The distal interphalangeal joints are the terminal finger joints, allowing the fingertips to contact objects precisely and adapt their position for grip. The extensor tendon inserts at the dorsal base and the FDP tendon at the volar base, making DIP joint injuries prone to imbalanced tendon function. Heberden nodes (osteophytes at the DIP joint) are the hallmark of primary osteoarthritis of the hand.
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Mallet finger, the most common closed extensor tendon injury, avulses the terminal extensor from the distal phalanx base during sudden forced DIP flexion (catching a ball on the fingertip), producing a drooping distal phalanx managed with 6 to 8 weeks of continuous DIP extension splinting. Bony mallet injuries with a large fragment (about one third of the joint surface or more) or joint subluxation may need surgical fixation. Jersey finger, avulsion of the FDP from its distal phalanx insertion during gripping (pulling a jersey), is less common but requires surgical reattachment as the tendon retracts proximally. DIP arthrodesis reliably relieves pain from advanced DIP osteoarthritis.
Terminal extensor tendon avulsion producing DIP flexion drop deformity from a ball or object jamming the fingertip, managed with full-time DIP extension splinting for 6 to 8 weeks.
FDP avulsion from distal phalanx insertion producing inability to flex the DIP joint, requiring urgent surgical repair as the retracted tendon loses vascularity.
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