The Proximal Interphalangeal (PIP) bones are an intricate network of joints that allow us to complete domain over the movements of our fingers. Sustaining an injury to these fragile joints can mean a complete loss of finger dexterity and movement.
If you suspect you’ve become the recipient of such an injury, read on to learn more about what structures make up the PIP joint, how these structures can become damaged, and how to treat the problem if an injury has been sustained.
Anatomy of the Proximal Interphalangeal Joint
Our hands are made up of 27 of the smallest bones in our bodies. These bones are connected to each other through a small network of muscles, tendons, and ligaments which work together to enable the hand motions we are used to. The Proximal Interphalangeal or PIP joint is a small part of this complicated network of tissues.
Each finger (with the exception of the thumb) is composed of three bones known as phalanges. A person can easily see where each phalanx begins and ends by looking at the lines etched in their fingers due to the movements of the joint which forms between each phalanx.
A phalanx is named according to its position within the finger. The outer-most phalanges are known as distal phalanges. Those in the center are known as intermediate or middle phalanges. Those closest to the hand are known as proximal phalanges and these are what we refer to when we talk about PIP joint pain.
The phalanges are connected to each other via a long strand of tendon tissue that runs from the base of the wrist up to the middle of the distal phalanx. These tendons are known as flexor tendons and as they contract, the fingers bend at the joints formed between each phalanx.
Aside from the flexor tendons, each phalanx is kept in alignment through a network of soft tissues consisting of:
- Joint capsules: the cartilage that allows for smooth interaction between the bones
- Volar plate: connective tissues that attach the tops of the phalanges to one another
- Collateral ligaments: connective tissues that attach the sides and bottoms of each phalanx to one another
- Central slips: branches of the flexor tendon which allow for independent movement of each phalange
When any of the tissues are damaged, be it through blunt trauma or degeneration over time, a person may begin to experience pain in their proximal phalanx. As the tissues degenerate further or even rupture, the pain may become a chronic problem. If this pain is centralized to the joint formed between the proximal phalanx and the metacarpals of the palm, it is only then that the issue is considered a PIP injury.
Symptoms and Signs of Proximal Interphalangeal Issues
PIP-related injuries are typically caused by acute trauma such as sudden overextension of the joint between the proximal phalanx and metacarpal bones. Even though most of the common injuries occur suddenly, a person may only begin to experience the symptoms of injury over time.
Symptoms of a PIP related injury include:
- Pain in joint
- Swelling and bruising at the base of the finger
- Loss of joint function
- Finger weakness
- Tenderness to the touch
Additionally, PIP joint injuries can cause a host of other issues if not treated properly. If the PIP joint is not seated correctly as it heals, this may cause disfigurements, misalignments, chronic stiffness, and eventual decay of the soft tissues within the PIP joint.
Suffering any sort of acute injury to the phalanges of the finger should be met with an immediate examination and medical evaluation of the injury in order to prevent further complications.
Causes of Proximal Interphalangeal Joint Pain
As most of the risk factors for a PIP injury are sudden in nature, those most at risk are athletes or those whose jobs involve physical strain on the hand. Causal factors for a PIP related injury include:
- Blunt trauma to the PIP joint
- Overextension of the finger, typically backward
- The immense strain on the finger for extended periods of time
In some cases, PIP injuries and their ensuing pain may be related to age. As we grow older, the soft tissues within our joints break down due to everyday use. The soft structures within the hand are especially susceptible to this decay due to the abundance of purpose for our hands. PIP-related pain due to aging will typically come in flashes or will slowly progress, getting worse over time.
Diagnosing Proximal Interphalangeal Joint Damage
If the symptoms of a PIP injury are chronic, an individual may be able to determine there is a deeper issue on their own. Still, it is best to seek medical evaluation of the PIP joint in order to rule out other potential causes and seek the best treatment method for a particular issue.
Medical evaluations for PIP injuries will begin with lifestyle evaluations and research into the patient’s medical history. Lifestyle choices such as participating in sports that require articulate movements of the fingers – baseball, football, weightlifting – are special risk factors for PIP-related injuries. A medical history that involves hand-related injuries may also be a considerable factor in PIP-related damage.
After these precautionary methods, doctors will move on to the physical evaluation of the PIP joint. A doctor will test the range of motion of the PIP as well as examine how sensitive it is to various amounts of pressure. If a patient responds poorly to these tests, the doctor will move on to medical imaging tests.
Medical imaging aims to examine the structures within the PIP joint. CT scans, MRIs, X-rays, or a combination of these will be used to examine the health of the tendons, ligaments, bones, and muscles within the finger.
Using the above techniques will give the doctor an idea of the progression of the damage and help them develop a treatment plan aimed at maximizing functionality and reducing pain.
Conventional Treatments for Chronic Proximal Interphalangeal Joint Pain
There is a number of conventional treatment options for patients suffering from a PIP joint injury. A patient will explain their functional goals to their doctor and based on the condition of the joint, the doctor will explain whether these are obtainable through conventional means.
These conventional treatment options and how they may help PIP joint injuries include:
Physical therapy is a type of treatment that seeks to reduce discomfort and improve your ability to move and function. Oftentimes, stretches, massage, and guided exercise may be all a patient needs in order to reach their functional goals. These treatments can help train a patient to use their PIP joint in ways that do not induce pain as well as treat any pain that may be caused by everyday movements.
If the PIP joint swells or becomes stiff, over-the-counter medications such as naproxen, ibuprofen, and acetaminophen can help control the pain caused by these symptoms. A doctor may prescribe higher doses of these medications or may move on to medications that block the brain’s reception of pain.
Surgery is typically a last resort in treating PIP joint pain and is often unnecessary. If a patient’s pain continually worsens or if a patient loses the complete function of the PIP joint, then surgery may be needed. If the PIP injury set in an awkward position, surgical intervention will be an absolute necessity in order to restore proper function to the PIP.
In other cases, the PIP joint may have developed bone spurs as an effect of a PIP injury, these will need to be shaved off through surgical means. Surgery requires long recovery periods in addition to a regimen of physical therapy as well as medication.
Doctors try to avoid surgery for PIP injuries as much as possible. This is why it is important to seek immediate medical attention when a PIP injury is suspected. The earlier an issue is caught and treated, the less chance surgical intervention will be necessary.
While conventional treatments are the most recommended by doctors, they may not always be the best option for a patient’s particular injury. If the patient’s functional goals seem unachievable through these conventional means, the doctor may recommend alternative treatment options such as regenerative therapy.
Regenerative Therapy for Proximal Interphalangeal Joint Pain
The PIP joint involves a network of soft tissues which is why it can be effectively treated by regenerative therapy. These therapies aim to eliminate pain and restore function by repairing damaged soft tissue structures within the site of an injury.
Platelets are one of the body’s natural defenses against injury. They provide natural clots that seal injuries as well as send out chemical signals which trigger a healing response from the body. By isolating platelets from a patient’s blood, mixing them with a number of growth factors, and then reinjecting them into the site of injury, PRP therapy can help the body restore any damaged soft tissues lost throughout the lifetime of an injury.
Autologous Stem Cell Procedure
As the name implies, stem cell therapy is the application of stem cells to an injury to help the body recover. The stem cells used at CELLAXYS are derived from the adipose (fat) and bone marrow tissues within a patient’s body. By extracting these tissues and processing them, we can create pseudo-stem-cells known as mesenchymal stem cells through a process first applied in the 1970s.
Once inside the body, these stem cells surround an injury and use resources from surrounding areas to repair damaged tissue.
While conventional treatment options such as physical therapy are an absolute necessity when restoring function to an injured PIP joint, they do not treat the cause of pain – soft tissue damage. By adding PRP or stem cell therapy to conventional treatments, a patient can meet and even exceed their functional goals.
Additionally, these treatments are simple outpatient procedures with minimal downtimes. Our patients that have been treated for PIP injuries have reported full functionality within weeks and have been able to enjoy these effects for upwards of six months.