Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Baseball Mallet Finger

SYMPTOMS

There is localised pain and swelling around the distal inter-phalangeal (DIP) joint, which is difficult or impossible to extend fully. In chronic cases, pain and swelling may be absent but the inability to extend the distal phalanx remains.

AETIOLOGY

This injury is a rupture of the most distal insertion of the extensor digitorum tendon at the DIP joint, often after a direct trauma to the tip of the finger from, for example, a basketball or volleyball.

CLINICAL FINDINGS

There is tenderness on palpation over the DIP joint. The patient cannot actively extend the distal phalanx and cannot hold it extended against resistance.

INVESTIGATIONS

X-ray may show a small avulsion fracture of the dorsal plate that corresponds to the tendon insertion. MRI or ultrasound may show the tendon rupture and haematoma.

TREATMENT

If there is no fracture this injury usually heals by immobilising the distal phalanx in a ‘mallet bandage’. If there is a fracture, re-fixing surgery is usually required.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon if there is a fracture on X-ray or if the diagnosis is unclear. A mallet bandage should be available to be applied on the field by the team medic.

EXERCISE PRESCRIPTION

Usually the two or three adjacent fingers can be strapped together and normal activities may be continued throughout  healing in some sports. However, in sports like boxing, martial arts and similar ones, six to eight weeks’ absence may be needed. Running, cyclingand water exercises (when the wound is healed after surgery) are good alternatives to keep up general fitness. Gym training can be maintained.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs. If there was a fracture, X-rays should show healing.

DIFFERENTIAL DIAGNOSES

This is a clear clinical and sometimes radiological diagnosis.

PROGNOSIS

Excellent, if treated appropriately. If it is missed, surgery can be performed at a later stage.

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