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Kinetics-Att 13(2), pp. 11-13 CASE REVIEW CLOSED TENDON injuries of the hand and wrist are very common among athletes. Because such injuries are often considered minor, many go untreated during the competitive season. A good result is usually obtained when treatment is initiated early, but permanent disability may result if treatment is delayed until the season is over. Mallet finger, which is the most common closed tendon injury in the athletic population, is a disruption of the terminal extensor tendon at its insertion on the distal phalanx. 1,2 A mallet-type injury to the thumb is quite rare, but it can occur during participation in a contact sport. According to Doyle, 3 mallet-type injuries of the thumb account for 2%-3% of all mallet finger injuries. The mechanism of thumb extensor tendon injury is similar to that which occurs in the other fingers. A direct blow to the tip of an extended finger forces the distal phalanx into flexion. A direct blow to the dorsum of the distal interphalangeal (DIP) joint, or a hyperextension force at this joint can also be the cause of these injuries. 1 Mallet thumb involves disruption of the extensor pollicis

HISTORY:A 20 yo female collegiate lacrosse goalie presented to the clinic for right elbow pain and popping. Her pain began about 18 months ago when she fell on an outstretched hand during a game, causing a valgus stress at her right elbow. She was treated initially as a UCL sprain with decreased activity, then return to normal participation. She reported intermittent pain since. Her pain was at her right medial elbow (severity of 6/10), worse first thing in the morning. She described popping with flexion and extension and reported dysesthesias in the right 4 th and 5 th digits with this maneuver. Denied swelling. EXAM: MSK: R Shoulder: Full AROM symmetric with contralateral. R Elbow: Full AROM, pain in deep flexion. No joint effusion. Clicking noted over cubital tunnel. Pain and laxity on valgus stress at 30 and 70 degrees of flexion. Pain with Milking maneuver. No pain at the tricep or with resisted extension. Focal tenderness to palpation at the medial joint line and at the inferior and posterior medial epicondyle. Positive Tinel's. R Wrist: Full AROM symmetric with contralateral. Skin: No ecchymosis or erythema. Neuro: Sensation grossly intact, strength 5/5 symmetric in upper extremities. DIFFERENTIAL: Valgus extension overload syndrome, ulnar neuropathy, ulnar nerve subluxation, UCL sprain/tear, loose body RESULTS: R elbow: X ray 3 view: No fracture or dislocation. MSKUS: Hypoechoic area within the UCL consistent with partial tear. Laxity demonstrated on stress testing. Subluxation of the ulnar nerve demonstrated from within the cubital tunnel riding over the medial epicondyle during flexion. MR arthrogram: Partial-thickness tear (grade 2 sprain) of the UCL at its insertion. A few intact insertional fibers remain. FINAL DIAGNOSIS: Right UCL partial tear and ulnar nerve subluxation TREATMENTS/OUTCOME: We discussed treatment options with patient, with concomitant issues surgical intervention was chosen. Patient underwent a right UCL repair and ulnar nerve subcutaneous transposition without complication. At 5 weeks post op she had full AROM and resolved ulnar dysesthesias. She then underwent a guided physical therapy program and at 3 months after surgery she had full painless ROM and no instability. She was cleared to increased activity as tolerated and allowed to participate in her season starting 4 months post-operative.

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