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CONDITION/SYNONYMS

  • Baseball finger

  • Dropped finger

ICD-9-CM CODE

  • 736.1 Mallet finger

ICD-10-CM CODE

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

PREFERRED PRACTICE PATTERN

  • 4E: Impaired joint mobility, motor function, muscle performance, and ROM associated with localized inflammation1

PATIENT PRESENTATION

The patient is a 46-year-old man who injured his middle finger while playing a casual game of basketball with friends. He reports that he attempted to catch a rebound, and the ball struck his outstretched finger, forcibly bending it. Examination revealed a characteristically flexed distal interphalangeal (DIP) joint and patient’s inability to actively extend the DIP joint; X-ray revealed no bony disruption; mild swelling was present.

KEY FEATURES

Description

  • 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 DIP joint

Essentials of Diagnosis

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

  • Finger extension strength, often extensor digitorum communis injury

General Considerations

  • Swelling

  • Inflammation around the joint

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

  • Altered joint position

FIGURE 175-1

Mallet splint. The finger is splinted with distal interphalangeal joint held in extension. (From Patel DR, Greydanus DE, Baker RJ. Pediatric Practice: Sports Medicine. www.accesspediatrics.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Demographics

  • Adults

    • Hit or blow onto the finger tip from sports, i.e., basketball3

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Pain with grasping

  • Decreased extension of the finger, extensor lag

  • Joint redness and pain

Functional Implications

  • Pain with grasping, holding objects

  • Inability to extend the finger

  • At risk of injury in factories as finger not in alignment with the others and can get caught or injured

Possible Contributing Causes

  • Muscle imbalance

  • Extensor digitorum communis injury

  • Trauma

  • Joint arthritis/injury

  • Muscle atrophy

  • Nerve damage

  • Osteoarthritis

  • Rheumatoid arthritis

FIGURE 175-2

Mechanism of mallet finger injury. (From Patel DR, Greydanus DE, Baker RJ. Pediatric Practice: Sports Medicine. www.accesspediatrics.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Differential Diagnosis

  • Gout

  • Boutonnière deformity

  • Stress fracture

MEANS OF CONFIRMATION

  • Imaging

    • X-ray

FINDINGS AND INTERPRETATION

  • Bone spur, location and size

    ...

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