A review of mallet finger and jersey finger injuries in the athlete

Abstract

Purpose of review: The purposes of this review are to discuss the diagnosis and management of mallet and jersey finger injuries in athletes and to highlight how treatment impacts return to play.

Recent findings: Mallet finger: although numerous non-operative and operative techniques have been described, there continues to be little consensus regarding the optimal procedure. Jersey finger: ultrasound appears to be a cost-effective imaging modality that may be useful for preoperative planning. Wide-awake surgery offers optimal intraoperative assessment of the tendon repair. Tendon repair with volar plate augmentation has been shown to improve the strength of the repair in the laboratory, and early clinical results are encouraging. Most mallet finger injuries will heal with non-operative treatment over a period of 8-12 weeks, even when treatment is delayed up to 3-4 months. An acute diagnosis of jersey finger requires surgical treatment and generally means 8-12 weeks of inability to compete in most contact sports.

Keywords: Athlete; Distal phalanx; Jersey finger; Mallet finger; Tendon avulsion.

Fig. 1

a A 49-year-old male with a purely tendinous mallet finger and noticeable extensor lag. There is also noticeable hyperextension at the level of the PIPJ, resulting in a swan-neck deformity b A 16-year old male with a bony mallet finger involving a fleck of bone and minimal extensor lag as the finger is in a cylinder cast. The shadow of the cast can be appreciated on the radiograph

Fig. 2

Various splints have been used including stack splints (a) and dorsal Alumafoam splints (b)

Fig. 3

An example of skin maceration over the DIPJ. This rarely leads to long-term complications unless full-thickness skin loss occurs

Fig. 4

Left middle bony mallet involving a large portion of the articular surface (a). Treated with extension block pinning (b). Radiographic evidence of healing 10 weeks postoperatively (c). The patient was able to resume piano without any difficulties (d)

Fig. 5

A 16-year old male wrestler with a mallet finger that progressed to a flexible swan-neck deformity secondary to concomitant palmar plate injury (a). Reconstruction of the flexible swan-neck deformity using SORL reconstruction with a slip of the EDQ as a tendon graft (b). The graft is fixed to the distal phalanx through a vertical bone tunnel, then rerouted proximally deep to the neurovascular bundle and fixed to the proximal phalanx through a transverse bone tunnel. Tension is adjusted such that passive PIPJ extension results in passive DIPJ extension, a so called dynamic tenodesis (c). Patient immobilized for 6 weeks in a static cast (d). At 4 weeks, the cast may be weaned and gentle active range of motion begun (e). Final follow-up 6 months, full active range of motion (f)

Fig. 6

A classic case of jersey finger in a 14-year-old boy who injured his ring finger following a football tackle

Fig. 7

The avulsed tendon is seen to be retracted to the level of the PIP joint and proximal to the A4 pulley. This is the most common variant of jersey finger

Fig. 8

This patient was diagnosed intra-operatively with a zone III intra-tendinous FDP rupture. He presented clinically with inability to actively flex the DIPJ. Jersey finger was suspected and dissection proceeded from the DIPJ proximally until the site of rupture was identified. Preoperative imaging with ultrasound or MRI may have localized the site of rupture and limited unnecessary dissection

Fig. 9

The pull-out suture technique is depicted in this figure. The tendon is initially sutured with a Bunnell stitch and passed through the A4 pulley and then attached to the distal phalanx and tied to a dorsal button

Fig. 10

Care must be taken at all times to avoid damaging the germinal matrix with the Keith needles and pullout suture. This patient was able to regain nearly full active flexion following repair by 2 (a, b). Full flexion and extension demonstrated 6 months after surgery (c, d)