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Lecture

April 8 - ch19 finger injuries.doc

6 Pages
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Department
Physical Education and Sport
Course Code
PEDS240
Professor
Brad Kern

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April 8 – Ch 19 – Recognition and Management of Finger injuries Mallet Finger Cause of Mallet Finger • Caused by a blow that contacts tip of finger avulsing extensor tendon from insertion • Occurs distally to the DIP • If you rupture the extensor tendon, finger will look flexed at 30 degrees. Sometimes it is associated with an avulsion fracture Signs of Mallet Finger • Pain at DIP; xray shows avulsed bone on dorsal proximal distal phalanx • Unable to extend distal end of finger (carrying at 30 degree angle) • Point tenderness at sight of injury Caring for Mallet Finger • RICE and splinting (in extension) for 6-8 weeks • Keep the brace on at all times Boutonniere Deformity Cause of Boutonniere Deformity • Rupture of extensor tendon dorsal to the middle phalanx • Forces and locks DIP joint into extension and PIP into flexion. You can passively move the joint out of this lock. • This can occur when the tip of the finger gets a blow Signs of a Boutonniere Deformity • Severe pain, obvious deformity and inability to extend DIP joint • Swelling, point tenderness Caring for a Boutonniere Deformity • Cold application, followed by splinting of PIP • Splinting must be continued for 5-8 weeks • Because injury is mainly to the extensor, they just brace the PIP • Athlete is encouraged to flex distal phalanx Jersey Finger Cause of Jersey Finger • Rupture of flexor digitorm profundus tendon from insertion on distal phalanx • Athlete will be unable to flex their finger • Often occurs with ring finger when athlete tries to grab a jersey Signs of Jersey Finger • DIP cannot be flexed, finger remains extended • Pain and point tenderness over distal phalanx Caring for Jersey Finger • Must be surgically repaired • Rehab requires 12 weeks and there is often poor gliding of tendon with possibility of re-rupture Gamekeeper’s Thumb Cause of Gamekeepers Thumb • Sprain of UCL and MCP joint of the thumb • Mechanism is forceful abduction of proximal phalanx occasionally combined with hyperextension • Gamekeepers thumb happens alot to skiers due to valgus force on thumb which can damage the ulnar collateral ligament in the thumb Signs of gamekeepers thumb • Pain over UCL in addition to weak and painful pinch • Tenderness and swelling over medial aspect of thumb • With thumb injuries, we should always check for avulsion fractures Caring for Gamekeepers Thumb • Immediate follow-up must occur • If instability exists, athlete should be referred to orthopedist • If stable, xray should be performed to rule out fracture • Thumb splint should be applied for protection for 3 weeks o
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