Mallet finger is an injury to the tendon that allows you to bend and straighten your finger. It is most common at the index and middle fingers. An injured finger is often unable to bend or extend fully without discomfort. Any rapid motion that jams the tip of a finger against an object can cause a mallet finger.
Mallet finger is extremely common among baseball and basketball players; but, the injury can occur because of a crushing accident on the job or even because of a cut finger while working in the kitchen.
There are nonsurgical and surgical options to treat mallet finger.
A mallet finger is a deformity of a finger caused when the extensor tendon is damaged. When an object strikes the thumb or tip of the finger, the force damages the thin tendon that straightens the finger. In some cases, a small piece of bone is pulled away along the tendon, known as an avulsion injury. Also known as baseball finger, mallet finger results in the inability to straighten the thumb or finger.
Three common mallet finger injuries that can occur include:
- Damaged tendon, but no fractures (bone cracks or breaks) are present
- Ruptured tendon with a small fracture caused by the force of the injury
- Ruptured tendon resulting in a large fracture
Who is a Candidate For Mallet Finger Treatment?
People with mallet finger may delay seeking medical attention, even though they may be in a great deal of pain, simply because they can still use their hand. In most cases, the board certified hand surgeon will order X-rays in order to look for a major fracture or malalignment of the joint.
Symptoms of mallet finger may include:
- Painful, swollen, or bruised finger
- The fingertip may droop noticeably
- Blood collects beneath the nail; the nail can be detached from beneath the skin fold at the base of the nail
In children, mallet finger injuries may involve the cartilage that controls bone growth. A hand surgeon should carefully evaluate and treat this injury in children so the finger does not become stunted or deformed.
Mallet Finger Treatment Options
Depending on your specific case, you may or may not need surgery to treat your mallet finger. Once you visit your board certified hand surgeon, they will prescribe the proper treatment to help return your finger to proper function.
The majority of mallet finger injuries are treated with splinting. A splint holds the fingertip straight (in extension) until it heals. There are several types of splints used to treat mallet finger, many of them are fabricated by a hand therapist. This allows the two ends of the torn tendon or bone to stay together and heal.
Surgery is needed to repair the torn tendon when the nonsurgical treatment fails. In these cases, pins, wires or even small screws are used to secure the bone fragment and realign the joint. Surgical treatment of the damaged tendon can include tightening the stretched tendon tissue, using tendon grafts or even fusing the joint straight. Your hand surgeon will advise you on the best technique for your particular situation. Surgery may be advised if there is an open wound, but most injuries that cause mallet finger do not cut the skin.
What Should You Expect After Mallet Finger Treatment?
A mallet finger that is up to three months old may require splinting in full extension for eight to 12 weeks. For 3 to 4 weeks after the initial splinting period, you will gradually wear the splint less often, perhaps only at night.
Patients should monitor the skin under their splint to avoid skin breakdown. If problems arise, a new or different splint may be needed. Nearby joints may be stiff after keeping the finger splinted for this length of time. Therapy and exercise may be prescribed to assist your finger regain its range of motion and to reduce joint stiffness.
Rehabilitation after surgery for mallet finger focuses mainly on keeping the other joints mobile and preventing stiffness from lack of use. If there is a large fracture fragment or the joint is out of line, surgery is done to repair the fracture using pins to hold the pieces of bone together while the injury heals.
A physical or occupational therapist may be consulted to teach you home exercises and to make sure the other joints do not become stiff. After the surgical pin has been removed, exercises may be instituted gradually to strengthen the finger and increase flexibility with the hope of returning the finger to full function.