Mallet finger injuries occur when the extensor tendon and often a fragment of bone detaches from the distal phalanx.
Each of our fingers consist of three separate bones called phalanges. These bones articulate allowing each finger to bend in three places. Tendons are long, thin, flexible bands of fibrous connective tissue that attach muscle to the bone, allowing our fingers to bend and straighten. When a tendon is cut or ruptured the muscle will no longer be able to control your finger because the connection is lost. Mallet finger injuries occur when the extensor tendon ruptures from the distal phalanx. Often times an associated avulsion fracture can occur, meaning that a small fragment of bone detaches from the distal phalanx with the tendon.
Mallet finger is a common injury that can occur on the sports field, at work, or in the kitchen. Usually the patient will report that something hit the tip of their finger while it was in a bent position and then they were unable to straighten it. The finger may be sore, but sometimes people feel little pain and only notice that they are unable to straighten the tip of the finger. Our doctors can usually tell right away when this injury has occurred through examination of the finger. X-rays are often taken to determine whether there is bony involvement of the distal phalanx.
The goal of treatment in mallet finger is to get the tendon to heal back to the distal phalanx. If there is an associated avulsion fracture the treatment is essentially the same, but healing can occur sooner in these cases because the piece of bone attached to the tendon may aid in the healing process. Although mallet finger seems like a small and sometimes insignificant injury the healing process can feel long. The good news is that the vast majority of mallet fingers will heal without surgery.
Initial treatment is a strict splinting regimen for 6-8 weeks. This involves a splint that keeps the most distal finger joint in complete extension. The splint must be kept on and not removed throughout the healing process so that the distal interphalangeal (DIP) joint does not bend. If the tip of the finger bends, it can disrupt any healing that has occurred and you often have to start the 8 week process again. If you need help changing your splint or need a new splint during this time you can call our office for a splint change. You should keep the splint covered while showering or getting your hands wet to avoid the splint slipping off or irritation of the skin on the top of the finger.
Once the tendon heals back to the bone, the patient will begin to wean the splint and begin gentle range of motion exercises. In most cases, the patient may have a slight extensor lag (meaning the finger may be unable to fully straighten at the tip), but the finger is fully functional. Generally, physical therapy is not a necessary part of your recovery. Most patients can return to their activities soon after they wean the splint.
In rare instances, some patients may be unable to tolerate 8 weeks of strict splinting for mallet finger treatment. If this is the case, there is a surgery that can be done. This involves having a pin inserted across the distal interphalangeal joint to place the tendon in a place where it will heal. The pin will stay in place for 8 weeks. Most patients will still feel more comfortable wearing a splint during this 8-week period, but it may be removed without the fear of having stress put on the tendon as it heals. After 8 weeks the pin will be removed and the patient will regain motion in their DIP joint. This is done as a same day procedure at the hospital or in a surgery center. Physical therapy is usually not necessary, but may be used if there are issues regaining motion.
Mallet fingers can be very bothersome and pesky injuries. Our goal at Modern Orthopaedics is for you to return to the things you love! This may take time and patience, but we want you to experience a full recovery. We understand that every patient is unique and we will develop your treatment plans accordingly. We want to understand your goals and help you reach them. Please contact our office with any finger issues and receive superior care from our doctors and staff.
As our patient, you will have an in-depth consultation with one of our doctors. We will create an individualized treatment plan together, tailored to your problem and lifestyle. Our doctors prefer non-invasive treatments whenever possible, including physical therapy and/or injections. If your problem ultimately does require surgery, our doctors prefer the least invasive surgical techniques possible. Our goals are the same as yours: to get you back to living your best life, pain free.