Best Practice Case Studies-Case 128 Asset 5 Finger Injuries

Video Transcription

Video Summary

This lecture reviewed common <strong>finger injuries in athletes</strong> and how to diagnose and treat them, with emphasis on using <strong>ultrasound, exam maneuvers, and radiographs</strong>.

Key injuries included:

- <strong>Mallet finger</strong>: disruption of the distal extensor mechanism causing inability to extend the DIP joint. It may be tendinous or bony. Most cases are treated with <strong>continuous DIP extension splinting for 6–8 weeks</strong>. Larger avulsion fractures, volar subluxation, open injuries, or failed conservative care may require <strong>hand surgery referral</strong>.
- <strong>Boutonniere deformity / central slip injury</strong>: missed central slip rupture leading to PIP flexion and DIP hyperextension due to volar migration of the lateral bands. Diagnosis can be aided by the <strong>Elson test</strong>. Treatment is <strong>PIP extension splinting</strong> followed by buddy taping.
- <strong>Jersey finger</strong>: flexor digitorum profundus avulsion causing inability to flex the DIP. This injury should be <strong>referred urgently to surgery</strong> and splinted in <strong>flexion</strong> while awaiting evaluation.
- <strong>Volar plate injury</strong>: usually from PIP hyperextension. Treated with an <strong>extension-block splint</strong> to prevent further hyperextension; larger avulsion fractures need referral.
- <strong>Collateral ligament injury</strong>: diagnosed with stress testing; partial tears are treated with <strong>buddy taping</strong>, while complete ruptures or significant avulsion fractures warrant referral.
- <strong>Trigger finger</strong>: stenosing tenosynovitis at the A1 pulley. Ultrasound can help confirm the diagnosis and guide steroid injection. Up to <strong>two injections</strong> may be cost-effective; structural causes like tumor, foreign body, or exostosis should prompt referral.
- <strong>Pediatric injuries</strong>: do not miss <strong>Seymour fractures</strong> or other physeal injuries, which require X-ray and often surgical management.

The lecture concluded with practical reminders: splint correctly, avoid missing subluxation or pediatric fractures, and use imaging liberally for finger injuries.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 128

Topic Hand

Keywords

4th Edition

4th Edition, Case 128

Hand

finger injuries

athletes

ultrasound

radiographs

mallet finger

boutonniere deformity

jersey finger

volar plate injury

collateral ligament injury

trigger finger