Treatment for a Typical Mallet Finger

Treatment for a Typical Mallet Finger
Dr. Jeffrey C. Wint Hand Surgeon Springfield, MA

Dr. Jeffrey Wint is a hand surgeon practicing in Springfield, MA. Dr. Wint specializes in caring for hand, wrist and forearm problems without the option of surgery unless necessary. Many hand surgeons are also experts in diagnosing and caring for shoulder and elbow problems and tend to suggest non-surgical treatments such... more

A mallet finger occurs when the extensor tendon at the tip of a finger ruptures. The rupture of this tendon can involve the tendon alone, be associated with a small bone fragment or fracture or can be associated with a fracture that requires significant care.

The force applied to the finger can come from something as simple as tucking in a bed sheet or can come from a direct blow to the end of a finger. Mallet finger has also been known as baseball finger.

A mallet finger often begins with pain at the distal joint of the finger.  At times there is an immediate loss of motion while at other times the finger seems to stay straight for a while and only later starts to lose its ability to be extended actively at the tip.  These  injuries are typically "closed"  in that the skin and nail is intact but at times there is an injury to the skin or nail bed as well. The injury may seem "closed" but actually is "open" and can become infected at times.  In severe cases the injury is  clearly associated with an open injury to the joint or bone, a so called open or compound fracture. Sharp or penetrating injuries can cut the tendon and enter the joint as well but treatment of those sharp injuries may not follow the same treatment as a typical mallet finger does.

In adults, the injury can involve the joint surface.  In children it can involves the growth plate or physis.

The diagnosis is often made based upon the type of injury and the appearance of the finger.  The fingertip will droop down and there is a loss of active motion.  Often the finger can be passively pushed up to straighten it but the independent active motion to extend the digit at the tip has been lost

X-rays are often taken to further delineate the injury and see how much if any bone, joint or growth plate is involved.

Treatment depends largely upon the extent the soft tissue and underlying boney injury.

Typical treatment with an alumifoam splint for mallet finger injuries: 8 weeks full-time splinting, 4 weeks part-time splinting

Full time splinting of the dip joint, or distal interphalangeal joint (8 weeks)

During this time the splint is usually applied to the dorsal side or nail side of the finger. It is important to make sure the splint keeps the fingertip straight. Many times the splint is placed without attention to this detail and the result will be compromised. A layer of coban can be applied first, followed by the splint with tape and additional tape or coban over that to cover. The skin must be kept clean. This means removing the splint and washing or using alcohol based hand sanitizer to clean. Make sure there is no redness or skin breakdown. If so at times one may switch the splint to the underside of the finger for a few days. BUT splinting on the palm side may result in slight bending within the splint or it may block motion of the adjacent proximal interphalangeal joint, (the PIP joint).

It is easiest to shower with the splint on, covering it with a bag, and then removing the splint for skin care. 

DO NOT MOVE THE FINGERTIP WHEN UNSPLINTED FOR 8 WEEKS. It may be tempting to do so, but it can stretch out the tendon.

However, The PIP joint must be moved so it does not get stiff.

After 8 weeks, then part time splinting begins for 4 weeks 

Part time (4 weeks): This phase is night-time (or sleep-time) and heavy activity.

DO NOT push the fingertip down but let the tip gradually get its motion. You may see a droop at the middle or end of the day but that is why there is nighttime splinting. If you do not nighttime and part time splint for 4 weeks or if you try to stretch the joint out, you may get a recurrence.

Always call or ask if you have questions, or pain or skin irritation.

If you are having issues with the alumifoam splint, then alternatives are always possible. No one splint may be right for everyone.

Alternatives to splinting this way may include casting in therapy, or a different type of splint.

The successful treatment of these injuries is relatively simple in many ways, but time consuming, and there is great need for attention to seemingly minor details.