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Mallet finger is a deformity of the finger that occurs when the tendon that attaches to the end of the finger just below the nail is detached from the bone. This may happen when the end of the finger is bent forward when hit on the end, by a ball for example.
Symptoms include pain and swelling in the end of the finger accompanied by a deformity of the finger where the end of the finger is permanently bent forward. Treatment will usually consist of splinting the finger in a straight position for two months.
Finger Joint Dislocation (MCP, DIP, PIP)
Dislocation of the finger joints is most common during ball sports, for example football, basketball and especially cricket when the finger is hit on the end by the ball. The little finger and the thumb are most commonly affected. Dislocation occurs when the bone comes out of its ‘socket’ causing damage to the ligaments and capsule around the joint. Symptoms include deformity, impaired function, pain and immediate swelling followed by bruising.
Swelling control using ice and compression is very important and one should seek medical advice. Stiffness and lack of movement are common long-term symptoms if the finger is not managed effectively.
Volar Plate Avulsion Injury
This is a hyperextension injury which is essentially a ligamentous injury although it may involve a portion of bone avulsed off by a ligament. It usually involves a piece of bone avulsed off the base of the middle phalanx by the volar plate which is usually not significantly displaced and usually will heal without problem. It also usually involves a collateral ligament tear which heals without problem but often heals with abundant scar tissue leading to an appearance of chronic swelling on one side of the joint, which is permanent.
No more than a few days of immobilization is necessary and is important to work on obtaining full range of motion of the joint. The middle joint of the fingers is the worst with regards to stiffness and early range of motion is very important. Range of motion exercises may be explained to the patient or therapy with a hand therapist may be necessary.
“Buddy taping” of the fingers after the initial few days of immobilization is all that is necessary for finger support. At first, “buddy taping” will be necessary all the time, gradually progressing to “buddy taping” only with exertive or sporting activities with effected hand.
If motion is begun early, full range of motion can be expected. For those who have been immobilized longer, permanent stiffness may result. Rarely, with severe stiffness, surgical release of the scarred tendons and joint capsule may be necessary, also rarely, instability may result which may require reconstructive surgery. Most patients do extremely well, being able to progress to painless activity with full function, with minimal abnormal appearance.
Fractures of the bones of the finger are less common than joint dislocations but occur also as a result of being hit on the end of the finger in many ball sports. Pain, swelling and deformity may be felt and the break should be iced and compressed until medical attention can be sought.
Early Injury Management
For approximately the first 72 hours following an injury, the RICE regime should be followed to ensure control of inflammation and pain relief.
R - Rest
I – Ice
C - Compression
E – Elevation
Rest from aggravating activity.
Ice should be applied in the first 72 hours or when inflammation persists. Ice should be applied for 15 to 20 minutes at a time. Ice should not be applied directly to the skin, but through a wet towel or cloth.
Compression can be achieved with an elastic bandage.
Elevation is used to help swelling to return to the heart through the blood stream.
The injured area should be elevated above the level of the heart.