Small things that make a difference

Tuesday, December 2, 2008

Our body is often taken for granted, presuming that it will work regardless of what insult or injury we inflict. And while we cherish our hearts, minds and our senses, it may be our hands that are most forgotten and mistreated. The hands and fingers can become a powerful fist and still maintain the fine motor function to thread a needle. Yet a relatively minor injury can cause the mechanism to fall apart. Ask Brady Quinn, recently injured Cleveland Brown quarterback, whose injured index finger tip made it impossible for him to throw a spiral.

The hand and fingers are really a set of pulleys that allow each finger’s joint to move independently. While most of the muscles that move the fingers are located in the forearm, it is the tendon that attach across each joint that allows movement when the muscle contracts. Any damage to the muscle, the tendon or the bone will interfere with that joint’s function.

Count the joints in the hand: two for the thumb, and three for each finger for a total of 14 muscle tendon units that have to work together for the hand to function. The joints are named for the bones that they connect. Each finger has three phalanges (except for thumb which has two): distal near the nail, middle in the middle and proximal closest to the hand and its metacarpal bones. The joints are named for the bones they connect: MCP metacarpal-phalangeal, PIP proximal interphalangeal and DIP the distal interphalangeal.

Mr. Quinn damaged his DIP joint, the one that bends the tip of the finger and when throwing a football, imparts the spin on the ball. It’s a common injury called a mallet finger, where the extensor tendon, the one that straightens the fingertip is torn away from the bone. Sometimes a bit of bone comes with it; sometimes it’s just the tendon. Regardless, the fingertip droops and it’s a problem even for non-football players. Imagine dialing a phone (I know it’s a little dated) or stuffing your hand in the pocket of your blue jeans. The finger would get in the way if it couldn’t extend. It’s a small action that is taken for granted but is more than a little inconvenient when it fails.

There are a couple options for treatment of a mallet finger. Option one is non invasive and takes a leap of faith that it will work. Put a metal splint on the finger, leave it on 24 hours a day for 6 weeks and let the injury heal itself. Add a couple of weeks for getting the range of motion back and you’re done. Option two involves an operation where the tendon is skewered with a small pin and attached back to where it belongs. After a few weeks, the pin is removed, rehab happens and all is well. Each option has its pros and cons and after a couple of weeks of thinking about it, Quinn has decided on the surgical approach. Often in medicine, there is no right or wrong decision. What works for one person’s situation may not be right for another.

The hand is an amazing thing. It gets placed in great danger everyday. It comes close to sharp objects like knives and saws. It gets exposed to caustic chemicals or to cold and heat. The closest a hand gets to gratitude is perhaps some lotion or gentle soap. Like Rodney Dangerfield, they get no respect.

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