What is a mallet finger?
A mallet finger results from an avulsion of the extensor tendon on the back of the finger at the end or distal most joint. Each finger has both an extensor tendon that straightens the finger and a flexor tendon that bends the finger at the distal joint. These tendons work in balance to control fine movements of the fingers. In a mallet finger, either through a fractures or rupture, the extensor tendon pulls away from the bone and only the flexor tendon pulls the finger. This results in the finger “drooping” and being unable to extend.
How do mallet fingers occur?
Mallet fingers occur as a jamming type of injury. Common mechanisms include getting hit on the end the finger by a ball or things as simple as jamming the finger while making the bed. Patients will notice swelling and the finger drooping. There may not be much pain.
Diagnosing mallet finger
On physical exam, the patient is unable to actively extend or straighten the finger. There may be swelling and pain. Xray’s are performed because a mallet finger may be associated with a fracture of the distal phalanx. Patients may notice hyperextension of the proximal interphalangeal joint in compensation for the “droop” at the distal interphalangeal joint.
Nonsurgical treatment of mallet finger
The fundamental principle behind treatment is to have the extensor tendon heal back to bone. Typically, this involves splint immobilization for 6-8 weeks with the finger fully extended and not allowing the finger to flex at all during that time. If, for example, the finger is kept straight for 3 days and then allowed to flex, then those three days of healing are lost. Patients then slowly wean out of the splint over a few more weeks. If the tendon is not showing signs of healing, the splint may have to be reapplied.
Surgically treating mallet finger
Surgery is occasionally indicated in mallet finger. Small fracture fragments may have to be fixed with wires. If the joint is dislocated or subluxation, surgery is indicated. Patients that cannot wear a splint full time may benefit from surgical repair. An example would be a health care worker that has to constantly wash their hands. High performance athletes may benefit from surgery as well. Typically, a pin is placed across the joint to serve as an internal splint. This allows for things like wearing ski gloves or playing contact sports like football. There is still a risk of bending or breaking the wire, so caution is still necessary. The pin is removed at 6-8 weeks like if it were treated in a splint.
It is important to treat mallet finger as quickly as possible. Over time, the extensor tendon retracts making splint treatment and even surgical repair difficult. In this setting, sometimes a tendon graft is need for repair. If left too long, fusion of the joint may be the only option.
Recovering from mallet finger
With both nonsurgical and surgical treatment, it is important that Dr. Kavi Sachar examine you soon after the injury. The earlier it is treated; the more successful treatment is. Patients occasionally heal with a slight “droop.” Most patients regain normal motion and function.
Schedule a consultation
Board-certified and fellowship-trained hand surgeon Dr. Kavi Sachar is widely regarded as one the nation’s leading experts on mallet finger. Dr. Sachar has three office locations in Vail, Aspen, and Frisco, Colorado. If you or a family member suffer from mallet finger, contact Sachar today. Dr. Sachar is part of the world-renowned Steadman Clinic. Dr. Sachar and his team are here to help.
At a Glance
Dr. Kavi Sachar
- Specializing in Hand, Wrist, & Elbow Surgery
- Board Certified Orthopedic & Hand Surgeon
- Consultant to the US Ski & Snowboard Team & Colorado Avalanche
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