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
Stress radiographs (ie, radiographs of the thumb with valgus stress applied at the MCP joint) can aid in diagnosis but are controversial. Some experts think that these stress views can further damage the UCL; others recommend against them because they carry a false-negative rate ≥ 25%.15,16 If you choose to perform stress views, order standard radiographs beforehand to rule out bony injury.17
Treatment. UCL tears are classified as 3 tiers to guide treatment.
- Grade 1 injury (a partial tear) is characterized by pain upon palpation but no instability on the stress exam.
- Grade 2 injury (also a partial tear) is marked by laxity on the stress exam with a firm endpoint.
- Grade 3 injury (complete tear) shows laxity and a soft endpoint on a stress exam16,17; Stener lesions are seen only in grade 3 tears.16,17
Grades 1 and 2 UCL tears without fracture or with a nondisplaced avulsion fracture can be managed nonoperatively by immobilizing the thumb in a spica splint or cast for 4 to 6 weeks.16,18 The MCP joint is immobilized and the interphalangeal joint is allowed to move freely.2,16,17
Grade 3 injuries should be referred to a hand specialist for surgical repair.16 Patients presenting > 12 weeks after acute injury or with a chronic UCL tear should also be referred for surgical repair.16
CORRESPONDENCE
Caitlin A. Nicholson, MD, 1611 West Harrison Street, Suite 300, Chicago, IL 60612; Caitlin.nicholson@gmail.com
