Mallet Finger: Symptoms, Treatment and Healing

Mallet finger usually occurs on the dominant hand. The fingers most commonly injured are the middle, ring and small fingers. Symptoms of mallet finger include the following:

● Bruising
● Inability to extend the affected finger
● Pain and tenderness at the site of injury
● Swelling at the site of injury —swelling can last even up to a year.
● Arthritis. A mallet finger that was not properly treated can lead to arthritis, which can cause pain and stiffness in the affected finger joint.

To understand this injury one must understand the role tendons play in the extension of your fingers. Tendons are tissues that attach directly to bones and connect muscles to bones. The tendons responsible for extension of the fingers are located at the back of the forearm. From the forearm they travel up the wrist and into the fingers.

These tendons then attach to the distal phalanx, which are bones located underneath the nails. With a mallet finger, the tendon tears off the bone underneath the fingernails. When this happens, the tip of the finger can no longer fully extend.

Sometimes, the tendon tears with a small piece of bone attached to it —this is known as an avulsion injury. If a piece of bone breaks off with the tendon, the joint can become affected. If not properly treated, the avulsion injury may lead to arthritis.

To diagnose a mallet finger your physician will examine the affected finger and assess your range of motion. Additionally, your physician will ask you to straighten the affected finger to determine if the tendon was injured.

Radiographs of the affected finger will also be obtained to determine if the joint (and not just the tendon) was affected by the injury. A different treatment plan may be needed if the joint is out of alignment.

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Mallet fingers can typically be treated without surgery. However, it is crucial to obtain treatment as soon as possible after the injury occurs. Addressing this injury early may reduce the need for surgery and the possible development of arthritis. Without proper treatment, the finger can become stiff, deformed and arthritic.

The majority of mallet fingers are treated with a splint that holds the affected finger straight for 6 to 8 weeks. The splint is designed to only immobilize one joint —this prevents the other joints and fingers from developing stiffness. Keeping the splint on 24 hours a day, 7 days a week, is absolutely crucial for successful treatment.

If the splint comes off, healing is disrupted and the splint will have to be worn for another 6-8 weeks. It is also important to keep the splint dry. Patients are advised to wrap the splint to prevent it from getting wet. Additionally, your physician will demonstrate how to safely change splints in case it does get wet. For some patients, wearing a splint can irritate their skin. To prevent an open wound from forming, tell your doctor immediately if you notice irritation.

Surgical treatment is required for certain mallet finger injuries. For example, if the joint is affected and not aligned correctly, your physician may recommend surgery. Surgical procedures are typically performed at a surgical center with local anesthesia.

The finger is pinned straight and the pin is removed in the office several weeks after surgery. It is normal for a small droop to remain even after surgery. However, this droop does not typically affect one’s hand function.