Tips for managing 4 common soft-tissue finger and thumb injuries
After examination and, in some cases, imaging, most of these injuries can be managed conservatively with splinting or injection. Some cases require prompt surgical referral.
PRACTICE RECOMMENDATIONS
› Treat trigger finger with a corticosteroid injection into the flexor tendon sheath. A
› Refer a case of jersey finger to a hand surgeon within 1 week after injury for flexor tendon repair. C
› Treat mallet finger with strict distal interphalangeal joint immobilization for 6 to 8 weeks. A
› Treat Grades 1 and 2 skier’s thumb with immobilization in a thumb spica splint or a cast for 4 to 6 weeks. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Splinting is an effective treatment for patients who cannot undergo corticosteroid injection or surgery. The MCP or PIP joint is immobilized in extension while movement of the distal interphalangeal (DIP) joint is maintained. Instruct the patient that the splint must be worn day and night; splinting is continued for ≥ 6 weeks.21 Splinting relieves symptoms in 47% to 70% of cases and is most effective in patients whose symptoms have been present for < 6 months.3,7
Patients whose trigger finger is locked in flexion and those who have not experienced improvement after 2 or 3 corticosteroid injections should be referred for surgery.4 The surgical cure rate is nearly 100%; only 6% of patients experience repeat triggering 6 to 12 months postoperatively.4,7,22
Jersey finger
Causes and incidence. Jersey finger is caused by avulsion injury to the flexor digitorum profundus (FDP) tendon at its insertion on the distal phalanx.8,9 It occurs when a flexed finger is forced into extension, such as when a football or rugby player grabs another player’s jersey during a tackle.9,10 This action causes the FDP tendon to detach from the distal phalanx, sometimes with a bony fragment.9,11 Once detached, the tendon might retract proximally within the finger or to the palm, with consequent loss of its blood supply.9
Although jersey finger is not as common as the other conditions discussed in this article,9 it is important not to miss this diagnosis because of the risk of chronic disability when it is not treated promptly. Seventy-five percent of cases occur in the ring finger, which is more susceptible to injury because it extends past the other digits in a power grip.8,9
Presentation and exam. On exam, the affected finger lies in slight extension compared to the other digits; the patient is unable to actively flex the DIP joint.8,9 There may be tenderness to palpation over the volar distal phalanx. The retracted FDP tendon might be palpable more proximally in the digit.
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