?RCL PIPJ Injury

[Diane]

Hi Steve,

I scanned this guy who had an axial loading to his pinky, swollen around the Right 5th PIPJ for months.
I thought there was an avulsion fragment at the level of the middle phalanx base which was seen on XR.
What are your thoughts on the pictures of the RCL? I was thinking there could have been an anechoic area = ? tear. Pt was mostly sore here.
I’ve included some cineloops of me attempting to move the finger.

Thanks!

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[Stephen Bird]

Great images, so it makes my job really easy,

This is a typical volar plate avulsion injury which has taken a small piece of the base of the Px with it.

This is a common injury (netball is the most common).

The RCL is also torn.

The volar plate and the RCL are simply parts of the joint capsule and the vector of force here has damaged these two components.

Time for some buddy strapping to the ring finger.

I love that you call it the “pinky”

but now we are supposed to call them : Thumb, Index, Middle, Ring and Little. This removes all confusion.

Not 1, 2 , 3 , 4, and 5

and NOT : Hitch-hiker, pointer, rude finger, useless finger and Pinky !!!

Great case Diane, beautiful images.

Steve

[Diane]

Thanks Steve, I didn’t realise those terms were standard. What do you use for naming the toes? I googled it and it came up as:
“The first toe, also known as the hallux (“big toe” or “great toe”), the innermost toe.
The second toe, or “long toe”
The third toe, or “middle toe”
The fourth toe, or “ring toe”
The fifth toe, or “little toe”, “pinky toe”, or “baby toe”), the outermost toe.”

Also for a torn RCL, is there any clinical significance? Or is it like a torn ATFL of the ankle where they can get by with it?

Thanks!

[Stephen Bird]

Perhaps:

This little piggy went to market
This little piggy stayed home,
This little piggy had roast beef,
This little piggy had none
etc

Was this a thing when you were a kid?

Haha

I use either great toe or Halux,

then call them 2nd, 3rd, 4th, 5th

But I agree this might be incorrect,

Foe the RCL, it just scars up like an ATFL as there is no adductor aponeurosis to get in the way so conservative management is the normal process.

Steve

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