Snapping Knuckle Fix

Chapters

• 0:02 Host Intro And Credentials
• 0:18 What Causes Knuckle Snapping
• 0:42 Extensor Tendons And Sagittal Band
• 1:59 How Clinicians Test And Confirm
• 3:17 Bracing Timeline And Weaning
• 4:19 Avoiding Stiffness And Custom Splints
• 5:32 Patient Education And Next Steps
• 6:00 Calls To Action And Resources

Transcript

SPEAKER_00: 0:02

Welcome back to the Hand to Shoulder Solution, Giving Pain the Middle Finger. I'm your host, Carl Petito. I'm an occupational therapist and a board certified hand therapist specializing in rehabilitation of orthopedic conditions that affect the fingertips through the shoulder. Now, let's talk about another common condition, and that's snapping on the back of one of the knuckles. It's usually the middle finger knuckle or the ring finger knuckle, big knuckles of the hand. What happens is a tendon that connects a big muscle up here to the end of the fingers is rolling off the back of the knuckle. So let's explain something. The muscles up here, there's one muscle is called EDC, Extensor Digitorum Communus. And when that contracts, it does this. It opens your fingers, and you can see the tendons pop up in the back of your hand. If you lift up really hard, or if you if you bend your fingers like this and then resist, you can see them pop up. They travel over the back of the knuckle. And on the back of the knuckle, there's a little groove, and something has to keep the tendon inside of that groove so it doesn't roll out. And what that is, is a very thin, it's a paper thin ligament called the sagittal band. The sagittal band keeps that tendon in place with arthritis, with other problems, with um training on the heavy bag, with you know, you know, striking the fist on things. Sometimes that sagittal band will rupture. And when that rupture is, when people close, that tendon will roll a snap, it'll go pop and lie right in between these bones right here, and it'll go right into that deep groove. And then straightening the fingers will cause the tendon to now roll back into place. That's often confused with trigger finger, which happens on the palmer surface of the hand where a nodule on the tendon is clicking or catching on a strap of ligamentous material that holds the tendon against the bone. And some people will feel that and say, Oh, yeah, that's definitely, you know, it's triggering. I feel a catching in the finger, it's popping. But actually, we always have to check the back of the fist and look at those tendons to see if those are rolling off of the back of the knuckle or not. And when you look at these blue cords right here, you can see them, and they travel all the way through the back of the wrist and attach to these muscles on the forearm. So, what do we do about that? When a patient comes into me and they're they're showing me that that tendon is rolling off the back of the knuckle, what I'll do is put my pen underneath their finger and say, okay, now close, and now it's not doing it. Because I'm stopping some motion and allowing the tendon to stay on slack so it's not rolling off. Why is that important? Well, it's important because when it's rolling off, it's very, very uncomfortable, it can be very, very painful. But this is the position to fabricate a custom brace to allow that to heal. That will heal in six weeks, six to eight weeks, and then at that time I start to coach the patient into uh toward weaning away from that, wearing a little bit less, stopping wearing it for light activities, wearing it for heavy activities. Initially, patients will wear it all day and all night, but I'll fabricate a splint that's sort of like a ring, it'll wrap around a couple of the neighboring fingers, then there'd be a bridge right here, and they're able to use their hand functionally all day long with that splint in place that is allowing that healing. Now, even if a patient went and had the surgery and this paper thin ligament was repaired, they would still have to be in that brace uh for six to eight weeks and allow that to heal. More often than not, almost all of the time, the brace does the trick and the patient does not need surgery. So it's very important, as with all things, to catch this early. If you're noticing that this cord or this tendon which connects to your extensor muscle here, when you bend and that's rolling off, you have to get into your doctor right away. And I would ask to be seen by uh a hand surgeon, a fellowship trained hand surgeon uh and also a certified hand therapist. How often do I see the patient as a hand therapist? I'll see the patient probably once every two or three weeks, and then after the second or third visit, you start weaning down from the orthosis and getting away from the splint. Now, why not a cast? We don't want to immobilize too much because if you mobile immobilize more than you have to, then a lot of stiffness starts to set in, and then you have a new problem, and you have multiple joints now with a lot of a lot of stiffness. The material that I use is called thermoplastic. I heat it up in hot water, I custom mold it to the patient and make sure it's it slides off smoothly and it can be taken off so the patient can can bathe and wash and then put the splint back on. But folks have to be very, very careful not to bend because the second that tendon rolls off again, now we're starting from square one. So, you know, everything that we do in orthopedics is very detail-oriented, and we and success is in the details, and we spend a lot of time educating patients so they know exactly what they can do and what they shouldn't do in order for optimal healing. Thank you very much for watching. And if you got anything out of this, uh please like it and subscribe to the channel. Also, check out my website, carlpetito.com. And any questions, uh write in your questions. I'd like to engage with the public. And also coming in 2026, you'll be able to make an appointment with me to talk about any condition that's been bothering you and to ensure that you're finding the right location for the appropriate healthcare practitioner for your needs. A lot of good things coming up. My team and I are very excited. Thank you for watching. And you know, if you know anybody who's having any problems, arthritis, tendinitis, pain in the wrist, pain in the shoulder, carpal tunnel syndrome, elbow pain, numbness and tingling, you name it, uh, send a link to this channel to them. And if if they have questions, they can write in. I just my goal is to extend my reach. I all day long in the clinic, I'm re I'm repeating a lot of the same things over and over again. And a lot of things are a very simple fix. And just remember anytime you can get in sooner rather than later, that's always better. Thank you again.