FREQUENTLY ASKED QUESTIONSQ. What will my recovery be like?
A. Rehabilitation during and following treatment for a mallet finger focuses mainly on keeping the other joints mobile and preventing stiffness from disuse. A physical or occupational therapist may be consulted to teach you home exercises and make sure the other joints do not become stiff. Once the mallet finger has healed sufficiently and the splint is removed, exercises may be instituted to strengthen the finger involved and increase flexibility.
Q. Can I avoid a splint?
A. The only way to avoid a splint is to have surgery, where an internal splint or wire will be inserted across the joint. This is usually removed 6 weeks later. In most cases, external splintage is usually sufficient.
INTRODUCTION
When you think about how much we use our hands, it's not hard to understand why injuries to the fingers are common. Most of these injuries heal without significant problems. One such injury is an injury to the distal interphalangeal, or DIP, joint of the finger. This joint is commonly injured during sporting activities such as basketball or netball. If the tip of the finger is struck with the ball, the tendon that attaches to the small bone underneath can be injured. Untreated, this can cause the end of the finger to fail to straighten completely.
ANATOMY
The joint near the end of the finger is called the distal interphalangeal or DIP joint. One part of the extensor tendon is attached to the base of the distal phalanx. When it tightens, the finger straightens. Another tendon, the flexor tendon, is attached to the palm of the finger. When it pulls, the DIP bends.
CAUSES
A mallet finger results when the extensor tendon is torn from the attachment on the bone. When this occurs, a small fragment of bone may be pulled, or avulsed, from the distal phalanx. The result is the same in both cases - the end of the finger droops down and cannot be straightened.
SYMPTOMS
Initially, the finger is painful and swollen around the DIP joint. The end of the finger is bent and cannot be straightened voluntarily. The finger can be straightened easily with help from the other hand.
DIAGNOSIS
Usually the diagnosis is evident from the physical examination. X-rays are required to see if there is an associated avulsion fracture since this may change the recommended treatment. No other tests are normally required.
TREATMENT
Treatment for mallet finger is usually non-surgical. If there is no fracture, then the assumption is that the end of the tendon has been ruptured, allowing the end of the finger to droop. Usually continuous splinting for 6 weeks followed by 3 weeks of nighttime splinting will result in satisfactory healing and allow the finger to extend.
The key is continuous splinting for the first six weeks. The splint holds the DIP joint in full extension and allows the ends of the tendon to move as close together as possible. During this time, it is important to keep moving the other joints of the finger. If the splint is removed and the finger is allowed to bend, the healing process is disrupted and must start all over again. The splint must remain on at all times - even in the shower.
Splinting will even work when the injury is quite old. Most doctors will try a 6 week trial of splinting to see if the drooping lessens to a tolerable limit before considering surgery.
SURGERY
Surgical treatment is reserved for cases where there is displacement of the joint in fractures, or where splintage has failed.