What is the Hammer Finger?
Hammer toe is a deformation of the terminal interphalangeal joint, which makes it impossible to fully extend the fingers of the hand.
In most occasions, hammer toe is caused by a traumatic event: the tendon that allows the third (distal) phalanx to be extended can stretch or break; consequently the finger tip remains in the flexion position and its straightening (extension) therefore becomes impossible.
Treatment includes immobilization of the finger in a passive extension position with a brace, for approximately 6 to 8 weeks. If the tendon of the common extensor muscle of the fingers is detached from the phalanx or if the fracture is extensive, the patient can be surgery to facilitate the repair process of the affected structures Avulsion fractures usually heal after approximately 6 weeks, but tendon damage takes approximately 8-10 weeks to heal.
Causes
The hammer toe is due to a forced flexion of the distal interphalangeal joint (IFD, in the last part of the finger), which can cause tendon damage (stretching or rupture) or a fracture of the part of the bone where it tendon inserts itself (avulsion fracture).
Hammer toe in the hand is a common sports injury, mainly affecting softball, baseball, volleyball, basketball or soccer goalkeepers: during play, the ball hits the open hand in order to be caught and can cause hyperflexion. or a rupture of the extensor tendon near its insertion on the distal phalanx.
Symptoms
Symptoms affecting the damaged finger can include:
- Pain, especially in case of muscular effort;
- Swelling;
- Inability or difficulty to fully extend the finger, resulting in severe functional and aesthetic deficit.
In case of trauma, the signs of the injury appear within a short time.
Delaying hammer toe treatment can cause permanent functional damage or make healing more difficult. After the injury it is advisable to immobilize the affected area and contact your doctor or the emergency room as soon as possible, so that the extent of the injury is assessed: the sooner the hammer toe is treated, the better the recovery. keep the hand raised above the level of the heart until the extremity is examined during the physical examination. The diagnosis of hammer toe is confirmed by the evident presence of the clinical signs described above. An x-ray exam helps determine the type of injury (tendon strain or rupture) and whether there is any bone fragment (avulsion fracture) at the base of the distal phalanx. The characteristics of the lesion allow to define the most appropriate therapeutic approach to be adopted.
Treatment
- Tendon stretch or tear: conservative treatment with a brace In most cases, the doctor may recommend that you put ice on the injured area to limit swelling and apply a brace (or splint), that is a "special rigid plastic splint (or splint). aluminum), which keeps the finger in a straight position and with the tip slightly backwards (ie with the last phalanx more extended). Immobilization of the affected part allows the terminal interphalangeal joint to be maintained in extension and allows the structures concerned to rest during healing.
The brace should be placed by a qualified professional who must ensure that the support fits properly and the finger is in the correct position for healing. The splint should be snug enough to hold the finger in a proper position, but not too tight to cut off blood flow (if the skin is white when removed, it may be too tight). The brace should only be removed from the patient for daily cleaning operations.
Conservative treatment can be used for different time periods:- If the tendon is strained and not torn: Hammer toe should heal in about 4 to 6 weeks by wearing a brace all the time.
- If the tendon is torn or a small bone detachment is present: the brace should be worn day and night for 6 - 8 weeks to allow the two ends of the torn tendon and / or bone fracture to heal. , it is necessary to wear this support for another 3 - 4 weeks, but only during an overnight stay.
- The finger is still swollen at the end of the treatment;
- Pain tends to get worse;
- Numbness or tingling develops at the tip of the finger and the skin changes color.
- Tendon rupture and major bone detachment: percutaneous Kirschner treatment and extension block
If you delay starting treatment after the injury, you may need to wear the brace for longer. While it is still possible to use your finger, it is important to remember not to move it too much until it is completely healed, as this may delay healing and cause permanent damage.
For pain relief, painkilling drugs such as paracetamol, ibuprofen or naproxen can be taken, on medical advice. acute: you can apply the ice pack for 10-20 minutes 3 times a day or as needed.
The patient should consult the doctor if:
If the damage is more severe (for example, in the presence of a severe bone fracture or possible subluxation), surgery may be required. If passive extension cannot be achieved, the physician can proceed with immobilization by extending the joint with Kirschner wires (also called K-wire) for 4 weeks. In the most recent trauma, the K wire facilitates the autonomous repair process of the tendon and the avulsed bone fragment. In the less recent injury, however, the finger is immobilized with the same procedure, but after surgical suturing of the tendon. In case of finding a large bone fragment, that is when the lesion involves more than 30% of the articular surface, the fracture can be stabilized with metal wires to facilitate the repair process.
Other surgical options may be proposed to the patient if conservative treatment is not effective or if too much time has passed since the injury (example: distal interphalangeal arthrodesis, tenodermodesis or tenotomy).
The healing time depends on the cause and timing of the intervention: early treatment significantly decreases the severity of the injury and accelerates recovery. For this reason, the correct diagnosis of the injury should be made within the shortest possible time. Hammer toe it should heal within 6-8 weeks. However, it may take a few months to regain full function of the finger. Symptoms such as redness, swelling and pain of the skin covering the tip of the finger also tend to disappear completely. after three or four months after the injury Your doctor may recommend some exercises for rehabilitation and indicate if you need to continue wearing the brace overnight for a few weeks.
The patient should be informed that the finger may remain slightly flexed at the end of the treatment, but this does not compromise normal work or daily functions. Finally, most people affected by hammer toe can still practice sports with a brace to protect the joint.
