Will my inability to extend my middle finger, but ability to flex it, due to a possible nerve injury or compression, given my history of mild wrist drop and stiffness after a previous needle injection, heal on its own or require medical intervention?

Inability to Extend Middle Finger with Preserved Flexion

You need immediate medical evaluation with radiographs and clinical examination to determine if this is an extensor tendon injury (mallet finger), nerve injury, or other structural damage—the prognosis depends entirely on the specific diagnosis and timing of treatment. 1, 2

Immediate Assessment Required

Obtain radiographs immediately to differentiate between:

• Bony mallet finger (avulsion fracture at extensor tendon insertion at DIP joint) 1, 2
• Tendinous mallet finger (pure tendon rupture without bone fragment) 2
• Nerve injury (radial nerve injury affecting finger extension, particularly given your history of needle injection) 3, 4

The American College of Radiology emphasizes that radiography is always indicated as initial imaging for suspected acute hand trauma, as standard radiographs are sufficient for differentiating between tendinous and bony injuries and can detect fracture fragments. 1, 2, 5

Most Likely Diagnoses Based on Your Presentation

If This is Mallet Finger (Most Common for Single Finger Extension Loss)

Prognosis is generally good with appropriate treatment:

• Tendinous mallet finger: Requires 6-8 weeks of continuous DIP joint splinting in slight hyperextension 2
• Critical point: Even brief removal of the splint restarts the healing timeline—uninterrupted immobilization is essential 2
• Surgical indications (require orthopedic referral): 1, 2
  • Avulsion fractures involving ≥1/3 of the articular surface
  • Palmar subluxation of the distal phalanx
  • Interfragmentary gap >3mm
  • Open injuries

During splinting, you must perform active finger motion exercises of the PIP and MCP joints immediately while keeping the DIP splinted to prevent stiffness. 2

If This is Nerve Injury (Given Your History of Needle Injection and Wrist Drop)

Prognosis varies significantly:

• Radial nerve injury from injection: 23% (13/56 patients) recovered spontaneously in one series; others required neurolysis or tendon transfers 4
• Superficial radial nerve injury from wrist injection: 36.4% (4/11 patients) completely recovered within 3 months; 63.6% had persistent symptoms 3
• Median/ulnar nerve injection injuries: Showed significant improvement with neurolysis and debridement, but with some permanent functional loss even at 1-11 years follow-up 6

If nerve injury is suspected, early intervention matters:

• Patients with causalgia (severe burning pain) may benefit from steroid infiltration injections 3-5 times 3
• Surgical neurolysis within appropriate timeframe (typically performed in cases not responding to conservative treatment) 4, 6
• Modified tendon transfers may be needed for persistent radial nerve palsy 4

Critical Next Steps

1. Seek immediate evaluation with hand surgeon or orthopedic specialist 1, 2

2. Obtain 3-view radiographs of the affected finger to rule out fracture and guide treatment 1, 2

3. Do not attempt to straighten the finger yourself before proper evaluation and splinting 2

4. Apply ice (not heat) with ice-water mixture for 10-20 minutes with thin towel barrier to reduce swelling 2

5. If unremitting pain develops, re-evaluate immediately as this may indicate complications 1, 2

Prognosis Summary

The prognosis depends critically on the specific diagnosis:

• Mallet finger with proper treatment: Excellent prognosis with 6-8 weeks continuous splinting 2
• Nerve injury from injection: Variable—ranging from complete recovery in 3 months to permanent partial deficit 3, 4, 6
• Delayed treatment of either condition: Significantly worsens outcomes 2, 7

The key determinant of your outcome is obtaining proper diagnosis and treatment within the next few days, not weeks. Delaying evaluation can lead to permanent functional impairment regardless of the underlying cause. 1, 2, 7