Mallet finger: Difference between revisions
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==Background== | ==Background== | ||
[[File:PMC4807168 aps-43-134-g001.png|thumb|Possible mechanisms of injury from axial force applied to the tip of a straight digit (black arrows) causing: (top) DIP joint hyperextension (white upper arrow) and fracture, or (bottom) DIP hyperflexion (lower white arrow) and tendon lesion.]] | |||
[[File:PMC4807168 aps-43-134-g004.png|thumb|Mallet finger injury types (Tubiana classification system).]] | |||
*Caused by forced flexion of | *May be accompanied by avulsion fracture | ||
*Caused by forced flexion of extended DIP joint | |||
*If untreated, leads to [[swan neck deformity]] | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:Mallet finger.jpg|thumb|Finger in maximum extension]] | [[File:Mallet finger.jpg|thumb|Finger in maximum extension]] | ||
* | *Rupture of extensor tendon in area of distal phalanx distal to DIP joint | ||
* | *DIP joint flexed to 40°, unable to fully extend | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
[[File:Mallet finger.png|thumb|Mallet finger without fracture]] | [[File:Mallet finger.png|thumb|Mallet finger without fracture]] | ||
[[File:MalletFinger.png|thumb|Mallet finger with fracture at the insertion of the extensor tendon]] | [[File:MalletFinger.png|thumb|Mallet finger with fracture at the insertion of the extensor tendon]] | ||
* | *Clinical diagnosis | ||
*Consider finger x-ray (PA and lateral) to evaluate for avulsion fracture | |||
==Management== | ==Management== | ||
*Splint DIP joint in continuous slight hyperextension x | *Splint DIP joint in continuous slight hyperextension x 6 wk | ||
*Splinting of the PIP joint is not necessary<ref>Katzman B et al. Immobilization of the mallet finger: effects of the extensor tendon. J Hand Surg Br. 1992; 24(1):80-84</ref> | *Splinting of the PIP joint is not necessary and should be avoided<ref>Katzman B et al. Immobilization of the mallet finger: effects of the extensor tendon. J Hand Surg Br. 1992; 24(1):80-84</ref> | ||
**Inadvertently splinting PIP for 6 weeks results in collateral ligamentous overgrowth and functional disability<ref>Prosser R. Splinting in the management of proximal interphalangeal joint flexion contracture. J Hand Ther. 1996 Oct-Dec;9(4):378-86.</ref> | |||
*Give an extra splint | *Give an extra splint | ||
* | |||
[[File:Splint1.jpg|thumb|Special Mallet finger splint (if available)]] | |||
==Disposition== | |||
*Discharge with hand surgery follow-up in 7-10 days | |||
==See Also== | ==See Also== | ||
*[[ | *[[Hand and finger diagnoses]] | ||
==References== | ==References== | ||
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[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:Sports Medicine]] | |||
Latest revision as of 18:05, 15 March 2023
Background
- May be accompanied by avulsion fracture
- Caused by forced flexion of extended DIP joint
- If untreated, leads to swan neck deformity
Clinical Features
- Rupture of extensor tendon in area of distal phalanx distal to DIP joint
- DIP joint flexed to 40°, unable to fully extend
Differential Diagnosis
Hand and finger injuries
- Distal finger
- Other finger/thumb
- Boutonniere deformity
- Mallet finger
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
- Hand
- Wrist
- Drummer's wrist
- Ganglion cyst
- Lunotriquetral ligament instability
- Scaphoid fracture
- Extensor digitorum tenosynovitis
- Compressive neuropathy ("bracelet syndrome")
- Intersection syndrome
- Snapping Extensor Carpi Ulnaris
- Vaughn Jackson syndrome
- General
Evaluation
- Clinical diagnosis
- Consider finger x-ray (PA and lateral) to evaluate for avulsion fracture
Management
- Splint DIP joint in continuous slight hyperextension x 6 wk
- Splinting of the PIP joint is not necessary and should be avoided[1]
- Inadvertently splinting PIP for 6 weeks results in collateral ligamentous overgrowth and functional disability[2]
- Give an extra splint
Disposition
- Discharge with hand surgery follow-up in 7-10 days