Amputation of the fingers can occur at different levels, and all must be cared for as soon as possible. If the finger is completely amputated, an attempt to put it back together under a microscope is important. If the amputation is at the level of the fingertip, the tip of the finger needs to be reconstructed. Typically the amputated part can be found, and its important to first clean it with water, and cover it in a gauze. The part then needs to be put it in a watertight bag, and the bag then placed into another watertight bag that has ice on it. It is important to not put the amputated part in direct contact with ice, because this could further damage the part. The goal of treatment is to try and replant the part, but if we are unable to, we need to reconstruct the finger to provide length and function. If its a fingertip, the nail bed needs to also be reconstructed so that your nail does not grow distorted.
Digital Nerve Injuries
Penetrating injuries to the fingers can lead to loss of sensation, and at times a painful mass along the sides of the injured finger. The fingers have two nerves, also knowns as digital nerves, on the sides of your fingers. Penetrating injuries with a knife while cooking, work related injuries with a table saw, or lacerations with sharp objects can lead to an injury to the nerves. You may have decreased sensation along the side of the finger where the injury occurred, pain, swelling, and if some time has passed, you might have a very painful mass. This is called a neuroma, which is the nerve ending that is now walled off into a ball and is very sensitive to touch. The goal of treatment is to identify the nerve endings, remove the neuroma if there is one, and fix the nerve by bringing the two ends together without tension, and suture them with special sutures that are thinner than a human hair.
Phalangeal fractures are fractures of the small bones of the fingers. There are three small bones in each finger, the proximal, middle, and distal phalanges that allow the fingers to move. Finger fractures can occur from blunt (twisting, fall, crush injury, or sports) or penetrating (gun shots, table saw, or work related) trauma. You may have swelling, tenderness, deformity of the finger, and/or difficulty moving the finger. Sometimes, the affected finger, when you flex your fingers will cross and touch the finger next to it, preventing you from grabbing things. The goal of treatment is to identify the fracture, reduce the fracture to its normal position, and allow the bone to heal. Sometimes physical and occupational therapy might be required.
Finger Masses can be Ganglion cysts, synovial cysts, and benign and malignant masses
Finger masses are common, and can lead to patients worrying about their nature. Most finger masses are benign such as ganglion or synovial cysts, which present as a pain lump within the finger. The masses can grow, and as the place pressure on the nerves cause pain. Typically there is no swelling associated or skin discoloration. If you have skin redness and pain, this could also be signs of infection such as an abscess. The goal of treatment is to identify what type of a mass you have, and if its benign or malignant by sending it for pathological evaluation. There are nerves, arteries and tendons within the finger that need to be protected as the mass is removed to prevent complications.
Jersey finger is an injury to the flexor tendon that attaches to the smallest and most distal bone in our finger on the palmar side. It was coined jersey finger because it occurs commonly on football players that would grab the jersey of their opponent, which causes the tip of the finger to be forcefully extend as the finger is in flexion. The consequence is that the tendon that attaches to the smallest and most distal bone will pull off (avulsed) from the bone and therefore the fingertip can not flex at the tip anymore. Typically you will feel a pop in the finger when you pull on something that forcefully extends you finger at the time of injury, associated with pain, and not being able to bend the distal tip of the finger. The goal of treatment is to repair the tendon back to the distal bone, and if there is a fracture associated to reduce the fracture as well.
A mallet finger is an injury to the extensor tendon that attaches to the smallest and most distal bone in our finger on the top side. It was coined mallet finger, also known as a Baseball finger, because it occurs commonly on patients that have their finger (or thumb) in extension (straight), and the finger is hit by an object (Baseball) at the tip forcing the tip into flexion very abruptly. The consequence is that the tendon that attaches to the smallest and most distal bone will pull off (avulsed) from the bone and therefore the fingertip can not extend at the tip anymore. Typically you will feel a pop in the finger when you get hit with an object and forcefully your finger tip is flexed. At the time of injury it is associated with pain, and not being able to straightened the distal tip of the finger. The goal of treatment is to repair the tendon back to the distal bone, and if there is a fracture associated to reduce the fracture as well. Many times we can treat a Mallet finger with splints without surgery, but if there is a fracture you might require a small procedure.