finger injuries

Question 1

What Issue / Tx
(1) Rupture of the flexor digitorum profundus tendon from its distal attachment
(2) Common in contact sports
(3) Often overlooked as “jammed” finger
(4) Flexed DIP joint is suddenly and forcefully hyperextended
–(a) Leads to rupture of flexor digitorum profundus
(5) Ring finger involved in 75% of cases
(6) Acute pain and swelling of the DIP/distal phalynx
(7) Inability to actively flex the DIP join

Answer 1

Jersey Finger
Splint the finger with PIP and DIP joint slightly flexed
–Prevents extension of the DIP joint
– Avoid extension of the DIP until eval by ortho hand
All cases require referral to ortho hand
-(a) Failure to recognize and properly treat can lead to chronic inability to flex the injured DIP
-(b) Even with surgical repair there will likely be some deficits in flexion of DIP

Question 2

What issue / Tx
(1) Injury to the Extensor Tendon
(2) Rupture, laceration or avulsion of the insertion of the extensor tendon and base of distal
phalanx
(3) Direct blow to the finger causing sudden forced flexion of the DIP/distal phalanx
(4) Pain at the DIP joint
(a) Possible swelling, ecchymosis, deformity
(5) Commonly a flexed DIP at rest
(6) Inability to extend the DIP joint fully

Answer 2

Mallet Finger
Treatment: Maximize function, minimize discomfort
(a) Splint the finger in full extension
(b) If fractured do not attempt to reduce fracture
(c) Splint type does not affect outcome according to available clinical trials
(d) 6-8 weeks of splinting!
1) Sleep with the splint on as well

Question 3

What Issue / Tx
Extensor tendon rupture at insertion on middle phalanx
(a) Flexion of PIP/Extension of DIP
(b) History of trauma
(c) Painful PIP joint
(d) Deformity for up to 3 weeks

Answer 3

Boutonniere Deformity
Treatment
(a) Splint PIP joint in extension for 3-6 weeks
(b) Allow DIP to move freely
(c) Physical therapy for ROM
(d) Ortho consult for ongoing deformity