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by Kellicker PG

Finger Extensor Tendon Injury

(Mallet Finger; Boutonniere Deformity)

Definition

Tendons are responsible for connecting muscles to bone. The fingers have tendons that run from the forearm through the finger. The extensor tendons are located on the back of the hand and fingers. They let you open your hand and straighten your fingers. An extensor tendon injury is a cut or tear to one of these tendons. When they are damaged, you can lose the ability to extend your hand and/or finger(s). Two common extensor injuries are:
  • Mallet finger—the tendon is affected at the last joint on the finger, usually from a jammed finger
  • Boutonniere Deformity—the tendon is affected at the middle joint, usually caused by an arthritis-like condition
Extensor Tendons of the Hand
extensor tendon
Copyright © Nucleus Medical Media, Inc.

Causes

Extensor tendon injuries may be caused by:
  • A cut or laceration to back of hand or fingers
  • Broken bones
  • A crush injury
  • An open wound or cut
  • Jamming a finger
  • Arthritis
  • Nerve compression

Risk Factors

Factors that may increase your chance of an extensor tendon injury include:
  • Participating in certain sports
    • Basketball
    • Football
  • Arthritis

Symptoms

Symptoms may include:
  • Inability to open hand or fingers
  • Pain
  • Numbness or weakness
  • Cut to back of hand or fingers
  • Jammed finger

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. During the exam, you will be asked to bend and straighten your fingers. Your doctor will also check your fingers for sensation, blood flow, and strength. You may be referred to a hand surgeon or an orthopedist—doctor who specializes in bones.
Images may be taken of your hand. This can be done with x-ray.

Treatment

Talk with your doctor about the best plan for you. Depending on the type of injury, you may require surgery. Surgery may be scheduled right away or within several days.
Treatment options include the following:

Medications

Depending upon the type of injury, you may receive antibiotics to prevent infection.

Surgery

Tendons that are cut or ruptured require surgery. The hand surgeon may sew the tendon back together. A pin may need to be inserted through the bone to form a type of inside splint.

Rehabilitation

After surgery, you will be given a splint to protect your hand. Your doctor will tell you how long to wear it. It may be up to two months.
A physical therapist or occupational therapist will work with you for several weeks to regain your strength and range of motion. Right after surgery, movement will be limited. This will allow your hand to heal.
After surgery, you will be given a splint to protect your hand. Your doctor will tell you how long to wear it. It may be up to two months.
A physical therapist or occupational therapist will work with you for several weeks to regain your strength and range of motion. Right after surgery, movement will be limited. This will allow your hand to heal.

Splinting

Some extensor tendon injuries are treated with a hand splint. Splints are worn until healing has occurred. This is usually several weeks.

Prevention

Extensor tendon injuries are typically caused by accidental injuries. There are no known prevention guidelines for this injury. But, the deformities caused by these injuries may be prevented by taking certain measures, like splinting the finger or undergoing surgery.

RESOURCES

American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org

American Society for Surgery of the Hand http://www.assh.org

CANADIAN RESOURCES

The Canadian Orthopaedic Association http://www.coa-aco.org

Canadian Orthopaedic Foundation http://www.canorth.org

References

Extensor tendon injuries. American Society for Surgery of the Hand website. Available at: http://www.assh.org/Public/HandConditions/Pages/ExtensorTendonInjuries.aspx. Published 2010. Accessed August 21, 2013.

Leggit JC, Meko CJ. Acute Finger Injuries: Part I. Tendons and Ligaments. Am Fam Physician. 2006 Mar 1;73(5):810-816. Available at: http://www.aafp.org/afp/2006/0301/p810.html. Accessed August 21, 2013.

To P, Watson JT. Boutonniere deformity. J Hand Surg Am. 2011;36(1):139-142.

Zhang X, Yang L, et al. Treatment of bony boutonniere deformity with a loop wire. J Hand Surg Am. 2011;36(6):1080-1085.

Revision Information

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