My Middle Finger Pops

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My Middle Finger Pops - Page #1

Author: Bernadette Pendergraph, MD Co Author #1: Bernadette Pendergraph, MD Co Author #2: Jason Alvarado, MD Co Author #3: Shintau Lin, MD Senior Editor: Carolyn Landsberg, MD Editor: Jennifer Gaitley, MD Patient Presentation: A 26-year-old male, left hand dominant, professional boxer complained about left middle finger pain with punching following one particular punch. History: This patient complained of sudden onset of left middle finger pain while punching an opponent during a match. He was unable to continue and went to the emergency room for an x-ray. He was placed in a volar splint. He was later referred to our sports medicine clinic and was evaluated eleven days later. He still had pain and swelling over his middle knuckle and noticed something pop in his hand when he extended his digit. He denied any numbness or tingling as well as any weakness of the hand except as related to his knuckle pain. He had worn his splint regularly for three days and then only when he was not training. He denied any other medical problems or joint issues. Physical Exam: His left hand exam showed swelling of the third metacarpophalangeal joint but no ecchymosis or extensor lag. He had tenderness to palpation of the dorsoradial side of his metacarpophalangeal joint. Resisted extension of the middle finger was 4/5 while the rest of hand strength was 5/5. With flexion of his middle finger, the extensor tendon would mildly sublux ulnarly. Sensation was intact with normal capillary refill. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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