This article is about one of the most common finger deformities that we see in clinical practice. Mallet Finger is an injury to the extensor tendon which usually straightens the end joint of the fingers and thumb. The information can also be seen in video format below.
Mallet Finger
Mallet finger is one of the most common finger deformities that we see. It happens after an injury where the finger tip suddenly catches against something or gets stubbed against an object, or is hit by an object. So it can occur when catching a ball awkwardly where the finger tip is suddenly forced into a bent position. It's therefore a common injury in baseball where it has the alternate name of 'baseball finger' and also in cricket. It also happens frequently when changing bed sheets, as the finger tip catches on the mattress, so its a common in injury with hotel housekeepers.
With this injury, either the end of the extensor tendon call pull off the small fragment of bone where it attaches (called an avulsion fracture) or the tendon can tear near to its attachment point. With either type of injury the result is the same; the tendon can no longer do its job of straightening the end of the finger and therefore the finger tip hands down loosely in a bent position. The problem can also happen in the thumb, causing a 'mallet thumb' but this is fairly uncommon. So with a mallet injury your finger, or thumb, will end up looking like the picture below, where the tip droops down and you can’t straighten it without help from the other hand.
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| Tendon Tear |
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| Avulsion Fracture |
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| Mallet Finger Appearance |
The treatment of a mallet finger depends on how quickly you take action. The sooner, the better. The injured tendon has a good capacity to heal but in order to do so, the end finger (or thumb) joint, called the DIP joint, must be kept straight by using a mallet splint.
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| Mallet Finger Splint (product link) |
Using a mallet splint keeps the finger DIP joint straight which allows the torn tendon ends to lie close together, or the bony avulsion fragment to lie near its original attachment point. The smaller the gap between the tendon ends or bone fragments, the better chance of it re-attaching.
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The sooner the splint is applied, the better chance of recovery because its the bleeding and inflammation from the injury that fills the gap between the torn fragments which will ultimately stimulate the formation of new tendon fibres. If the injury is left too late, when the inflammation has resolved, the capacity for healing is much less. Even after 2 weeks, the chances of recovery are reduced so time is really important with a mallet injury.
From the moment when the mallet finger splint is applied, the end finger joint should now kept fully straight for at least 8 weeks. If you have diabetes, are a smoker, or have any medical problem which effects tissue healing then you should be using it for around 12 weeks.
You can take the splint off to clean the finger but you must keep it straight for the whole process. The easiest way to do this is to use 2 cleaning wipes. Take the splint off carefully, making sure the end joint stays straight. Then press your finger pad firmly down on one of the wipes which should be layed out on a firm surface. Then slide your finger slowly and firmly over the wipe to clean the finger pad. Then use the other wipe to clean to top and sides of your finger before carefully replacing and securing the mallet splint.
If the tendon has reattached after 8 weeks, and you can now move the finger tip in both directions, then you can leave the splint off and start using your finger normally. The tendon will still be weak though and so you will need to avoid sports or any aggressive / strenuous finger movements for a further 8 weeks.
If the tendon has not healed after 8 weeks in a splint then you might need to see a hand surgeon. There is a limited window for tendon repair and so you will need to be seen as soon as possible. Its best to keep using the splint while you are waiting as this will limit any tendon retraction and make the job easier for the surgeon. Over time, the torn tendon will retract up the finger and get to the point where surgical repair is no longer possible.
If you have an old mallet injury or one which is just too late for surgery, then its fine to leave it alone. Most are not painful and the only symptom you will notice is the drooping finger. So unless you need to fully straighten your finger for a particular activity, you shouldn’t notice any problems with normal activities. You should still be able to grip just fine. If it's painful though, then the only option would be surgical fusion of the DIP joint. It will be fused in a slightly bent position so that it looks and functions normally when gripping. In fact it's fused in a similar position to how it looks with a mallet injury, so the cosmetic appearance of the finger will be unchanged. Therefore, surgical fusion is only warranted in chronic mallet injuries which are painful in the long term.
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