Am Fam Phys 2001;63:1961; Hand Clin 1995;11:373

Cause:Forced flexion of the distal interphalangeal joint

Pathophys:Rupture of extensor digitorum longus or bony avulsion at EDL insertion onto distal phalanx

Ball sports, falling. Digits 2 and 3 most commonly affected

Sx:May be painless. History of forced flexion and pt may hear popping sound as injury occurs

Si:Flexion deformity at DIPJ, inability to actively extend DIPJ. Pain and/or palpable bony deformity on dorsal aspect of distal phalanx

Full recovery if treated

Permanent DIPJ dysfunction if untreated. Refer to hand surgeon if extensor lag present after 6-8 weeks of splinting.

Xray:PA, lateral and oblique views of the finger. Refer to hand surgeon for avulsion fx involving >30% of the articular surface. Postreduction radiographs if applicable

Rx:Splinting of the DIPJ in slight hyperextension for 6 weeks, 8 weeks for older adults, athletes. Reduce avulsion fx with dorsal pressure prior to splinting, only needs 4 weeks splint. Finger must never fall into flexion, resplint for 6 weeks if it does. Evaluate for extensor lag only after 6-8 weeks (see above).