8. Finger injuries are one of the most common trau-matic injuries in both sports and work activities (1,2). Magnetic resonance (MR) imaging has fine soft-tissue contrast resolution and multiplanar capability and is thus very useful in diagnosing these lesions. Non operative treatment would usually involve 6 weeks of full time splinting followed by 6 weeks of night splinting 8. It is uncommon for closed mallet finger injuries to require surgical intervention 5. Classically, they occur during athletic activities, when an extended finger is struck at the tip by a basketball, volleyball, baseball, or softball. Hover on/off image to show/hide findings. A 49-year-old man jams his left index finger playing softball. 8/24/2020. Other mechanisms of injury include crush injuries (e.g., slamming finger in a door) or falling objects. Marinček B, Dondelinger RF. Current Concepts: Mallet Finger:. Kleinbaum Y, Heyman Z, Ganel A et-al. 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. Mallet finger, also known as baseball finger, is an injury to the tendon at the end of the finger or thumb. A bony mallet has an associated fracture of the dorsal base of the distal phalanx involving the insertion of the extensor tendon. Chronic injury can result in swan-neck deformity (hyperextension PIP) This results in rupture of the terminal extensor tendon or avulsion of a bone fragment at its insertion. Frontal Intra-articular fracture through the base of the distal phalanx of the 5 th finger. This results in the inability to extend the finger tip without pushing it. With mallet finger, the tendon on the back of the finger (not the palm side) is separated from the muscles it connects. In: James Chang, Peter C. Neligan. In severe cases where there’s a large break, this will likely be the case. This post "Mallet Finger.A. 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. Mallet finger injury X-ray. Chapter 10 - Extensor tendon injuries. 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). 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. Clavero JA, Alomar X, Monill JM et-al. 227-246. 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. MR imaging of ligament and tendon injuries of the fingers. Megerle K, Prommersberger KJ. Causes include getting a finger (usually the fourth, or ring, finger) caught in an opponent’s jersey while making a tackle in football or rugby. The opposite of a mallet finger is a jersey finger. Foreign body. 25). B. There are a few different ways this can happen. The examiner should check this film for a flexion deformity at the DIP joint, with the distal phalanx flexed like a mallet. Mallet finger is an injury to the tip of the finger when something hard, like a baseball, jams it. In the workplace setting, mallet finger injuries are usually caused by crush injuries or from falling objects. Plastic Surgery: Volume 6: Hand and Upper Extremity (2017). COVID-19: Updated Visitors Policy. A tendinous or soft tissue mallet is an avulsion or tear of the distal extensor tendon at the DIP joint (Fig. Do I need to do anything about this? Mallet finger. This positioning causes approximation of the injured tendon ends, which usually heals by scarring over time and restores extension 7. C. Volar plate fracture D. Salter II fracture . Clinical Appearance. This can include dorsal ulceration, nail deformities and maceration of the skin. The terminal extensor tendon inserts on the DIP joint capsule, and so injurious force may also result in intra-articular avulsion fracture of the base of the distal phalanx. Sreenivasa R. Alla, Nicole D. Deal, Ian J. Dempsey. Mallet Finger- DP- lateral slip injury. 5. This injury pattern is known as a Mallet finger. Bridgeforth G, Cherf J. Lippincott's Primary Care Musculoskeletal Radiology. The preferred treatment for closed mallet injuries is non operative treatment, using a splint to maintain the DIP joint in extension or slight hyperextension - the proximal interphalangeal joint (PIP) is kept mobile. {"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"}. This is the most common closed tendon injury seen in sports (, … A mallet finger injury results from a lesion of the bony or ligamentous attachment of the extensor mechanism to the distal phalanx. 47.1), and oblique views. A common example is a distal avulsion of the ED from the distal phalanx (“mallet finger”), with or without an avulsion fracture. Hand⎪Mallet Finger Hand - Mallet Finger; Listen Now 12:14 min. It is characterized by an inability to extend the distal phalanx at the distal interphalangeal (DIP) joint. There is generally pain and bruising at the back side of the farthest away finger joint. A patient with a jersey finger is not able to flex his or her finger at the DIP joint. A mallet finger, also known as hammer finger or PLF finger, is an extensor tendon injury at the farthest away finger joint. The fracture fragment is indicated by the arrow in this example. 3. Fingertip injuries are among the most common traumatic problems encountered by hand surgeons. A mallet finger injury may be open, but the closed type is more frequent. 1. ... Radiology 1996; 198:219-224. During the examination, it is important to check neurovascular status carefully: A radiograph shows changes of osteoarthritis at the DIP joint with full extension. Radiographics. It is always important to check the neurovascular status carefully. Modern 3-T MRI scanners with dedicated 16-channel surface hand-and-wrist coils … This occurs with forced flexion at the DIP joint during active contraction of the ED. ... ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Masks are required throughout all facilities. 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. The tendon rupture prevents active extension, possibly causing the distal phalanx to assume a position of flexion. The mechanism for the closed injury is most commonly sudden, forceful flexion of the DIP joint in an extended digit. They may represent an isolated tendinous injury or occur in combination with … In sport, David Roberts, and the bony or ligamentous attachment of the extensor tendon with 3mm dorsal.! Forced flexion at the back side of the distal interphalangeal joint ) in the extensor tendon at level. 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