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
Surgical repair of mallet finger injury is indicated in any of these situations12,14:
- injury is caused by laceration
- there is volar subluxation of the DIP joint
- more than one-third of the articular surface is involved in an avulsion fracture.
Patients who cannot comply with wearing a splint 24 hours per day or whose occupation precludes wearing a splint at all (eg, surgeons, dentists, musicians) are also surgical candidates.12
Surgical and conservative treatments have similar clinical and functional outcomes, including loss of approximately 5° to 7° of active extension and an increased risk of DIP joint osteoarthritis.12,14,24 Patients with chronic mallet finger can be managed with 6 weeks of splinting initially but will likely require surgery.6,12,13
Skier’s thumb
This relatively common injury is a tear of the ulnar collateral ligament (UCL) at the MCP joint of the thumb.16
Causes and incidence. Skier’s thumb occurs when a valgus force hyperabducts the thumb,16 and is so named because the injury is often seen in recreational skiers who fall while holding a ski pole.15-17 It can also occur in racquet sports when a ball or racquet strikes the ulnar side of thumb.16
Continue to: In chronic cases...
