MANUAL MINORS
Injuries to the finger extensors affect the tendons responsible for extending the fingers and wrist. These structures are highly exposed to direct trauma and overuse, which can lead to tears, ruptures, or tendon inflammation. Common injuries include mallet finger, boutonnière deformity, and extensor tendinitis, all of which result in difficulty extending the fingers and wrist, affecting essential hand functions like grip and dexterity.
Diagnosis
Diagnosis is based on a combination of clinical history of trauma or repetitive use, along with physical examination to identify the inability to extend the fingers, swelling, and pain on the dorsal side of the hand or fingers. X-rays may be necessary to rule out associated fractures or bone avulsions, while ultrasound or MRI can be helpful in evaluating tendon status and confirming tears or ruptures.
Differential Diagnosis
Injury | Distinctive Features |
|---|---|
Mallet finger | Inability to extend the distal interphalangeal joint, caused by tear or avulsion of the extensor tendon. |
Boutonnière deformity | Flexion of the proximal interphalangeal joint and extension of the distal joint, caused by rupture of the extensor tendon. |
Extensor tendinitis | Pain on the back of the hand or wrist, associated with overuse, without complete tendon dysfunction. |
Interphalangeal joint dislocation | Pain, visible deformity, and limited movement, but without tendon rupture, easily visible on X-ray. |
Phalangeal fracture | Severe pain, palpable or visible bone deformity on X-ray, with no initial tendon dysfunction. |
Emergency Management
Emergency treatment for extensor tendon injuries includes immobilising the affected fingers with splints, administering analgesics for pain control, and in some cases, urgent surgical repair if there is a complete tendon rupture or associated fracture. Initial management for less severe injuries may include rest, ice, and nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation.
Definitive Treatment
Definitive treatment depends on the severity of the injury. For partial tears or tendinitis, immobilisation and physical therapy are sufficient to restore function. In cases of complete tendon ruptures, such as mallet finger or boutonnière deformity, surgical repair may be necessary, followed by a rehabilitation period to regain range of motion and strength in the fingers. Physical therapy is crucial for preventing stiffness and improving long-term function.
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