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  • Dropped finger

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  • 736.1 Mallet finger

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

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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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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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Imaging

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  • Bone spur, location and size

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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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  • For imaging, x-ray
  • For corticosteroid injection
  • For surgical consult

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  • Pain with grasping objects for work and daily activities

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  • Rest, to reduce inflammation
  • Bracing/splinting
  • Taping techniques
  • Address swelling and pain
  • Address pain
  • Address weakness and joint instability
    • Strengthening of extensors
  • Address lack of flexibility
  • Address joint mobilization
    • DIP glides & rotation
  • Address soft tissue mobilization

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

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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 weeks of immobilization

1. The American Physical Therapy Association. Pattern 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Localized Inflammation. Interactive Guide to Physical Therapist Practice. The American Physical Therapy Association. 2003. http://guidetoptpractice.apta.org/content/1/SEC12.extract?sid=ccb92104-9626-443e-ab17-b2a32a7792b7. [DOI: 10.2522/ptguide.978-1-931369-64-0]. Accessed March 1, 2012.
2. Dutton M. Musculoskeletal Physical Therapy. In: Dutton M, ed. McGraw-Hill's NPTE (National Physical Therapy Examination). 2nd ed. New York, NY: McGraw-Hill; 2012. http://www.accessphysiotherapy.com/content/56504934. Accessed November 11, ...

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