Finger Injury

Extensor Tendon Injury at DIP (Mallet Finger)

Pt presents with acute onset pain at distal interphalangeal (DIP) joint after being struck by a basketball with finger in full extension. Injury occurred within the previous 3 months. Dorsal DIP tenderness with no active DIP extension when isolated during exam.

• Imaging

  • Initial 3-view radiography (anteroposterior, true lateral, and oblique views) shows bone fragment on dorsal surface of proximal distal phalanx

  • 3-view radiography s/p splinting shows confirms alignment of fracture fragment

• Intervention

  • Continuously splint in extension DIP x 8 weeks

  • Unable to perform full passive extension and/or avulsion fracture involving > 30% of the joint: Refer to orthopedics

• Counseling

  • Pt counseled that failure to adhere to splinting recommendations and not to flex joint during treatment as it could result in permanent injury

  • Pt reassured that athletic activities that do not place joint at risk of re-injury may continue during splinting

  • Pt instructed to contact provider if distal phalanx blanching is noted during splint as reduced blood supply can result in distal finger necrosis

Notes

• Most common tendon injury of the hand

• Can be treated for up to 3 months s/p injury

• Passive extension is performed by examiner

• Patient adherence to splinting determines treatment success

• See link for more information and images

Flexor Digitorum Profundus Tendon Injury (Jersey Finger)

Pt presents with acute onset pain at the distal interphalangeal (DIP) joint after grabbing an opponent’s jersey during a game. Per description, mechanism of injury resulted in forceful hyperextension of DIP. Volar DIP joint tenderness and inability to actively flex DIP when isolated.

• 3-view radiography shows bone fragment at volar surface of proximal distal phalanx

• Finger splinted and patient urgently referred to hand surgeon due to risk for tendon retraction

• Pt advised that surgery may be required within 7-10 days to prevent permanent injury

Mnemonic device: The term ‘Jersey Finger’ also describes Garden State residents’ inability to perform active finger flexion while driving

Ulnar Collateral Ligament Injury (e.g. Skier’s Thumb)

Pt with presents with acute onset thumb pain that occured when s/p falling while holding a ski pole. Per description, mechanism of injury resulted in forced abduction and hyperextension of metacarpophalangeal joint. Exam reveals swelling and tenderness along ulnar aspect of thumb, inability to form a pinch grip with thumb and index finger.

• Obtain 3-view radiography of thumb

• Intervention

  • Stable joint: Immobilize with thumb-spica splint x 4 weeks; refer to orthopedics for instability persisting s/p splinting

  • Refer to orthopedics in cases of

    • Pediatric patient

    • Instability with MCP flexion when finger held at 30 degrees of flexion

• Pt advised to avoid heavy gripping or grasping until hand strength returns to baseline

Note: Ulnar collateral ligament injuries are knows as skier’s or gamekeeper’s thumb as they are commonly occur with repeat force applied by ski poles or breaking the necks of small animals (e.g. pheasants, rabbits)