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Condition/Disorder Synonym

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  • Dropped finger

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ICD-9-CM Code

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  • 736.1 Mallet finger

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ICD-10-CM Code

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  • M20.019 Mallet finger of unspecified finger(s)

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Preferred Practice Pattern

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Key Features

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Description

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  • Distal joint of the finger is bent into a claw like position

  • Usually due to trauma from impact on tip of the finger2

  • Flexor muscles, fascia, tendons shorten

  • Disruption of the extensor tendon, 15 to 20 degree loss of DIP finger extension

  • Flexion of the distal interphalangeal joint (DIP)

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Essentials of Diagnosis

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  • Diagnosis is usually made by clinical examination or x-ray

  • Assses finger extension strength, often extensor digitorum communis injury

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General Considerations

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  • Swelling

  • Inflammation around the joint

  • Can be associated with fracture, children type IV epiphyseal fracture3

  • Altered joint position

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Demographics

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  • Adults

    • Hit or blow onto the finger, often from playing basketball3

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Clinical Findings

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Signs and Symptoms

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  • Pain with grasping

  • Decreased extension of the finger

  • Joint redness and pain

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Functional Implications

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  • Pain with grasping, holding objects

  • Inability to extend the finger

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Possible Contributing Causes

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  • Muscle imbalance

  • Extensor digitorum communis injury

  • Trauma

  • Joint arthritis/injury

  • Muscle atrophy

  • Nerve damage

  • Osteoarthritis

  • Rheumatoid arthritis

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Differential Diagnosis

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  • Gout

  • Boutonniere deformity

  • Stress fracture

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Means of Confirmation or Diagnosis

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Imaging

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  • X-ray

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Findings and Interpretation

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  • Bone spur, location and size

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Treatment

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Medication

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  • Anti-inflammatory

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Medical Procedures

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  • Surgery to straighten out the finger and lengthen ligaments/tendons

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Referrals/Admittance

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  • For imaging, x-ray

  • For corticosteroid injection

  • For surgical consult

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Impairments

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  • Pain with grasping objects for work and daily activities

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Intervention

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  • Rest, to reduce inflammation

  • Bracing/splinting

  • Taping techniques

  • Address swelling and pain

    • Ice

  • Address pain

    • Ice

    • Massage

    • Joint mobilization

    • Electric stimulation

    • Iontophoresis

    • Infrared

  • Address weakness and joint instability

    • Strengthening of extensors

  • Address lack of flexibility

    • Stretching

      • Intrinsic flexor stretching

      • Fluidotherapy

  • Address joint mobilization

    • DIP glides & rotation

  • Address soft tissue mobilization

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Functional Goals

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  • Patient will be able to grasp and hold a shovel for gardening

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Prognosis

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  • Good; focus on stretching out the flexors

  • Surgery may be indicated if the flexion becomes severe

  • If associated with fragment fracture, one to six ...

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