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
Sudden forced flexion of an extended DIP joint during work or sports (eg, catching a ball) is the most common mechanism of injury.12,15 This action causes stretching or tearing of the extensor tendon as well as a possible avulsion fracture of the distal phalanx.13 Mallet finger can also result from a laceration or crush injury of the extensor tendon (open mallet finger) or hyperextension of the DIP joint, causing a fracture at the dorsal base of the distal phalanx.12
Presentation. Through any of the aforementioned mechanisms, the delicate balance between the flexor and extensor tendons is disrupted, causing the patient to present with a flexed DIP joint that can be passively, but not actively, extended.6,12 The DIP joint might also be painful and swollen. Patients whose injury occurred > 4 weeks prior to presentation (chronic mallet finger) might also have a so-called swan-neck deformity, with hyperextension of the PIP joint in the affected finger.12
Imaging. AP, oblique, and lateral radiographs are recommended to assess for bony injury.
Treatment. Splinting is the first-line treatment for almost all mallet finger injuries that are not the result of a laceration or crush injury. Immobilize the DIP joint in extension for 6 to 8 weeks, with an additional 2 to 4 weeks of splinting at night.6,12 The splint must be worn continuously in the initial 6 to 8 weeks, and the DIP joint should remain in extension—even when the patient is performing daily hygiene.12 It is imperative that patients comply with that period of continuous immobilization; if the DIP joint is allowed to flex, the course of treatment must be restarted.13
Many different types of splints exist; functional outcomes are equivalent across all of them.24,25 In our practice, we manage mallet finger with a volar-based splint (FIGURE 2), which is associated with fewer dermatologic complications and has provided the most success for our patients.23
Continue to: Surgical repair of mallet finger injury...
