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Condition/Disorder Synonym

  • 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

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 distal interphalangeal joint (DIP)

Essentials of Diagnosis

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

  • Assses 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

Demographics

  • Adults

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

Clinical Findings

Signs and Symptoms

  • Pain with grasping

  • Decreased extension of the finger

  • Joint redness and pain

Functional Implications

  • Pain with grasping, holding objects

  • Inability to extend the finger

Possible Contributing Causes

  • Muscle imbalance

  • Extensor digitorum communis injury

  • Trauma

  • Joint arthritis/injury

  • Muscle atrophy

  • Nerve damage

  • Osteoarthritis

  • Rheumatoid arthritis

Differential Diagnosis

  • Gout

  • Boutonniere deformity

  • Stress fracture

Means of Confirmation or Diagnosis

Imaging

  • X-ray

Findings and Interpretation

  • Bone spur, location and size

Treatment

Medication

  • Anti-inflammatory

Medical Procedures

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

Referrals/Admittance

  • For imaging, x-ray

  • For corticosteroid injection

  • For surgical consult

Impairments

  • Pain with grasping objects for work and daily activities

Intervention

  • 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

Functional Goals

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

Prognosis

  • 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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