Traumatic Finger Injuries: What the Orthopedic Surgeon Wants to Know. In: James Chang, Peter C. Neligan. The bony mallet finger refers to the avulsion fracture at the phalangette basilar part caused by traction of the extensor tendon when the original trauma occurs, leading to a limited extension of the distal phalanx. 3. The mallet deformity is produced by avulsion of the extensor tendon from its insertion (not visible on radiography) or by an avulsion fracture at the base of the distal phalanx. These complications are prevalent in both operative and non operatively managed cases, untreated mallet finger or incomplete healing may progress to a. The Radiology of Emergency Medicine 3rd Ed. The opposite of a mallet finger is a jersey finger. In sports, they are caused by high-velocity balls that strike the dorsal surface of the DIP joint while it is flexed. Megerle K, Prommersberger KJ. If there is a bony avulsion, a plain film will classically show a triangular avulsion fragment at the insertion of the common extensor tendon on the dorsal aspect of the distal phalanx at the DIP joint. These injuries result when traumatic forced flexion of the extended fingertip causes disruption of the distal extensor mechanism. List of conditions and treatments pages within the University of Michigan Comprehensive Musculoskeletal Center section of UofMHealth.org Observe skin color, warmth, and capillary refill to assess blood flow, Evaluate sensation to light touch and two-point discrimination to assess integrity of the digital nerves, Inability to extend the distal phalanx actively, Most tenderness to palpation over the dorsal distal phalanx and DIP joint, Possible compensatory swan neck deformity, Possible subungual hematoma (blood under the nail plate). Classically, they occur during athletic activities, when an extended finger is struck at the tip by a basketball, volleyball, baseball, or softball. FIGURE 47.1 Lateral radiograph of the left hand of the patient in the introductory case, demonstrating soft tissue swelling over the left, second distal interphalangeal joint with a flexion deformity at that joint consistent with a mallet finger. They may represent an isolated tendinous injury or occur in combination with an avulsion fracture of the dorsal base of the distal phalanx. A pure tendon injury shows no evidence of fracture, only the mallet deformity (Fig. This page includes the following topics and synonyms: Extensor Tendon Injury at the DIP Joint, DIP Extensor Tendon Avulsion, Mallet Finger, Mallet Fracture, Drop Finger, Baseball Finger. Kleinbaum Y, Heyman Z, Ganel A et-al. This 62 year old male presented to the Emergency Department after a fall. He is now unable to extend his finger and reports moderate pain, swelling, and soreness. This injury pattern is known as a Mallet finger. (2010) ISBN:1441959726. Trigger finger; We take a multidisciplinary approach to treatment, getting input from all of the medical areas that are involved with your care. The tendinous form is an extensor tendon rupture, and the bony form is a bony avulsion fracture of the distal phalanx. A mallet finger results from injury to the extensor mechanism. Win an All-Access Pass! Springer Verlag. A common example is a distal avulsion of the ED from the distal phalanx (“mallet finger”), with or without an avulsion fracture. B. 2005;26 (03): 223-6. They are the most prevalent finger tendon injury in sport. Sometimes, the tendon itself tears rather than avulsing the bone fragment, in which case … This happens when the end of the tendon that lifts your fingertip becomes separated from the fingertip. There are a few different ways this can happen. (2010) ISBN:0781793777. It is characterized by an inability to extend the finger at the distal interphalangeal (DIP) joint. The loss of continuity of the extensor tendon over the distal interphalangeal joint may cause the deformity called mallet finger. baseball, basketball), or a crush injury (slamming a door towards the distal interphalangeal joint) in the extensor direction. 47.1), and oblique views. This can include dorsal ulceration, nail deformities and maceration of the skin. Jersey Finger: Fragment arising from the volar base of the distal phalanx with hyperextension: Avulsion of the Flexor Digitorum Profundus: Mallet Finger: Fragment arising from the dorsal base of the distal phalanx with fixed flexion: Avulsion of the extensor tendon. He denies any coldness or discoloration. Patients may continue activities and notice the loss of extension after a day or more. MRI is used with increasing frequency by hand surgeons and other clinicians to help in the evaluation of patients presenting with suspected ligament and tendon injuries of the fingers. Modern 3-T MRI scanners with dedicated 16-channel surface hand-and-wrist coils … Non operative treatment would usually involve 6 weeks of full time splinting followed by 6 weeks of night splinting 8. It is characterized by an inability to extend the distal phalanx at the distal interphalangeal (DIP) joint. 2016;36 (4): 1106-28. Mallet finger injury X-ray. This results in the inability to extend the finger tip without pushing it. A Mallet finger involves an avulsion of the extensor tendon on the distal phalanx (fig. 5. —Mallet finger results from disruption of the extensor tendon at its insertion site at the dorsal aspect of the distal phalanx base, and mallet finger is the most common finger tendon injury in sports . Sreenivasa R. Alla, Nicole D. Deal, Ian J. Dempsey. Clinical Appearance. Mallet finger, also known as baseball finger, is an injury to the tendon at the end of the finger or thumb. Any rapid motion that jams the tip of a finger against an object can cause a mallet finger. This loss of extensor continuity results in incomplete extension of the DIP joint or extensor lag. However, mallet finger injuries can also result from seemingly trivial trauma of everyday activities, such as pushing off a sock or tucking in a bed sheet. Find out more. Brukner P, Khan K. Clinical Sports Medicine Third Revised Edition. A mallet finger, also known as hammer finger or PLF finger, is an extensor tendon injury at the farthest away finger joint. 25). ... ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Do I need to do anything about this? Springer. 1993, p458 : Case 2. The joint rests in an abnormally flexed position. COVID-19: Updated Visitors Policy. Bridgeforth G, Cherf J. Lippincott's Primary Care Musculoskeletal Radiology. A mallet finger is an injury to the extensor mechanism of the finger. This occurs with forced flexion at the DIP joint during active contraction of the ED. With mallet finger, the tendon on the back of the finger (not the palm side) is separated from the muscles it connects. Post-operative complications, e.g. infection or need for further surgery, are common. Mallet finger. B. It is uncommon for closed mallet finger injuries to require surgical intervention 5. Marinček B, Dondelinger RF. ... Radiology 1996; 198:219-224. This can damage the tendon and bone, causing the finger to droop. Chapter 10 - Extensor tendon injuries. 1. Emergency radiology, imaging and intervention. There is a corresponding defect in the phalangeal base. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Lippincott Primary Care Musculoskeletal Radiology. Mallet finger refers to injuries of the extensor mechanism of the finger at the level of the distal interphalangeal joint (DIP). Finger injuries are one of the most common trau-matic injuries in both sports and work activities (1,2). The injury may occur when a person is trying to catch a ball. Injury to these structures commonly results from direct axial or flexion loading of the DIP joint, as can occur by direct blow from a ball. The examiner should check this film for a flexion deformity at the DIP joint, with the distal phalanx flexed like a mallet. 227-246. Hand⎪Mallet Finger Hand - Mallet Finger; Listen Now 12:14 min. Lippincott Williams & Wilkins. The dorsum of the joint may be slightly tender and swollen, although there may be little pain. The injury classically occurs while playing sports where the DIP undergoes sudden flexion (extended finger is struck at the tip by an object, e.g. This may represent an epiphyseal injury in skeletally-immature children 7. The DIP joint is extended by combined pulling force of the terminal (lateral bands) of the extensor tendon, functioning together with the oblique retinacular ligament 7. 6. It is characterized by an inability to extend the distal phalanx at the distal interphalangeal (DIP) joint. (2014) HAND. Mallet finger is a common athletic injury that affects basketball and baseball players' routinely jammed fingers, but the injury can occur because of a crushing accident on the job, or even because of a cut finger while working in the kitchen. A patient with a jersey finger is not able to flex his or her finger at the DIP joint. (2007) ISBN:354026227X. The fracture fragment is indicated by the arrow in this example. There is a 4mm triangular avulsion fragment at the insertion of the common extensor tendon with 3mm dorsal displacement. Fingertip injuries are among the most common traumatic problems encountered by hand surgeons. Masks are required throughout all facilities. Other mechanisms of injury include crush injuries (e.g., slamming finger in a door) or falling objects. 8. If you can’t extend the tip of your finger, you may have what is called a mallet finger. There is an avulsed bone flake from the dorsal side of the distal phalanx base of the ring finger. Become a new yearly Curie (Radium) or Roentgen (Gold) Radiopaedia Supporter during December and be in the running to win one of four 12-month All-Access Passes. Mallet finger injury X-ray. The joint rests in an abnormally flexed position. Laceration of the extensor digitorum communis tendon just proximal to its insertion at the proximal phalangeal base. The mechanism that straightens the DIP joint is disrupted. Sonographic imaging of mallet finger. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 9 (2): 138-44. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. On the lateral radiograph, the flexion deformity caused by lack of integrity of the extensor mechanism is clearly evident. Surgery is considered for avulsion fracture where the fragment is larger than 1/3 of the joint surface and there is more than 2 mm of displacement or there is volar subluxation of the distal phalanx which is not reducible in a splint. Mallet finger refers to injuries of the extensor mechanism of the finger at the level of the distal interphalangeal joint (DIP). A mallet finger injury may be open, but the closed type is more frequent. 91 plays. The extensor tendon is damaged (possibly ruptured). During the examination, it is important to check neurovascular status carefully: A radiograph shows changes of osteoarthritis at the DIP joint with full extension. Mallet Finger- DP- lateral slip injury. An injury that results in a flexion deformity of the distal finger joint and may lead to an imbalance between flexion and extension forces more proximally in the digit. A 49-year-old man jams his left index finger playing softball. One such injury, which involves disruption of the extensor mechanism at the level of the distal interphalangeal (DIP) joint, is commonly referred to as a mallet, baseball, or drop finger. They are the most prevalent finger tendon injury in sport. ... ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Posteroanterior (PA) and lateral radiographs centered at the distal interphalangeal (DIP) joint of the affected finger are required. Open injuries are generally surgically explored to evaluate for additional tendinous injury. Magnetic resonance (MR) imaging has fine soft-tissue contrast resolution and multiplanar capability and is thus very useful in diagnosing these lesions. This is the most common closed tendon injury seen in sports (, … This injury is caused by hyperflexion of the distal interphalangeal joint, resulting in avulsion of the attachment of the extensor tendon from the base of the distal phalanx. Hover on/off image to show/hide findings. This injury usually results from a direct blow to the extended digit - for example, a blow to the finger tip with a cricket ball. A bony mallet has an associated fracture of the dorsal base of the distal phalanx involving the insertion of the extensor tendon. Mechanism Of Injury" belong to following category/categories, You may also find more related and detailed contents in these categories.. Orthopedic Disease anatomy There is slight flexion at this joint, which is where the term "mallet" comes from - the finger position resembles a mallet (for example, a piano key mallet). This results in rupture of the terminal extensor tendon or avulsion of a bone fragment at its insertion. 8/24/2020. 47.3). A mallet finger injury results from a lesion of the bony or ligamentous attachment of the extensor mechanism to the distal phalanx. Current Concepts: Mallet Finger:. 4. The dorsum of the joint may be slightly tender and swollen, although there may be little pain. Mallet finger. There is generally pain and bruising at the back side of the farthest away finger joint. {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":17538,"mcqUrl":"https://radiopaedia.org/articles/mallet-finger/questions/1284?lang=us"}. 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