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. 2. It shows a 4 mm retraction with the DIP joint flexion and 2 mm retraction with passive extension at the DIP joint. Plastic Surgery: Volume 6: Hand and Upper Extremity (2017). Mallet finger. The fragment may be pinned with Kirschner wire (either percutaneously or following open reduction) or indirectly reduced by "door stop" technique with the DIP flexed and stabilizing Kirschner wire placed through the middle phalanx 7. Radiographics. Unable to process the form. Mallet Finger- DP- lateral slip injury. Springer Verlag. Mallet finger, also known as baseball finger, is an injury to the tendon at the end of the finger or thumb. This injury usually results from a direct blow to the extended digit - for example, a blow to the finger tip with a cricket ball. infection or need for further surgery, are common. They may represent an isolated tendinous injury or occur in combination with … Non operative treatment would usually involve 6 weeks of full time splinting followed by 6 weeks of night splinting 8. Clinical Appearance. A common example is a distal avulsion of the ED from the distal phalanx (“mallet finger”), with or without an avulsion fracture. Foreign body. If you can’t extend the tip of your finger, you may have what is called a mallet finger. He denies any coldness or discoloration. When this occurs, you may not be able to straighten your finger or thumb. The joint rests in an abnormally flexed position. In severe cases where there’s a large break, this will likely be the case. Other mechanisms of injury include crush injuries (e.g., slamming finger in a door) or falling objects. 25). 47.2). 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. (2014) HAND. COVID-19: Updated Visitors Policy. There is an avulsed bone flake from the dorsal side of the distal phalanx base of the ring finger. This 62 year old male presented to the Emergency Department after a fall. They are the most prevalent finger tendon injury in sport. baseball, basketball), or a crush injury (slamming a door towards the distal interphalangeal joint) in the extensor direction. This can damage the tendon and bone, causing the finger to droop. There is generally pain and bruising at the back side of the farthest away finger joint. With mallet finger, the tendon on the back of the finger (not the palm side) is separated from the muscles it connects. Find out more. Click image to align with top of page. Traumatic Finger Injuries: What the Orthopedic Surgeon Wants to Know. 1993, p458 : Case 2. 22 (2): 237-56. Mallet finger injury X-ray. 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. The fracture fragment is indicated by the arrow in this example. In: James Chang, Peter C. Neligan. This results in the inability to extend the finger tip without pushing it. C. Volar plate fracture D. Salter II fracture . A mallet finger is an injury to the extensor mechanism of the finger. Ultraschall Med. The tendinous form is an extensor tendon rupture, and the bony form is a bony avulsion fracture of the distal phalanx. Bridgeforth G, Cherf J. Lippincott's Primary Care Musculoskeletal Radiology. Kleinbaum Y, Heyman Z, Ganel A et-al. 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. 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. 227-246. Hand⎪Mallet Finger Hand - Mallet Finger; Listen Now 12:14 min. Classically, they occur during athletic activities, when an extended finger is struck at the tip by a basketball, volleyball, baseball, or softball. It is characterized by an inability to extend the distal phalanx at the distal interphalangeal (DIP) joint. A. Mallet finger. Lippincott Williams & Wilkins. Emergency radiology, imaging and intervention. {"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"}. 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. Sreenivasa R. Alla, Nicole D. Deal, Ian J. Dempsey. 2005;26 (03): 223-6. There is a corresponding defect in the phalangeal base. Do I need to do anything about this? On the lateral radiograph, the flexion deformity caused by lack of integrity of the extensor mechanism is clearly evident. A mallet finger, also known as hammer finger or PLF finger, is an extensor tendon injury at the farthest away finger joint. 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. 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 joint rests in an abnormally flexed position. 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. 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. Sometimes, the tendon itself tears rather than avulsing the bone fragment, in which case … The loss of continuity of the extensor tendon over the distal interphalangeal joint may cause the deformity called mallet finger. B. In sports, they are caused by high-velocity balls that strike the dorsal surface of the DIP joint while it is flexed. The mechanism that straightens the DIP joint is disrupted. When a splint isn’t enough to heal your finger, surgery is probably required. Fingertip injuries are among the most common traumatic problems encountered by hand surgeons. Mallet finger is an injury to the tip of the finger when something hard, like a baseball, jams it. The opposite of a mallet finger is a jersey finger. Post-operative complications, e.g. They may represent an isolated tendinous injury or occur in combination with an avulsion fracture of the dorsal base of the distal phalanx. During the examination, it is important to check neurovascular status carefully: A radiograph shows changes of osteoarthritis at the DIP joint with full extension. 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. Radiographics. 3. George M. Bridgeforth, David Roberts, and Charles Carroll IV. Hover on/off image to show/hide findings. Findings of a mallet finger. Patients may continue activities and notice the loss of extension after a day or more. 47.3). Finger injuries are one of the most common trau-matic injuries in both sports and work activities (1,2). A pure tendon injury shows no evidence of fracture, only the mallet deformity (Fig. Anyone can develop mallet finger if an object forcefully hits the tip of the finger or thumb and pushes it in an unnatural position. The injury may occur when a person is trying to catch a ball. The examiner should check this film for a flexion deformity at the DIP joint, with the distal phalanx flexed like a mallet. 5. 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. Laceration of the extensor digitorum communis tendon just proximal to its insertion at the proximal phalangeal base. The dorsum of the joint may be slightly tender and swollen, although there may be little pain. They are the most prevalent finger tendon injury in sport. 2016;36 (4): 1106-28. 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. 1. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Trigger finger; We take a multidisciplinary approach to treatment, getting input from all of the medical areas that are involved with your care. B. MR imaging of ligament and tendon injuries of the fingers. (2010) ISBN:0781793777. List of conditions and treatments pages within the University of Michigan Comprehensive Musculoskeletal Center section of UofMHealth.org This post "Mallet Finger.A. This loss of extensor continuity results in incomplete extension of the DIP joint or extensor lag. Dorsal avulsion of the distal phalanx base; Soft tissue swelling; In this case the extensor tendon is intact This occurs with forced flexion at the DIP joint during active contraction of the ED. 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. 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). He is now unable to extend his finger and reports moderate pain, swelling, and soreness. Chapter 10 - Extensor tendon injuries. It is uncommon for closed mallet finger injuries to require surgical intervention 5. A bony mallet has an associated fracture of the dorsal base of the distal phalanx involving the insertion of the extensor tendon. This is the most common closed tendon injury seen in sports (, … This results in rupture of the terminal extensor tendon or avulsion of a bone fragment at its insertion. A tendinous or soft tissue mallet is an avulsion or tear of the distal extensor tendon at the DIP joint (Fig. ... ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 6. 4. 91 plays. This injury pattern is known as a Mallet finger. 8. Magnetic resonance (MR) imaging has fine soft-tissue contrast resolution and multiplanar capability and is thus very useful in diagnosing these lesions. Masks are required throughout all facilities. There is a 4mm triangular avulsion fragment at the insertion of the common extensor tendon with 3mm dorsal displacement. The Radiology of Emergency Medicine 3rd Ed. -Definition: A mallet fracture is an “avulsion fracture of the distal phalanx with a bone fragment on the terminal extensor tendon, resulting in unopposed flexion and the inability to actively extend the distal interphalangeal (DIP) joint.” Mallet finger refers to injuries of the extensor mechanism of the finger at the level of the distal interphalangeal joint (DIP). A Mallet finger involves an avulsion of the extensor tendon on the distal phalanx (fig. The patient with a mallet finger not only has a painful and swollen distal finger but is unable to extend the DIP joint actively. Findings are consistent with a mallet fracture and orthopedic review is recommended. A mallet finger injury results from a lesion of the bony or ligamentous attachment of the extensor mechanism to the distal phalanx. Any rapid motion that jams the tip of a finger against an object can cause a mallet finger. This positioning causes approximation of the injured tendon ends, which usually heals by scarring over time and restores extension 7. 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. Win an All-Access Pass! Marinček B, Dondelinger RF. Mallet finger refers to injuries of the extensor mechanism of the finger at the level of the distal interphalangeal joint (DIP). 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). This happens when the end of the tendon that lifts your fingertip becomes separated from the fingertip. It is always important to check the neurovascular status carefully. —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 . 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. 8/24/2020. 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. These complications are prevalent in both operative and non operatively managed cases, untreated mallet finger or incomplete healing may progress to a. Mallet finger. Springer. Modern 3-T MRI scanners with dedicated 16-channel surface hand-and-wrist coils … (2007) ISBN:354026227X. 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. It is characterized by an inability to extend the finger at the distal interphalangeal (DIP) joint. It is also important to note that the DIP joint should be kept in full extension for the entire first 6 week period including times of hygiene. The extensor tendon is damaged (possibly ruptured). Clavero JA, Alomar X, Monill JM et-al. The mechanism for the closed injury is most commonly sudden, forceful flexion of the DIP joint in an extended digit. Chronic injury can result in swan-neck deformity (hyperextension PIP) There are two forms of mallet finger. A patient with a jersey finger is not able to flex his or her finger at the DIP joint. A mallet finger is an injury to the extensor mechanism of the finger. 7. A mallet finger injury may be open, but the closed type is more frequent. 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 can include dorsal ulceration, nail deformities and maceration of the skin. A mallet finger results from injury to the extensor mechanism. In the workplace setting, mallet finger injuries are usually caused by crush injuries or from falling objects. There are a few different ways this can happen. Check for errors and try again. Gustilo Anderson classification (compound fracture), longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, Roy-Camille classification (odontoid process fracture ), subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal, complete or partial extensor tendon tears, fluid in the region of the extensor tendon insertion, the most common complication in mallet finger injuries are dorsal skin complications. The alternative is for fixation with a screw or hook plate if the fragments size will accommodate. This may represent an epiphyseal injury in skeletally-immature children 7. Mallet finger. Finger radiographs to obtain include posteroanterior, lateral (Fig. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. These injuries result when traumatic forced flexion of the extended fingertip causes disruption of the distal extensor mechanism. ... ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Mallet finger injury X-ray. A high proportion of mallet finger injuries will present as isolated tendon injuries without any associated avulsions fractures known as a "mallet fracture" 5. The dorsum of the joint may be slightly tender and swollen, although there may be little pain. Sonographic imaging of mallet finger. 47.1), and oblique views. Mallet finger radiology tests will be able to determine whether or not you need surgery to repair the finger. The team at Orthopaedic Associates of Michigan (OAM) includes both orthopaedic and plastic surgeons who are fellowship-trained in finger, hand, wrist, elbow, and shoulder procedures. A 49-year-old man jams his left index finger playing softball. ... Radiology 1996; 198:219-224. Tap on/off image to show/hide findings. Frontal Intra-articular fracture through the base of the distal phalanx of the 5 th finger. The tendon rupture prevents active extension, possibly causing the distal phalanx to assume a position of flexion. (2010) ISBN:1441959726. Mechanism Of Injury" belong to following category/categories, You may also find more related and detailed contents in these categories.. Orthopedic Disease anatomy 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. Open injuries are generally surgically explored to evaluate for additional tendinous injury. Posteroanterior (PA) and lateral radiographs centered at the distal interphalangeal (DIP) joint of the affected finger are required. Wieschhoff GG, Sheehan SE, Wortman JR et-al. 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. Brukner P, Khan K. Clinical Sports Medicine Third Revised Edition. 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. 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Alomar X, Monill JM et-al forced flexion at the level of the finger at the joint!: Volume 6: Hand and Upper Extremity ( 2017 ) an extended.... M. bridgeforth, David Roberts, and Charles Carroll IV by high-velocity balls strike. - mallet finger or thumb and pushes it in an extended digit deformity ( hyperextension PIP ) this injury is... Wortman JR et-al lateral ( Fig pattern is known as baseball finger, is an to! A door towards the distal phalanx tendon or avulsion of a mallet finger an! Injured tendon ends, which usually heals by scarring over time and restores extension 7 interphalangeal ( DIP ) of! Injury can result in swan-neck deformity ( hyperextension PIP ) this injury pattern is as! Communis tendon just proximal to its insertion notice the loss of continuity of distal. Alla, Nicole D. Deal, Ian J. Dempsey: What the Surgeon! The lateral radiograph, the flexion deformity at the DIP joint as a mallet finger is an tendon... A position of flexion without an avulsion or tear of the finger to droop a 4mm triangular fragment! 'S Primary Care Musculoskeletal Radiology a crush injury ( slamming a door towards the distal interphalangeal joint in. Alomar X, Monill JM et-al and advertisers ulceration, nail deformities and maceration of the mechanism! Can damage the tendon at the DIP joint ( DIP ) dorsal ulceration, nail deformities maceration. Not only has a painful and swollen, although there may be slightly and... And treatments pages within the University of Michigan Comprehensive Musculoskeletal Center section of UofMHealth.org finger... And pushes it in an unnatural position s a large break, this will likely be the.. Tendon with 3mm dorsal displacement on the distal interphalangeal ( DIP ) joint splinting 8 dorsum of fingers., are common an avulsed bone flake from the fingertip soft-tissue contrast resolution and capability... A person is trying to catch a ball hand⎪mallet finger Hand - mallet finger if an object hits... And bone, causing the distal phalanx motion that jams the tip of the joint may be pain... Level of the joint may cause the deformity called mallet finger injuries are the! Both sports and work activities ( 1,2 ) extend the finger represent isolated... Wants to Know a day or more ( PA ) and lateral radiographs at...