Distal interphalangeal (DIP) dislocation DIP dislocations can occur dorsally, volarly, or laterally, with dorsal dislocations being most common. Dorsal DIP injuries are often associated with fractures and skin injuries, and isolated DIP dislocation without these associated injuries is rare. Volar DIP dislocations are similar to dorsal PIP dislocations in that both are associated with extensor tendon injury. Lateral DIP dislocations are associated with the greatest degree of postdislocation instability (Taqi & Collins, 2022). Clinical Presentation Clients will present with pain/discomfort and clicking and/ or locking of the affected finger. The finger may lock in extension or be unable to extend from a flexed position (Jeanmonod et al., 2023) There are often functional limitations with use of the hand. Examination may reveal a tender nodule at the distal palmar crease. The finger may be flexed and locked and moving it may cause pain and snapping (Jeanmonod et al., 2023).
Deformity with PIP fracture or fracture-dislocation may be angular or rotational. Rotational deformity may be less obvious with observation but can be tested via finger flexion from an extended position. When flexed, all the fingers should point toward the scaphoid tubercle. Overlap or scissoring in this position may indicate rotational deformity. Palpation not only of the injury site but of the surrounding soft tissue is important in determining the complexity of the injury (McDaniel& Rehman, 2023). Trigger finger Trigger finger is a clicking and/or locking of a finger or thumb due to stenosing finger flexor tenosynovitis. The thumb as well as the third and fourth fingers are most commonly involved, as is the dominant hand. Trigger finger involves the A1 pulley, which becomes thickened and stenotic with progressive deterioration of the inner fibrocartilaginous gliding surface, which produces tendon friction. This friction leads to inflammation and nodular changes in the tendon (Merry et al., 2020). Trigger finger is associated with certain medical conditions, including diabetes, amyloidosis, carpal tunnel syndrome, gout, thyroid disease, and rheumatoid arthritis (Jeanmonod et al., 2023). Flexor digitorum profundus tendon avulsion injury (AKA jersey finger) The flexor digitorum profundus (FDP) is the chief gripping muscle when the wrist is extended and the sole flexor of the DIP joint in fingers 2 through 5. This injury is called jersey finger because it occurs to the finger that is caught in the jersey of a player who continues to run away. Forceful extension of the finger leads to avulsion of the FDP tendon (Abrego & Shamrock, 2023). These injuries can be classified into three types: (1) retraction of the tendon into the palm; (2) tendon retracted to the PIP, with possible small bone fragment avulsion; and (3) avulsion with a large bony fragment that prevents retraction beyond the middle phalanx (Gil & Weiss, 2020). Thumb ulnar collateral ligament injury (AKA Gamekeeper’s thumb or skier’s thumb) The ulnar collateral ligament stabilizes the base of the thumb at the first metacarpophalangeal (MP) joint. Ulnar collateral injuries of the thumb were first described in gamekeepers who sustained the injury by repeatedly killing small game by breaking their necks. In such cases, repeated thumb hyperextension would mechanically lead to overloading and degeneration/tears of the ulnar collateral ligament at the base of the thumb (Mohseni & Graham, 2023). Skiers also experience this injury from sudden hyperextension and hyperabduction of the thumb from falling on a ski pole with an outstretched hand (Gil & Weiss, 2020). Mallet finger Mallet finger occurs when there is a disruption of the terminal slip of the finger extensor mechanism that causes the characteristic extensor lag (Gil & Weiss, 2020). The most common mechanism of injury is a sudden flexion of the finger at the DIP joint, resulting in a tearing of the extensor tendon where it attaches at the distal phalanx (Turner et al., 2023).
Clinical Presentation The patient’s history is relevant, including mechanism of injury and a pop or ripping sensation when the injury occurred. Patients with this injury have an inability to actively flex the DIP. Pain, bruising, and edema may be present in the finger and palm. Palpation may reveal tenderness along the palm of the hand (Abrego & Shamrock, 2023).
Clinical Presentation Patients with this injury complain of pain at the base of the thumb that increases with gripping (Gil & Weiss, 2020). Their history typically includes a fall with extreme hyperextension or hyperabduction of the thumb. Examination should include a valgus stress test that is performed by abducting the thumb at its base to determine if laxity is present (Mohensi & Graham, 2023). A lack of end feel would indicate instability related to ulnar collateral injury. The valgus test should also be completed with the thumb in 45 degrees of flexion (Mohensi & Graham, 2023). Clinical Presentation Patients with this injury will complain of pain and swelling at the end of the finger. The distal phalanx will be flexed, and the patient will not be able to actively extend the DIP joint. During evaluation, it is important to assess range of motion by isolating the DIP joint. Tenderness and swelling may be present over the joint (Turner et al., 2023).
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