Am Fam Phys 2001;63:1961; Hand Clin 2000;16:359

Cause:Forced extension of the distal interphalangeal joint

Pathophys:Rupture of flexor digitorum profundus or bony avulsion at FDP insertion onto distal phalanx

Jersey tackle in football, lifting car door latch, ball sports. Digit 4 most commonly affected

Sx:May be painless. History of forced extension. Often presents late

Si:Swelling and redness at distal interphalangeal joint (DIPJ), inability to actively flex DIPJ while middle phalanx immobilized. Do not test strength in flexion—can cause retraction of tendon into wrist and complicate surgery. Pain and/or palpable bony deformity on volar aspect of distal phalanx

Needs surgery for full recovery

Permanent DIPJ dysfunction if untreated. Refer to hand surgeon immediately. Delay leads to tendon retraction into wrist.

Xray:PA, lateral and oblique views of the finger. Splint and refer to hand surgeon

Rx:Surgical tendon reattachment in all cases