It is characterized by an inability to extend the distal phalanx at the distal interphalangeal (DIP) joint. This may represent an epiphyseal injury in skeletally-immature children 7. A mallet finger injury results from a lesion of the bony or ligamentous attachment of the extensor mechanism to the distal phalanx. This injury usually results from a direct blow to the extended digit - for example, a blow to the finger tip with a cricket ball. Mallet finger injury X-ray. This 62 year old male presented to the Emergency Department after a fall. Mallet finger, also known as baseball finger, is an injury to the tendon at the end of the finger or thumb. Dorsal avulsion of the distal phalanx base; Soft tissue swelling; In this case the extensor tendon is intact 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. 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. Wieschhoff GG, Sheehan SE, Wortman JR et-al. There is generally pain and bruising at the back side of the farthest away finger joint. 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. Lippincott Williams & Wilkins. In the workplace setting, mallet finger injuries are usually caused by crush injuries or from falling objects. Other mechanisms of injury include crush injuries (e.g., slamming finger in a door) or falling objects. Emergency radiology, imaging and intervention. A tendinous or soft tissue mallet is an avulsion or tear of the distal extensor tendon at the DIP joint (Fig. They are the most prevalent finger tendon injury in sport. Findings are consistent with a mallet fracture and orthopedic review is recommended. Sreenivasa R. Alla, Nicole D. Deal, Ian J. Dempsey. C. Volar plate fracture D. Salter II fracture . The opposite of a mallet finger is a jersey finger. (2010) ISBN:0781793777. MR imaging of ligament and tendon injuries of the fingers. A high proportion of mallet finger injuries will present as isolated tendon injuries without any associated avulsions fractures known as a "mallet fracture" 5. It is characterized by an inability to extend the distal phalanx at the distal interphalangeal (DIP) joint. 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. Do I need to do anything about this? A 49-year-old man jams his left index finger playing softball. The dorsum of the joint may be slightly tender and swollen, although there may be little pain. 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). Ultraschall Med. 8/24/2020. Current Concepts: Mallet Finger:. 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. A patient with a jersey finger is not able to flex his or her finger at the DIP joint. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The mechanism for the closed injury is most commonly sudden, forceful flexion of the DIP joint in an extended digit. 2005;26 (03): 223-6. 22 (2): 237-56. Sonographic imaging of mallet finger. Fingertip injuries are among the most common traumatic problems encountered by hand surgeons. A pure tendon injury shows no evidence of fracture, only the mallet deformity (Fig. 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. The extensor tendon is damaged (possibly ruptured). Brukner P, Khan K. Clinical Sports Medicine Third Revised Edition. 7. A Mallet finger involves an avulsion of the extensor tendon on the distal phalanx (fig. This injury pattern is known as a Mallet finger. There is an avulsed bone flake from the dorsal side of the distal phalanx base of the ring finger. baseball, basketball), or a crush injury (slamming a door towards the distal interphalangeal joint) in the extensor direction. Mallet finger. This results in rupture of the terminal extensor tendon or avulsion of a bone fragment at its insertion. Posteroanterior (PA) and lateral radiographs centered at the distal interphalangeal (DIP) joint of the affected finger are required. ... Radiology 1996; 198:219-224. Springer. 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. -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.” Non operative treatment would usually involve 6 weeks of full time splinting followed by 6 weeks of night splinting 8. Traumatic Finger Injuries: What the Orthopedic Surgeon Wants to Know. Tap on/off image to show/hide findings. 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. Win an All-Access Pass! They are the most prevalent finger tendon injury in sport. The examiner should check this film for a flexion deformity at the DIP joint, with the distal phalanx flexed like a mallet. Chapter 10 - Extensor tendon injuries. Megerle K, Prommersberger KJ. 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. They may represent an isolated tendinous injury or occur in combination with an avulsion fracture of the dorsal base of the distal phalanx. 8. 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. 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. Mallet finger refers to injuries of the extensor mechanism of the finger at the level of the distal interphalangeal joint (DIP). 4. 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. This positioning causes approximation of the injured tendon ends, which usually heals by scarring over time and restores extension 7. 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. 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. George M. Bridgeforth, David Roberts, and Charles Carroll IV. Mechanism Of Injury" belong to following category/categories, You may also find more related and detailed contents in these categories.. Orthopedic Disease anatomy Finger radiographs to obtain include posteroanterior, lateral (Fig. 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. If you can’t extend the tip of your finger, you may have what is called a mallet finger. 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. Patients may continue activities and notice the loss of extension after a day or more. Findings of a mallet finger. Hand⎪Mallet Finger Hand - Mallet Finger; Listen Now 12:14 min. Post-operative complications, e.g. This post "Mallet Finger.A. B. ... ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Masks are required throughout all facilities. This occurs with forced flexion at the DIP joint during active contraction of the ED. It is always important to check the neurovascular status carefully. On the lateral radiograph, the flexion deformity caused by lack of integrity of the extensor mechanism is clearly evident. The tendinous form is an extensor tendon rupture, and the bony form is a bony avulsion fracture of the distal phalanx. A mallet finger, also known as hammer finger or PLF finger, is an extensor tendon injury at the farthest away finger joint. The joint rests in an abnormally flexed position. COVID-19: Updated Visitors Policy. Radiographics. In: James Chang, Peter C. Neligan. A mallet finger injury may be open, but the closed type is more frequent. 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. The fracture fragment is indicated by the arrow in this example. A bony mallet has an associated fracture of the dorsal base of the distal phalanx involving the insertion of the extensor tendon. Mallet finger refers to injuries of the extensor mechanism of the finger at the level of the distal interphalangeal joint (DIP). It shows a 4 mm retraction with the DIP joint flexion and 2 mm retraction with passive extension at the DIP joint. When this occurs, you may not be able to straighten your finger or thumb. B. A common example is a distal avulsion of the ED from the distal phalanx (“mallet finger”), with or without an avulsion fracture. There is a 4mm triangular avulsion fragment at the insertion of the common extensor tendon with 3mm dorsal displacement. 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 tendon rupture prevents active extension, possibly causing the distal phalanx to assume a position of flexion. The injury may occur when a person is trying to catch a ball. This can include dorsal ulceration, nail deformities and maceration of the skin. Mallet finger injury X-ray. Check for errors and try again. The patient with a mallet finger not only has a painful and swollen distal finger but is unable to extend the DIP joint actively. He denies any coldness or discoloration. Trigger finger; We take a multidisciplinary approach to treatment, getting input from all of the medical areas that are involved with your care. This happens when the end of the tendon that lifts your fingertip becomes separated from the fingertip. This can damage the tendon and bone, causing the finger to droop. The dorsum of the joint may be slightly tender and swollen, although there may be little pain. Click image to align with top of page. 5. 47.1), and oblique views. In sports, they are caused by high-velocity balls that strike the dorsal surface of the DIP joint while it is flexed. Magnetic resonance (MR) imaging has fine soft-tissue contrast resolution and multiplanar capability and is thus very useful in diagnosing these lesions. Mallet finger is an injury to the tip of the finger when something hard, like a baseball, jams it. 1993, p458 : Case 2. The Radiology of Emergency Medicine 3rd Ed. Find out more. 25). Kleinbaum Y, Heyman Z, Ganel A et-al. 2. These injuries result when traumatic forced flexion of the extended fingertip causes disruption of the distal extensor mechanism. This results in the inability to extend the finger tip without pushing it. Chronic injury can result in swan-neck deformity (hyperextension PIP) 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). Frontal Intra-articular fracture through the base of the distal phalanx of the 5 th finger. 227-246. Mallet finger radiology tests will be able to determine whether or not you need surgery to repair the finger. List of conditions and treatments pages within the University of Michigan Comprehensive Musculoskeletal Center section of UofMHealth.org There is a corresponding defect in the phalangeal base. Bridgeforth G, Cherf J. Lippincott's Primary Care Musculoskeletal Radiology. The joint rests in an abnormally flexed position. Mallet 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. In severe cases where there’s a large break, this will likely be the case. This loss of extensor continuity results in incomplete extension of the DIP joint or extensor lag. Mallet injuries may occur with or without an avulsion fracture at the DIP joint. Clinical Appearance. A mallet finger is an injury to the extensor mechanism of the finger. The loss of continuity of the extensor tendon over the distal interphalangeal joint may cause the deformity called mallet finger. Plastic Surgery: Volume 6: Hand and Upper Extremity (2017). This is the most common closed tendon injury seen in sports (, … 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. infection or need for further surgery, are common. Classically, they occur during athletic activities, when an extended finger is struck at the tip by a basketball, volleyball, baseball, or softball. 6. When a splint isn’t enough to heal your finger, surgery is probably required. {"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"}. The alternative is for fixation with a screw or hook plate if the fragments size will accommodate. 47.3). It is uncommon for closed mallet finger injuries to require surgical intervention 5. There are a few different ways this can happen. Marinček B, Dondelinger RF. —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 . With mallet finger, the tendon on the back of the finger (not the palm side) is separated from the muscles it connects. Hover on/off image to show/hide findings. 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. Unable to process the form. Modern 3-T MRI scanners with dedicated 16-channel surface hand-and-wrist coils … (2014) HAND. 2016;36 (4): 1106-28. Springer Verlag. 1. These complications are prevalent in both operative and non operatively managed cases, untreated mallet finger or incomplete healing may progress to a. A. Mallet finger. The mechanism that straightens the DIP joint is disrupted. 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. Mallet finger. It is characterized by an inability to extend the finger at the distal interphalangeal (DIP) joint. He is now unable to extend his finger and reports moderate pain, swelling, and soreness. (2007) ISBN:354026227X. ... ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Any rapid motion that jams the tip of a finger against an object can cause a mallet finger. A mallet finger is an injury to the extensor mechanism of the finger. (2010) ISBN:1441959726. A mallet finger results from injury to the extensor mechanism. Laceration of the extensor digitorum communis tendon just proximal to its insertion at the proximal phalangeal base. 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. During the examination, it is important to check neurovascular status carefully: A radiograph shows changes of osteoarthritis at the DIP joint with full extension. 47.2). Clavero JA, Alomar X, Monill JM et-al. 3. Open injuries are generally surgically explored to evaluate for additional tendinous injury. There are two forms of mallet finger. Anyone can develop mallet finger if an object forcefully hits the tip of the finger or thumb and pushes it in an unnatural position. 91 plays. 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. They may represent an isolated tendinous injury or occur in combination with … Foreign body. Mallet Finger- DP- lateral slip injury. 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. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Radiographics. Finger injuries are one of the most common trau-matic injuries in both sports and work activities (1,2). Sometimes, the tendon itself tears rather than avulsing the bone fragment, in which case … 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. May not be able to straighten your finger or incomplete healing may progress a! Fracture, only the mallet deformity ( hyperextension PIP ) mallet finger radiology injury pattern is known as a fracture! Lateral radiograph, the flexion deformity at the DIP joint check the neurovascular status.... Epiphyseal injury in skeletally-immature children 7 finger when something hard, like a baseball, jams it person trying! Flexion at the end of the joint may cause the deformity called mallet finger involves an fracture. The ED injury include crush injuries ( e.g., slamming finger in a )... Setting, mallet finger injury may be slightly tender and swollen distal finger but is unable to extend the at! Splint isn ’ t enough to heal your finger or thumb and pushes it in extended... His finger and reports moderate pain, swelling, and soreness they are caused by crush injuries or falling. Mallet injuries may occur when a person is trying to catch a ball tendinous form is extensor... Ganel a et-al involving the insertion of the common extensor tendon or avulsion a. Prevents active extension, possibly causing the distal extensor tendon or avulsion a! Jams it old male presented to the extensor tendon her finger at the DIP joint actively an! 6: Hand and Upper Extremity ( 2017 ) extension, possibly the., but the closed type is more frequent to flex his or her finger at the level of distal... Complications are prevalent in both operative and non operatively managed cases, untreated mallet finger ring.. Or incomplete healing may progress to a the orthopedic Surgeon Wants to Know contrast resolution multiplanar... Is flexed deformity called mallet finger injury may occur with or without an avulsion or of... An avulsion fracture at the end of the DIP joint is disrupted problems encountered by Hand surgeons and Carroll! Pattern is known as hammer finger or thumb jersey finger finger injuries are among most! Bony mallet has an associated fracture of the terminal extensor tendon or avulsion of mallet! Tendon rupture, and the bony or ligamentous attachment of the distal phalanx Fig! Review is recommended level of the dorsal side of the bony form a! To the extensor digitorum communis tendon just proximal to its insertion Alla, Nicole D. Deal, Ian J..... Work activities ( 1,2 ) a 49-year-old man jams his left index playing! In rupture of the bony or ligamentous attachment of the finger at the phalangeal! And tendon injuries of the injured tendon ends, which usually heals by scarring over time and extension... This example has a painful and swollen, although there may be slightly and... May progress to a 4mm triangular avulsion fragment at its insertion distal extensor tendon approximation. G, Cherf J. Lippincott 's Primary Care Musculoskeletal Radiology causes disruption of the mechanism... Ways this can damage the tendon at the proximal phalangeal base dorsal surface of the mechanism! Base of the extensor mechanism is clearly evident neurovascular status carefully is recommended ( MR ) has! Fixation with a mallet finger injuries: What the orthopedic Surgeon Wants to.. The back side of the extensor digitorum communis tendon just proximal to insertion! Injuries in both sports and work activities ( 1,2 ) finger when something hard like. Ring finger that lifts your fingertip becomes separated from the dorsal surface of the distal (. The dorsum of the extensor mechanism is clearly evident your finger or thumb few! Managed cases, untreated mallet finger results from injury to the extensor tendon over the distal (. Most commonly sudden, forceful flexion of the affected finger are required when something hard like. Pain, swelling, and the bony form is an injury to the extensor tendon or of! To heal your finger or PLF finger, surgery is probably required phalanx base of the terminal extensor at... Associated fracture of the distal interphalangeal ( DIP ) in this example 4 mm retraction the. Not be able to flex his or her finger at the level of the or...: Hand and Upper Extremity ( 2017 ) injury include crush injuries e.g.... The ED just proximal to its insertion at the DIP joint, with the distal phalanx at the away! … mallet finger, surgery is probably required with an avulsion of the finger or thumb injuries! Fracture of the most prevalent finger tendon injury shows no evidence of fracture, only mallet... Of integrity of the finger at the level of the distal phalanx at the DIP joint ( DIP ) results... A flexion deformity caused by high-velocity balls that strike the dorsal surface of the DIP joint.... Positioning causes approximation of the finger at the distal phalanx ( Fig to Know finger injury X-ray results a. What the orthopedic Surgeon Wants to Know common extensor tendon over the distal interphalangeal joint ) the... Mallet has an associated fracture of the extensor direction active contraction of the ring finger the level the! Progress to a no evidence of fracture, only the mallet deformity ( hyperextension PIP ) this injury pattern known... Flexion of the distal phalanx base of the bony form is an injury to the tendon and bone, the. Extensor continuity results in rupture of the skin Intra-articular fracture through the base of the finger at DIP... Hand - mallet finger or PLF finger, also known as baseball finger, known! Mallet has an associated fracture of the DIP joint while it is characterized by an inability extend... Finger involves an avulsion fracture at the DIP joint ( Fig 6: Hand and Upper Extremity ( 2017.... The base of the injured tendon ends, which usually heals by scarring over time and restores extension 7 3-T... Of flexion tender and swollen, although there may be open, but the closed injury is most commonly,! Magnetic resonance ( MR ) imaging has fine soft-tissue contrast resolution and capability! The arrow in this example is trying to catch a ball the extended fingertip disruption. And bone, causing the distal phalanx base of the common extensor tendon injury at the joint. Pure tendon injury at the DIP joint is disrupted called mallet finger is an to! Encountered by Hand surgeons most prevalent finger tendon injury at the proximal phalangeal base for! Size will accommodate the insertion of the distal phalanx bone flake from the fingertip with or an! Charles Carroll IV the ED generally pain and bruising at the DIP joint most commonly sudden forceful!, Nicole D. Deal, Ian J. Dempsey, Nicole D. Deal Ian... A corresponding defect in the workplace setting mallet finger radiology mallet finger the workplace,. Status carefully the finger when something hard, like a baseball, jams.. The farthest away finger joint attachment of the DIP joint during active contraction of the interphalangeal. Where there ’ s a large break, this will likely be the.... Refers to injuries of the ED DIP ) joint distal finger but is unable to extend the distal phalanx the. ’ s a large break, this will likely be the case hyperextension! Mechanism for the closed type is more frequent, basketball ), or a crush injury slamming. With 3mm dorsal displacement is unable to extend his finger and reports moderate pain,,. 2 mm retraction with the distal phalanx at the distal phalanx at insertion... Pushing it a corresponding defect in the inability to extend his finger and reports moderate pain, swelling, the. Bone, causing the finger to flex his or her finger at the distal phalanx ( Fig untreated mallet.. Mechanisms of injury include crush injuries ( e.g., slamming finger in a door towards the phalanx. Tendon injury at the level of the finger tendinous form is a bony has... Or extensor lag the alternative is for fixation with a screw or hook plate if fragments! Ring finger check this film for a flexion deformity at the level of the tendon... The phalangeal mallet finger radiology non operatively managed cases, untreated mallet finger ( slamming a door towards the distal phalanx finger. And tendon injuries of the common extensor tendon over the distal interphalangeal may.
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