FINGER INJURIES Chapter 24, pgs 727 730, 741 743 1. Demonstrate mastery of anatomical references to the hand and fingers. 2. Compare and contrast Mallet Finger, Swan Neck Deformity and Boutonnière Deformity. Prentice, W. (2014). Principles of athletic training: A competency based approach. (15th ed.). New York: McGraw Hill.
Spring 2014 EXSC 201 01 2 Bony Anatomy (Joints) 5th Metacarpal 1 st MP joint 2 nd PIP joint 4th DIP joint
Spring 2014 EXSC 201 01 3 Soft Tissue Anatomy 1. collateral ligaments 2. volar plate 3. flexor & extensor tendons
Spring 2014 EXSC 201 01 4 Collateral Ligaments (MCP joints) looser in extension; tighten during increasing flexion stabilize joints during motion
Spring 2014 EXSC 201 01 5 Soft Tissue Box at DIP & PIP Joints 1. joint capsule, 2. collateral ligaments, 3. central slip, and dorsal extensor tendon divides into a central slip that extends the PIP joint; the two lateral bands extend the DIP joint flexor digitorum superficialis tendon attaches to base of the middle phalanx and flexes the PIP joint; the flexor digitorum profundus tendon is under and splits the flexor digitorum superficialis tendon to flex the DIP joint 4. volar plate
Spring 2014 EXSC 201 01 6
Spring 2014 EXSC 201 01 7 Volar Plate forms the floor of PIP & DIP joints; separates the joint space from the flexor tendons ligamentous at its origin on proximal phalanx and cartilaginous in its insertion onto the middle phalanx
Spring 2014 EXSC 201 01 8 Volar Plate Injuries 1. Symptoms & Signs pain & stiffness at joint discoloration, swelling & point tenderness at joint, esp. volar surface collateral ligament injury may be present 2. Mechanism of Injury hyperextension of joint
Spring 2014 EXSC 201 01 9 Volar Plate Injuries Lateral radiograph of the hand. This shows an avulsion fracture of the base of the middle phalanx of the third digit.
Spring 2014 EXSC 201 01 10 Volar Plate Injuries 3. Treatment typically RIC & immobilization if needed 4. Return to Play Criteria sport dependent; in most, return can be immediate with buddy taping for support
Spring 2014 EXSC 201 01 11 Soft Tissue Anatomy 1. collateral ligaments 2. volar plate 3. flexor & extensor tendons
Spring 2014 EXSC 201 01 12 Mallet Finger avulsion of the extensor tendon of distal phalanx, causing a deformity where there is fixed flexion at the DIP also called baseball finger
Spring 2014 EXSC 201 01 13 Mallet Finger 1. Symptoms & Signs pain at DIP, dorsal surface dropped finger inability to extend DIP 2. Mechanism of Injury blow to fingertip
Spring 2014 EXSC 201 01 14 Mallet Finger 3. Treatment RIC & NSAID for pain Constant splint of DIP at 0 for 8 weeks followed by night & activity splint for 6 weeks Do not hesitate to refer to M.D. 4. Return to Play Criteria sport dependent; in most, return can be immediate with buddy taping for support
Spring 2014 EXSC 201 01 15 Swan Neck Deformity a deformity where there is fixed flexion at the DIP & hyperextension at the PIP may be a complication of a poorly treated Mallet Finger: hyperextension of PIP because of imbalance of pull distributed along extensor mechanism may also occur acutely or because of degenerative disease
Spring 2014 EXSC 201 01 16
Spring 2014 EXSC 201 01 17 Boutonnière Deformity avulsion of the extensor tendon over the middle phalanx which causes a deformity where there is fixed flexion at the PIP and hyperextension at the DIP also called buttonhole deformity
Spring 2014 EXSC 201 01 18 Boutonnière Deformity 1. Symptoms & Signs pain at PIP, dorsal surface obvious deformity (DIP is extended, PIP is flexed) inability to extend DIP 2. Mechanism of Injury blow to fingertip
Spring 2014 EXSC 201 01 19 Boutonnière Deformity 3. Treatment RIC & NSAID for pain Constant splint of PIP at 0 for 8 weeks followed by night & activity splint for 6 weeks Do not hesitate to refer to M.D. 4. Return to Play Criteria sport dependent; in most, return can be immediate with buddy taping for support
Spring 2014 EXSC 201 01 20 Surgical Repair Mallet Finger, Swan Neck or Boutonnière 1. fix DIP (or PIP) with pin to allow tendon to repair 2. retrieve tendon + do as noted above + other reconstructive work 3. fuse joint no motion occurs 4. replace joint
Spring 2016 EXSC 201 01 21 Homework 1. Review these notes. 2. Terms Test?!