Swollen Finger (Full Version)

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Alex Brenner PT MPT OCS -> Swollen Finger (December 22, 2004 6:32:00 AM)

35 year old male was playing flag football, he went to grab a flag off another player and jammed his finger. This was several weeks ago, pnt continues to have finger pain and swelling. X-rays are as followed:

All images obtained with permission
[IMG]http://img.photobucket.com/albums/v85/brennerak/Test.jpg[/IMG]

What are the findings?



UTDC -> Re: Swollen Finger (December 22, 2004 7:04:00 AM)

Small avulsion at the lateral aspect of the 4th DIP. Based on the mechanism, I would suspect a flexon tendon avulsion, although I don't see it.

Jeff



SJBird55 -> Re: Swollen Finger (December 22, 2004 7:53:00 AM)

Hmm, it looks more like a problem at the 4th proximal interphalangeal joint to me. I don't know what though. I can't tell if there is a very slightly displace fracture or if there is a fragment...



steve -> Re: Swollen Finger (December 22, 2004 12:26:00 PM)

I'm going to have to agree with Jeff on this one, looks like a fracture of the lateral aspect of the 4th DIP. What was the clinical presentation like? Dropped distal phalanx (ie. Mallet finger)?

Steve



chiroortho -> Re: Swollen Finger (December 22, 2004 2:25:00 PM)

Remember 'jersey finger'?



atoz76 -> Re: Swollen Finger (December 28, 2004 1:47:00 AM)

The base of the 4th metacarpal looks kinda unusual. I think there may be a problem in the 4th MCP as well as it looks a little bit off when viewed on the lateral radiographs. I guess there may be something wrong with the 4th DIP too.



Alex Brenner PT MPT OCS -> Re: Swollen Finger (December 30, 2004 4:12:00 PM)

There is an avulsion fracture of digit four off the medial aspect of the distal phalanx. You can also note soft tissue swelling on the medial and lateral sides of the DIP. All other structures were within normal limits.

How would you treat this?

[IMG]http://img.photobucket.com/albums/v85/brennerak/Test5.jpg[/IMG]



SJBird55 -> Re: Swollen Finger (December 31, 2004 2:54:00 AM)

The swelling is at the PIP, right?

Go to that middle view up above. Why does that area that is swollen look goofy in that view?

If the distal phalanx has that avulsion fracture, well, why is there edema at the PIP? I'm sure he isn't walking around with his hand completely elevated, so technically, I would logically expect edema mostly distally. What's going on at the PIP?



UTDC -> Re: Swollen Finger (December 31, 2004 7:49:00 AM)

A soft tissue injury to the PIP would explain the finding.


Jeff



Alex Brenner PT MPT OCS -> Re: Swollen Finger (December 31, 2004 8:13:00 AM)

You are correct, it should have read swelling at the PIP. This patient also injured the collateral ligaments at his PIP. Thanks for pointing it out.



SJBird55 -> Re: Swollen Finger (December 31, 2004 9:30:00 AM)

Well, before I'd answer how it would be treated, I would ask what is his complaint? To me, it appears that the PIP needs to be addressed more so than that distal phalanx.

Did you realize that if you look at the bottom radiograph for a few minutes and then scroll up to the same image without the yellow that you'll see a blue circle where the yellow circle would be? What's up with that?



David Adamczyk -> Re: Swollen Finger (January 1, 2005 2:46:00 PM)

SJ,

You are seeing the complimentary color for yellow. You would also see the blue (purple) ring if you looked at a blank sheet of paper. See the book "Hello Red Fox": http://www.eric-carle.com/rev-HRF.html

Happy New Year



SJBird55 -> Re: Swollen Finger (January 1, 2005 3:02:00 PM)

That's pretty interesting (somewhat more interesting than a sore, swollen finger).



FLOrthoPT -> Re: Swollen Finger (January 1, 2005 4:12:00 PM)

very interesting indeed...
I can definitely remember some guys in college who always had some funny smell coming from smokey filled rooms who would love this book!



InOrbit -> Re: Swollen Finger (January 2, 2005 4:19:00 PM)

ArmyPT,
from the history appears to be a case of mallet finger.
Had a few questions :
Is there any residual instability in the PIP/DIP joints ?

Was there a period of sufficient immobilisation of the digit to promote bone healing since fracture line is still clearly visible? Was there any immobilisation at all ?

Does pnt present with any extensor tendon weakness ?



steve -> Re: Swollen Finger (January 2, 2005 6:37:00 PM)

Gutter splint (Or a prefab dip extensor splint), if the presentation is congruent with a mallet finger. Collaterals, unless completely unstable should heal during this time. Check if extensor lag is present after 3 weeks - if still present, continue for up to 6 weeks, PIP may be placed in flexed position if there is any sign of a swan neck deformity.

Steve



Alex Brenner PT MPT OCS -> Re: Swollen Finger (January 6, 2005 1:29:00 AM)

InOrbit,
There is no instability in the PIP or DIPs. The patient did not perform any immobilization. No extensor tendon weakness, just pain over the DIP and PIP during resisted finger extension. Pain over the DIP with varus and valgus stress.



InOrbit -> Re: Swollen Finger (January 7, 2005 8:37:00 AM)

my POC would be as follows:
- Ice to reduce pain and swelling 2-3 times a day
- splint the DIP in extension
- Gentle active movts for the affected digit during therapy session to maintain ranges and current strength.
-Strengthening for the rest of the intrinsics to prevent and wasting and weakness.

Also, in my opinion pnt shd defer playing at this point.



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