We report the first series of proximal interphalangeal joint sprains and reviewed 50 sprains in 48 patients. The majority of patients were males injured at work. The radial collateral ligament was injured about twice as often as the ulnar ligaments. The little finger was injured significantly less than the others. Proximal interphalangeal joint sprains can be diagnosed by the following: pain localized to the injured ligament, swelling greatest at the site of the injured ligament, tenderness greatest at the site of the injured ligament, pain at the site of the injured ligament during lateral stress, and/or mild lateral instability on radiographs or physical examination during stress testing. All patients required several different splints for treatment; in decreasing frequency, we used immobilizing, coupling, dynamic proximal interphalangeal flexion, dynamic proximal interphalangeal and distal interphalangeal flexion, and dynamic proximal interphalangeal extension splints. The mean active range of motion before treatment was 70 degrees and after treatment was 95 degrees. Significantly more patients had loss of full extension than had loss of full flexion. Forty-six percent of the patients had no pain after treatment, 46 percent had mild pain, 8 percent had moderate pain, and none had severe pain. Patients treated within 4 weeks of their injury (group 1) gained significantly greater range of motion (35 degrees) than those treated between 5 and 14 weeks after their injury (10 degrees) (group 2).(ABSTRACT TRUNCATED AT 250 WORDS)