apparatus and may be associated with tears of the ligaments, the volar plate, capsular injuries, or bony avulsion fragments.

• Common: dorsal PIP dislocation (finger middle joint) after ball contact or fall
• MCP dislocation (finger metacarpophalangeal joint) – can be complicated by interposition of the volar plate
• Thumb metatarsophalangeal joint: Subluxation/dislocation often associated with ligament injury (e.g. UCL).
• Wrist: perilunar and lunate dislocations – rare, but potentially dangerous to nerves and blood vessels

Anatomy: Why stability is so important

The fine mobility of the hand is made possible by the interaction of bones, joint surfaces, capsule, ligaments and tendons. On each finger, collateral ligaments and the volar plate stabilize the joint. At the wrist, numerous ligament complexes (e.g. scapholunate and lunotriquetral ligaments) secure the carpal bones.

• Capsule: surrounds the joint, protects and stabilizes
• Collateral ligaments: lateral stability, particularly relevant during flexion
• Volar plate: anterior joint stabilization, prevents hyperextension
• Tendons and muscles: dynamic stability and movement control
• Vessels and nerves: run close to the joint – at risk in the event of dislocations

Causes and risk factors

Dislocations and subluxations usually occur suddenly due to external force, less often due to previous damage to the ligaments. Depending on the mechanism, typical injury patterns can be recognized.

• Falling on your hand, twisting your ankle or twisting
• Sports injuries (catching a ball, martial arts, falling while cycling or skiing)
• Direct violence/crushing in work or leisure accidents
• Previous instability, hyperlaxity, previous ligament injuries
• Rare: degenerative or inflammatory processes with capsular ligament weakness

Symptoms: How do I recognize a dislocation?

Sudden onset of pain, visible misalignment and inability to move are typical. Swelling, bruising and discomfort can also occur. Warning signs indicate vascular or nerve involvement and require prompt medical evaluation.

• Visible misalignment, shortening or step formation
• Severe pain, evasive movements, movement lock
• Swelling, hematoma, rapid increase in tension
• Tingling, numbness, loss of strength (indication of nerve involvement)
• Pale or cold fingers, weak pulse (indication of circulatory problems)

First aid: What you can do acutely

• Rest in the least painful position and elevate your hand
• Cool (e.g. cold pack in a cloth), avoid skin contact with ice
• Remove rings/jewelry from affected fingers early
• Don’t “adjust” it yourself – reduction belongs in the hands of a doctor
• In case of sensory disturbances, paleness/coldness, open wounds or severe misalignment: seek medical treatment promptly; If there are threatening warning signs, call 112

Diagnostics in our practice in Hamburg

We take a structured anamnesis and check blood circulation, motor function and sensitivity (DMS). The clinical examination includes axis and stability control as well as the ligament system. Imaging clarifies the position of the joint and detects accompanying injuries.

Special constellations: Dorsal PIP dislocations are often accompanied by injuries to the volar plate. Complicated MCP dislocations (e.g. index finger) can be irreducible due to interposed structures. Perilunary or lunate dislocations of the wrist are potential emergencies because the median nerve can be at risk in the carpal tunnel.

Conservative treatment: reduction, immobilization, early function

The aim of conservative therapy is to restore the anatomical position of the joint, control pain and swelling and ensure joint function at an early stage. The closed reduction is carried out under adequate pain or conduction anesthesia by experienced practitioners. The stability is then checked and a splint/orthosis adapted to the injury pattern is applied.

• PIP dislocation (dorsal): after reduction, usually short-term splinting in slight flexion, subsequent functional taping (buddy taping) and early functional mobilization
• PIP dislocation (volar): careful mobilization in a pain-free zone, temporary splinting depending on stability, close monitoring
• MCP dislocation: stable situations can be treated after reduction with a splint/orthosis and controlled mobilization
• Thumb metatarsophalangeal joint (subluxation/dislocation): immobilization in thumb orthosis; If a UCL injury is suspected, differentiated clarification, see ski thumb
• Carpometacarpal subluxation/dislocation (finger base): depending on stability, splint versus wire-secured immobilization – individual indication

In addition, we recommend coordinated swelling management, scar and soft tissue care for skin injuries, as well as physiotherapy/occupational therapy to restore mobility, strength and fine motor skills. Pain therapy and anti-inflammatory measures are cautious and individually tailored.

Surgical procedures – when does an operation make sense?

Not every dislocation requires surgery. Surgical treatment is considered if reduction is not successful, the joint remains unstable after reduction, a dislocation fracture is present, soft tissue is interposed, vessels/nerves are at risk, or repeated dislocations occur. There is often an urgent indication for surgery on the wrist (e.g. perilunar/lunate dislocation).

• Closed or open reduction with stabilization
• Ligament suture/reconstruction in cases of relevant ligament insufficiency
• Temporary wire or screw fixation to heal the ligament/capsular apparatus
• Immobilization in a functional position with subsequent early function under therapy
• In selected cases: arthroscopically assisted procedures on the wrist

We discuss benefits and risks transparently. The goal is a stable, pain-reduced hand with the best possible function. The indication is always individual and evidence-based - regenerative procedures are only used if there is clear data and after informed consent.

Healing process, duration and prognosis

The healing time depends on the location, stability and accompanying injuries. Early, moderate mobilization is important to avoid stiffness. Swelling or reduced mobility, especially in the hand, can be noticeable for weeks to months.

• Immobilization usually lasts 1-4 weeks depending on the joint and stability
• Functional therapy begins early, individually dosed
• Everyday activities are often possible after a few weeks, stressful activities later
• Sport/high-risk sports only after medical clearance and sufficient stability
• Regular follow-up checks ensure the success of the therapy and adjust the load

Common forms of dislocations/subluxations of the hand

• PIP joint (finger middle joint): dorsal dislocation most common; volar less common, often more complex
• MCP joint (finger metacarpophalangeal joint): simple vs. complicated dislocation (interposition of the volar plate possible)
• Thumb metatarsophalangeal joint: subluxation/dislocation often combined with UCL lesion (“ski thumb”)
• Carpometacarpal joints (base of metacarpals): rare, usually after high-energy trauma
• Wrist: perilunar and lunate dislocations, often with ligament complex injuries - urgent clarification

Accompanying capsular ligament injuries are common and have a significant impact on stability and follow-up treatment.

Prevention and everyday tips

• Sport-specific technique and strength training for grip and support strength
• Protective gloves and wrist guards for high-risk sports
• Taping/orthosis in cases of known instability as recommended by a doctor
• Workplace and tool ergonomics, break management
• Fall prevention (coordination, balance), remove rings during sports/crafts

When is it an emergency?

The following signs require you to go to the emergency room or call emergency services immediately:

Your treatment in Hamburg-Winterhude

In our orthopedic practice at Dorotheenstrasse 48, 22301 Hamburg, you will receive structured diagnostics and guideline-oriented, conservative therapy. If the findings are complex, we coordinate further care on an interdisciplinary basis and, if necessary, promptly refer you for hand surgery.

We discuss individually whether purely conservative treatment is sufficient or whether a surgical approach makes sense. Our goal is to make a safe, informed decision without unnecessary interventions - with a focus on function, pain reduction and suitability for everyday use.

Further topics

Depending on the findings, the following content may also be relevant for you:

• Sprains (distortions): What to do if you strain without dislocating?
• Capsular ligament injuries: importance for stability and follow-up treatment
• Ski thumb (UCL rupture): Instability at the base of the thumb joint
• Crush Injuries: Soft Tissue Protection and Wound Management
• Cut injuries: tendon/nerve check and care