My Jammed Pinky
During my soccer game last week, I played goalie. Although mechanically disadvantaged with short arms, the challenge seemed possible to overcome. I was wrong. I allowed 4 goals in the span of 7 minutes. And we lost by 4. Rookie mistake. Moral of the story: Don’t let the second shortest player on the team play goalkeeper with 0 experience. During that 7 minute time span, I jammed my pinky finger. It’s disappointing because I use my hands everyday at work to improve the health of my patients’ lives. However, I can fix a jammed finger easily because it’s the same process for hip, ankle, and knee pain caused from being jammed.
Jammed joints, medically termed “acute synovitis”, occur when the capsule that covers the joint becomes agitated. It’s like a huge thick saran wrap covering that supports, encases, and gives the joint lubrication. If a joint gets annoyed or hurt, swelling, pain, and limited range of motion can all be possible symptoms. My poor little pinky had pain and limited range of motion. Limited range of motion (and/or pain) shows in a capsular pattern, which is a specific pattern that each joint tends to show.
MTP in the fifth digit, my pinky finger, can show variable capsular patterns. For me, both flexing and extending caused pain. In the knee, flexion is more limited than extension. The ankle, has a capsular pattern of plantar flexion (pointing the ankle down) more than dorsiflexion (pointing the foot up). In the hip, there is a ratio of 3:2:1 limitation in flexion, abduction, and internal rotation. The mechanism of injury is different for most joints, but the symptoms and treatment are similar.
Mechanism of Injury
In the case with my poor fingy (as Tom Haverford calls it), it was hyperextended. I also see that most ankle sprains are not, in reality, a sprain. They tend to be a hyperinversion causing an acute synovitis of the ankle, and that’s why healing takes so long- the treatment for an ATFL (anterior talo-fibular ligament) sprain and acute synovitis differ. Treating the ATFL will most definitely not help the joint. In running, the two longest bones in the body can accidentally jam into each other and cause an acute synovitis in the knee. These are normal injuries that happen and can heal, yet we find an incorrect diagnosis and treatment can prolong the injury or make it worse. Pain can usually be dramatically reduced in joints that present with a capsular pattern of limitation. Unfortunately, many people with good insurance will go to get imaging and have longer or worse outcomes.
Imaging
If a patient over 50 gets an X-Ray of their knee, typical osteoarthritis shows up, whether they have pain or not. I call this “age appropriate” degeneration. Our bodies break down over time, but that doesn’t mean pain is a symptom of what is seen on the X-Ray. Since humans are visual animals, and many surgeons are very convincing, patients think that they are due for a knee replacement after hurting themselves while running. And a knee replacement they get, without any other thought.
I think this can be a huge mistake. In the past 4 months, I can recall at least 4 people that were planning on getting a joint replacement due to pain and imaging, but had the surgery cancelled because it would have been inappropriate. They all got better without it. Why? Because what showed on the image wasn’t the pain generator and range of motion limiter. Their acute synovitis was the culprit (for someone with osteoarthritis, acute synovitis is more likely an “activated arthrosis”).
Acute synovitis doesn’t show up in imaging. Instead, it presents itself by way of a thorough examination. And once it does, the treatment is easy. In many cases, acute synovitis is a 1-3 treatment problem. No Surgery. No Injections (which I’ll cover in an upcoming blog). It’s a super boring treatment for both the patient and the therapist, but I have found specific forms of traction dramatically reduced pain and increase range of motion over just one session. If the patient and I can discover and take out a few triggers and keep him/her active, the pain resolves and activity continues like it did before.
Conclusion
So next time you jam your finger allowing a goal every two minutes in soccer, pull on it like you would when your dad asked you to pull his finger and he would fart. Not super hard or painful, but gently and productively. Recheck your pain and range of motion. This is an easy form of self-traction that we sometimes prescribe in a home plan in certain cases with ankle, hip, and knee pain caused by acute synovitis.
Dr. Tyler Burton PT