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
Imaging. Anteroposterior (AP), oblique, and lateral radiographs, although unnecessary for diagnosis, are recommended to assess for an avulsion fragment, associated fracture, or dislocation.9,11 Ultrasonography or magnetic resonance imaging is useful in chronic cases to quantify the degree of tendon retraction.9
Treatment. Refer acute cases of jersey finger for surgical management urgently because most cases require flexor tendon repair within 1 or 2 weeks for a successful outcome.9 Chronic jersey finger, in which injury occurred > 6 weeks before presentation, also requires surgical repair, although not as urgently.9
Complications of jersey finger include flexion contracture at the DIP joint and the so-called quadriga effect, in which the patient is unable to fully flex the fingers adjacent to the injured digit.8 These complications can cause chronic disability in the affected hand, making early diagnosis and referral key to successful treatment.9
Mallet finger
Also called drop finger, mallet finger is a result of loss of active extension at the DIP joint.12,13
Causes and incidence. Mallet finger is a relatively common injury that typically affects the long, ring, or small finger of the dominant hand in young to middle-aged men and older women.12,14,23 The condition is the result of forced flexion or hyperextension injury, which disrupts the extensor tendon.6,14
Continue to: Sudden forced flexion...
