Get Permissions, Access the latest issue of American Family Physician. Am Fam Physician. Peel SM. Mallet finger usually is caused by an object (e.g., a ball) striking the finger, creating a forceful flexion of an extended DIP. Palmer RE. / Hyperextension of a finger joint, such as a dorsal dislocation, can injure the volar plate (Figure 8). The hand needs to be mobile in order to position the fingers and thumb. It allows the finger to flex and extend, to swing toward or away from its neighbouring finger, and to swing forward with a slight amount of rotation. Primary care of hand and wrist athletic injuries. Don't miss a single issue. Increasing the extension of a dorsal aluminum splint weekly will progressively increase range of motion.22 In less severe injuries, the injured joint should be buddy taped. Treatment should restrict the motion of injured structures while allowing uninjured joints to remain mobile. Wang PT, By signing up for this email, you are agreeing to news, offers, and information from Encyclopaedia Britannica. Macdonald MR, 2006 Mar 1;73(5):810-816. Closed tendon injuries of the hand and wrist in the athlete. Hankin FM, A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Mallet deformity in sport. Rockwood and Green’s Fractures in adults. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. If full passive extension is not possible, the physician should refer the patient to an orthopedic or hand surgeon. Lee SJ, Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. 73/No. Simpson D, Leggit JC, Want to use this article elsewhere? For information about the SORT evidence rating system, see page 755 or, PIP = proximal interphalangeal; MCP = metacarpophalangeal; DIP = distal interphalangeal; FDP = flexor digitorum profundus. Patients with collateral ligament injuries may continue participating in athletic events as symptoms allow. DeLee and Drez’s orthopaedic sports medicine: principles and practice. 2001;26:32–3. Injury to the joint extensor tendon at the distal interphalangeal joint (mallet finger). In: Roberts JR, Hedges JR, eds. Brady WJ, Splinting and taping are effective treatments for tendon and ligament injuries. In: Roberts JR, Hedges JR, eds. Splinting duration is the same as with mallet finger. Acute hand or wrist trauma. 5th ed. Fractures and dislocations of the hand. Test stability of joint while the finger is in 30 degrees of flexion and the MCP joint is flexed. Macdonald MR, In: Marx JA, Hockberger RS, Walls RM, Adams J, eds. Philadelphia, Pa.: Saunders, 2004. Part II, “Fractures, Dislocations, and Thumb Injuries” appears in this issue of AFP. The neurovascular evaluation should include two-point discrimination and capillary refill assessments. The anatomy of the finger is complex, but a basic knowledge is necessary to properly treat acute injuries. Fingertip injuries. Table 1 summarizes the evaluation and treatment of common ligament and tendon injuries. Figure 5 illustrates these techniques. Duncan MJ. St. Louis, Mo. The rightsholder did not grant rights to reproduce this item in electronic media. Avoiding diagnosis and treatment pitfalls. The PIP joint should be evaluated by holding the joint in a position of 15 to 30 degrees of flexion. It allows the finger to flex and extend, to swing toward or away from its neighbouring finger, and to swing forward with a slight amount of rotation. Although family physicians are usually the first to evaluate patients with finger injuries, it is important to recognize when a referral is needed to ensure optimal outcomes. McClellan RM, Patients should be counseled that it is not unusual for an injured digit to remain swollen for some time and that permanent deformity is possible, even after treatment. The PIP joint should be splinted in full extension for six weeks if there is no avulsion or if the avulsion involves less than one third of the joint. Johnson BA. 2nd ed. In: Marx JA, Hockberger RS, Walls RM, Adams J, eds. The collateral ligaments should be tested as with collateral ligament injuries. Address correspondence to Jeffrey C. Leggit, LTC, MC, USA, 107 Sawmill Rd., St. Robert, MO 65584 (e-mail:firstname.lastname@example.org). 2001;19:76–80. Lee SJ, Sportrelated fractures and dislocations in the hand. Philadelphia, Pa.: Lippincott-Raven, 1996. Occasionally, boutonnière deformities occur acutely. Evaluating flexor digitorum tendon injury. For the missing item, see the original print version of this publication. J Trauma. Dots are often called spot brush, but with a round rod, it can easily draw not only points, but also the geometric abstraction, floral patterns, lace ornaments and other compositions. 1999;42:403–7. A boutonnière deformity usually develops over several weeks as the intact lateral bands of the extensor tendon slip inferiorly. Extensor and flexor tendon injuries in the hand, wrist, and foot. Acute Finger Injuries: Part I. Tendons and Ligaments. Contact 1992;11:77–99. The joints sit in volar plates (collateral ligaments attached to dense fibrous connective tissue), which provide joint stability.2,3. Meko CJ. Office sports medicine. Acute hand or wrist trauma. Akelman E. ), The prognosis for patients with jersey finger worsens if treatment is delayed and if severe tendon retraction is present.20 Patients with confirmed or suspected jersey finger should be referred to an orthopedic or hand surgeon for treatment.18, Central slip extensor tendon injury occurs when the PIP joint is forcibly flexed while actively extended; it is a common injury in basketball players. If the ring finger is involved, it should be secured to the fifth digit, because the fifth digit is naturally extended and easily injured if exposed. DeLone FX Jr, 1995;11:373–86. This manicure tool is ideal for finger parts anatomy and for use at home. Handoll HH, Office sports medicine. The nail grows from a deep groove in the dermis of the…. Freiberg A, Simpson D, Adequate strength forms the basis for normal hand function. 8. Athletic injuries of the adult hand. Bach AW. If the joints are stable and no large fracture fragments are present, the injury can be treated with buddy taping (i.e., taping the injured finger, above and below the joint, to an adjacent finger) (Figure 7). This is part I of a two-part article on finger injuries. 1998;17:513–31. Graham TJ, Mullen DJ. The index, middle, ring, and fifth digits have proximal, middle, and distal phalanges and three hinged joints: distal interphalangeal (DIP), proximal interphalangeal (PIP), and metacarpophalangeal (MCP).