Mallet finger

Mallet finger is quite common injury affecting the tip of the finger. A thin tendon inserting itself to the finger tip is damaged and the tip of the finger can no longer straighten. Although it is a relatively small injury the recovery usually takes over 3 months. It is important to follow your therapist advise because re-injury during the healing time is common if rules are not fully followed. If left untreated mallet finger injury can lead into swan neck deformity.

What is mallet finger? what are the symptoms of mallet finger? 

Mallet finger is an injury to the tip of your finger. The extensor tendon that ends at the tip of the finger gets injured and can no longer move the tip of the finger up away from the palm. It is also called baseball finger or drop finger.

The cause of the mallet finger injury is usually an impact of an object on an extended (straight) finger forcing it to flexion (bent position) - typically this happens in ball sports when ball travelling at high speed lands on straight finger and bends it inwards. However, the injury can also happen with relatively low force during activities like changing bed or loading washing machine.

The symptoms of the mallet finger are:

  • inability to straighten the tip of your finger
  • tenderness or pain over the joint closest to the finger tip (DIP joint)
  • swelling
  • redness
  • bruising

If you have any of these symptoms, especially if you can't lift the tip of your finger, make an appointment with your GP immediately. A physical examination and an X-ray will usually be sufficient to confirm the injury. The sooner you start the treatment the better chance to have the finger fully fixed. The best results can be achieved if the treatment starts within a week of the injury.

 

what is the treatment of mallet finger?

The treatment of mallet finger depends on the type of the mallet finger injury. There are  different classifications of this injury but in the nutshell it can either involve rupture of the extensor tendon or  the extensor tendon stays intact and the bone of the finger tip is broken off with the tendon attached to it - this is called extensor avulsion fracture.

Most of the mallet finger injuries are treated by putting finger into a special splint that keeps the tip of the finger straight or even better slightly hyperextended (pushed back as much as it goes) to allow the ruptured tendon or the broken off bone to reattach. HOWEVER, the type of splint used depends on the type of the injury - the extensor tendon rupture requires different splint than the avulsion fracture injury. There is an excellent video explaining the difference and importance of the correct splinting over here.

Sometimes the bones in the joint are misaligned and you might require a surgery to put the bones into correct position and keep them in place with a K-wire or pin. This stays in usually for around 3 weeks after which time it is removed and rehabilitation is started.

If the splint does not resolve the injury or if you left the injury unattended for too long, you might need a different type of surgery - it can either involve repairing the tendon (however this is quite difficult as the tendon is very thin) or fusing the joint in extended position (this means you will not be able to bend our finger tip again).

 

Hand Therapy after Mallet finger injury

Hand therapy is an important part of treatment after you had sustained the mallet finger injury. To start with, a hand therapist can make a tailored mallet finger splint for you depending on the type of injury you have. Your GP might fit you with an off-the shelf mallet splint and this might be sufficient, however often the splint does not fit snuggly and the tendon doesn't knit as well as it could with more fitting custom made splint.

Secondly, a hand therapist will advise you on exercises that need to be done whilst the splint is on. This involves exercises for the splinted finger but also the other uninjured fingers.

Hand therapist will monitor your progress and they would usually review you couple of times or as needed before the splint is taken off either at 6 or 8 weeks. Once the tendon seems to be healed and you are able to bend your fingertip to 30degrees, and more importantly, straighten the finger tip again, a gentle and gradual range of movement can commence. The therapist will make an exercise splint for you that will allow you to bend the finger tip only to some extent to avoid overstretching or even rupture of the newly healed tendon. You will be required to wear the mallet splint for the next 2 weeks all the time only taking it off for the exercises.

Once the finger moves more freely the therapy progresses to gradual strengthening and functional movements.

If you are attending our hand clinic for the mallet finger injury after diagnosis or surgery we will most likely do:

  • corrective splinting (with or without  kinesiotaping to keep the finger better aligned)
  • exercise program for whilst in the splint
  • exercise splint and progression of exercises depending as the healing progresses
  • hydrotherapy, ultrasound, massage to decrease stiffness  and pain
  • functional activities practice for return to work, sport or other leisure activities