Injured Bird
Russell Wilson’s Finger Injury
Things went from bad to worse on Thursday night when Russell Wilson went down in the third quarter with a right middle finger injury. As his hand followed through his throw, Wilson hit the hand of Aaron Donald violently which caused his middle finger to become dislocated. It has since been disclosed that he has two injuries to his finger including an extensor tendon rupture (mallet finger) and a comminuted fracture-dislocation of the proximal interphalangeal joint. He had surgery the next day to repair his finger and will likely be out for a minimum of 4-6 weeks.
What is Mallet Finger?
Mallet finger refers to a torn extensor tendon that inserts into the base of the distal phalanx (tip of the finger). When activated, the extensor tendon causes the distal interphalangeal joint to extend (straighten). When this tendon is ruptured, the distal phalanx hangs down in flexion because it is no longer supported by the dorsally located (top) extensor tendon.
Mallet finger is the most common finger tendon injury in sports (1). It can commonly occur when an object, like an opposing player’s hand in Russell’s case, strikes the tip of the finger. With the average hand speed of an NFL quarterback at 82 mph, it is not a surprise that a bone or soft tissue injury can occur. The impact on the tip of the finger causes the extensor tendon to pull away from its attachment just below the nail bed. When this happens, the tip of the finger undergoes a flexion deformity.
“With the average hand speed of an NFL quarterback at 82 mph, it is not a surprise that a bone or soft tissue injury can occur. ”
Wilson’s hand was shown on the Fox Broadcast repeatedly as he attempted to extend all of his fingers, but the distal phalanx hung helplessly below the rest of his extended middle finger.
Treatment for Mallet Finger
According to Wieshhoff et al., there is usually no indication for surgical treatment of a simple mallet finger. The conservative treatment is to splint the finger in extension for 4-6 weeks. In some cases, an avulsion fracture fragment (mallet fracture) is seen at the dorsal base of the distal phalanx. When this occurs, surgical intervention is often considered to prevent instability and ensure full range of motion. The surgeon that repaired Russell’s finger at Dr. Steven Shin, MD mentioned that both of his injuries were repaired, so there is high likelihood that Russell sustained a mallet fracture injury in addition to the extensor tendon rupture.
““I am fully confident Russell will return to the NFL this season and play at the same world-class level that fans have come to expect of one of the game’s very best quarterbacks.””
How Does this Effect Russell’s Ball?
This also affects his grip because even though the flexors of the hand and fingers would be active to squeeze the ball, there is also a level of co-contraction of antagonistic muscles required to keep the ball in his hand. The more he flexed his hand and fingers, the more uncomfortable it felt through his finger where he tore the extensor tendon. Similarly, when he would try to throw the ball, there would be a lack of control of his throwing finger either because of the ruptured tendon making it nearly impossible to finesse the ball into tight windows for his receivers. Mallet fingers can typically be treated conservatively with bracing to avoid surgery unless avulsions or other fractures are present as were in Wilson’s case Thursday night.
Fracture & Dislocation
What complicates Russel’s injury even more is that he also sustained a comminuted fracture-dislocation of bones closer to his knuckle (PIP Joint) on the same finger. The PIP joint is one of the most commonly “jammed” joints in the hand. In cases when the joint has been relocated and there is little or no articular surface involvement, the finger can be buddy taped for several weeks and have a great outcome. This is not very practical for a quarterback as much of the grip of the ball is achieved through the middle and index fingers.
Comminuted refers to there being more than two pieces of broken bone. Unfortunately, this requires a more complicated procedure that can involve screws, pins or wires depending on the exact conditions of the fracture and techniques used. According to Dr. Steven Shin, MD, Russell required surgical stabilization at this joint which suggests that the joint was not stable upon relocation and needed either wires or a plate to achieve an optimal outcome.
As a result, the hardware helps realign and set the bones in order for them to heal properly. The common extensor tendon that Wilson injured has its muscle origin much further up his arm which helps explain why he is wearing such a big splint so as to protect any significant hand or wrist movement while the bones and tendons heal. There are several nuances to what exact surgical techniques may have been used depending what parts of the bones and tendons around the proximal interphalangeal joint. As long as the hardware is in place and stable, he should be able to begin the rehab process sooner than later per his surgeon’s recommendations. He will have to work on reducing swelling and regaining his motion back in his fingers while the structures heal. Swelling and pain management are also important points to consider as well. Wilson’s surgeon is confident that he should return this season and be able to regain full form. Wilson and the team moved forward with this surgery in favor of his long term health.
How Important is the Middle Finger?
Extremely important. When throwing a football, Russell’s legs, core, and trunk provide his power, but his fingers deliver the spin and precise touch. The middle finger is the last finger that touches the ball as it is being released and is critical to create balance and spin on the football. When a spiral is thrown correctly it spins 450-600 rpm! To deliver that amount of spin, Russell needs to have a middle finger that is structurally stable and can achieve full active ROM.
“Without the middle finger fully recovered you would expect Russell’s accuracy to suffer significantly. This would be most evident on comeback routes, slants, and out routes. The long ball would still be there but with less precision.”
Besides throwing a football, Russell needs a strong grip for ball control as he receives snaps, runs with the ball, and withstands contact. The surgically repaired mallet finger and PIP will provide Russell with the stability, ROM, and confidence that he needs to return to his Pro-Bowl caliber level of play. Ball security on scrambling and during sacks will be something to watch as well.
What Does Russell Wilson’s Physical Therapy Look Like?
Russell is a master healer and has placed top-notch rehabilitation and recovery specialists around him for years to help him record 149 consecutive starts as quarterback. According to Wilson from a CBS interview on October 29th, 2020 “I have a whole performance team. I’ve got a whole group, I’ve got a full-time trainer that travels with me everywhere, works with Ciara too. I have a full-time physical therapist. I have a full-time mobile person that’s working on me, that’s making sure I’m moving the right way and everything else. I have a full-time massage person. We have two chefs. We have a whole performance team.”
When asked how often he works out and focuses on his body, Wilson boldly states “I do 365. The reality is Christmas and Thanksgiving—depending on the circumstances, but we usually have a game around then. I’m in between 363 and 365 amount of work that we do every day, something around the work I do. I’m trying to play until I’m 45, at least. For me, my mentality is that I’m going to leave it all on the field and do everything I can to take care of myself.”
I have no doubt that while he may not be throwing a football over the next 4-6 weeks for the Seahawks, he will be doing everything imaginable to maintain his fitness and mental toughness. I’m hard-pressed to think of another professional athlete that takes care of his body to the same degree as Russell Wilson. Like Russell has done so many times throughout his career, he will put in the work necessary to finish strong and make a comeback that we surely will not forget. Go Hawks!
Authors:
Mark Bouma, PT, DPT, OCS, COMT, CSCS, FAAOMPT, CFI
Victor Kollar, PT, DPT, TPIc
Ben Wobker, PT, MSPT, CSCS, SFMAc
Sources:
Bellingham Herald. https://www.bellinghamherald.com/sports/article254855797.html
Elfar, J., & Mann, T. (2013). Fracture-dislocations of the proximal interphalangeal joint. The Journal of the American Academy of Orthopaedic Surgeons, 21(2), 88–98. https://doi.org/10.5435/JAAOS-21-02-88.
Hu, Dan & Howard, David & Ren, Lei. (2014). Biomechanical Analysis of the Human Finger Extensor Mechanism during Isometric Pressing. PloS one. 9. e94533. 10.1371/journal.pone.0094533.
Seahawks News. https://www.seahawks.com/news/seahawks-qb-russell-wilson-undergoes-surgery-on-injured-finger
Yeh PC, Shin SS. Tendon ruptures: mallet, flexor digitorum profundus. Hand Clin 2012;28(3):425-430, xi.
Wieshchoff et al. Traumatic Finger Injuries: That the Orthopedic Surgeon Wants to Know. RadioGraphics 2016; 36:1106-1128.