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Wednesday, October 15, 2008
Updated: October 16, 11:32 AM ET
ANSWER GUY: DO YOU REALLY NEED YOUR PINKIE FINGER?


Yes, they're all precious. But which finger would you miss the least?

In his latest column for espnthemag.com, Rick Reilly writes about Trevor Wikre, the Mesa State College offensive lineman who elected to have his right pinkie finger amputated in lieu of treatment that would keep him out for the rest of his senior season. Wikre's surgery allowed him to get back on the field to pancake linebackers for a few more games, but at what cost? We spoke with Dr. Nader Paksima DO, MPH, Assistant Chief of the Hand Service at the NYU Hospital for Joint Diseases to get an idea of what life is like without your little finger.

Mag.com: Honestly, how important is your pinkie finger, really? Dr. Paksima: Sometimes people think "Well the little finger, that's pretty useless, that doesn't do anything." And that's actually not true. The little finger is very important in a strong grip.

How so? You know how you're supposed to hold a golf club? With the little finger and the ring finger, right? We call that the ulnar side of the hand, the little finger and the ring finger. That's responsible for tight grip, so if you're holding a hammer or a golf club or a screwdriver, that's the part of the hand that holds the instrument.

What about those other fingers? Don't they just pick up the slack? The other three digits—the index, the thumb and the middle finger—they fine tune where the tool goes. So if you have your little finger amputated, you're going to lose a significant amount of grip strength when holding everyday small objects. When you talk about utensils—like knives and forks—most of that stuff is fine manipulation rather than strength, so you're typically using the other three digits. You use the thumb, the index and the middle fingers in order to hold a spoon, or to hold a fork, or even to hold a pen and write things.

So, if we have to lose one of our fingers, which one should we pick? Believe it or not, the index finger is one that presents—I hesitate to say the least disability, but it's the one you would recover quickest from if it were amputated. If the index finger's gone, the brain quickly bypasses it and starts to use the middle finger. If you think about it, you could do everything you do with your index finger with your middle finger—you could hold a pen, you could button a shirt. So, there's probably less disability with loss of your index finger than with your little finger.

But I've got to put a big qualifier on that, because it really depends on what you do. Obviously, if the type of work you do involves dexterity, then an index finger would be critical. If the type of activity involves grip strength, then the little finger would be more important.

Would you consider Trevor's choice a viable method of treatment? No, I would not say that's a viable way to treat that, especially for the general population. This is a really specialized situation where someone is basically making a career choice. He chose to have a permanent disability so that he could continue to play, and that's not going to apply to the everyday person. That unique situation—athlete, in a season—that makes all the difference. But it's easy for me to say "That's the wrong choice," because my career doesn't depend on missing a couple weeks of play.

But isn't amputation sometimes the best option? Let's say that it wasn't a football injury. Let's say he had a saw injury, because we take care of a lot of people who have their fingers cut off and they come back with pieces and parts, and we have to sew them back on. Sometimes we opt to do an immediate amputation, especially if there's nerve damage and tendon damage. Then we know the results of re-implanting the fingers sometimes are not as good as the results of an amputation. So, in that scenario, it would make more sense to just go immediately to an amputation, and that's done every day. That doesn't make the news because that's sort of standard treatment. But in this setting, it's unusual because I understand his nerves were not injured. It's clearly not the first choice.