20240906 Ext tendon injuries Dr Ruben

A 32-year-old football player sustained an injury to his right middle finger a month ago while grabbing an opponent's jersey. He presents with a finger that is stuck in a flexed position at the proximal interphalangeal joint but can extend the joint proximal and distal to it. What is the likely condition?

• A) Boutonnière deformity

• B) Jersey finger

• C) Mallet finger

• D) Extensor tendinitis

• E) Swan neck deformity

A 28-year-old musician presents with a finger injury after accidentally striking it against a hard surface. He reports that his finger tip droops and he cannot extend it. On examination, there is no wound but the distal phalanx remains in a flexed position. What is the best initial treatment?

• A) Active range-of-motion exercises

• B) Surgical intervention

• C) Splinting in the extended position

• D) Application of a heat pack

• E) Splinting in the flexed position

A healthy 60-year-old patient who underwent extensor tendon repair 10 weeks ago presents with decreased finger extension and painless swelling at the surgical site. There is a concern for complications post-repair. Which complication should be most highly suspected in this patient?

• A) Tendon rupture

• B) Joint contracture

• C) Tendon adhesions or scar tissue formation

• D) Surgical site infection

• E) Complex regional pain syndrome

An 18-year-old male presents to your clinic after sustaining a left-hand injury while playing basketball with his friends. He has swelling over the left middle finger. Radiographs are normal. When you flex his PIPJ over the edge of a table and ask him to extend his finger against resistance, his DIPJ becomes taut. You discuss initial non-operative management with the patient. Which of the following is the most appropriate initial plan of care for the treatment?

• A) PIPJ dorsal blocking splint for 4-6 weeks

• B) Full time DIP splinting for 4-6 weeks

• C) MCPJ flexion splinting for 4-6 weeks

• D) PIPJ splinting for 6 weeks while allowing DIPJ motion

• E) PIPJ and DIPJ splinting for 6 weeks, then allow gentle passive ROM of DIPJ

A 12-year-old boy crushes his middle finger in a car door. He presents with pain and swelling of the finger. Examination reveals an apparent mallet deformity. The nail plate is avulsed with subungual hematoma and considerable swelling about the fingertip. Radiographs are as shown. What is the next best step?

• A) Mallet splint in situ

• B) Buddy taping to the ring finger

• C) Closed reduction and DIPJ sparing pinning

• D) Nail plate removal, nail bed repair, DIP sparing pinning

• E) Nail plate removal, nail bed repair, cross DIPJ pinning