Mallet Finger injury

mallet deformity sketch

QUESTION: A 32 year old female office worker suffered a mallet finger injury when she was hit on the end of the finger by the ball while playing netball. Her finger tip doesn’t straighten.  It is red and swollen, and painful if bumped.  Can this be managed with hand therapy or does she need to see a hand surgeon?

What is it?
A mallet finger is a traumatic injury to the extensor tendon of the finger resulting in an inability to straighten the end joint of the finger. It is caused by a blunt force to the end of the finger; eg. ball to end of finger, making bed, pulling up socks. A mallet finger can be ‘tendinous’ where the tendon ruptures, or ‘bony’ where the tendon pulls away with a piece of bone.

mallet deformity

Mallet finger deformity of the little finger

Clinical Examinations
An X-Ray may be required to help determine whether the mallet injury it is ‘tendinous’ or ‘bony.’ It can also help to determine if conservative treatment is applicable or whether a surgical opinion is required.

mallet deformity sketch

Tendon and Bony mallet avulsions

Treatment
Most mallet fingers can be treated successfully without surgery. Treatment involves splinting the end joint straight for 6-8weeks to allow the fracture/tendon to heal. Prompt treatment will ensure the best outcome. There is a range of different splinting options, your therapist can discuss what splint is best for you. Your therapist will provide you with:

  • Education about appropriate care of your injured finger
  • Appropriate range of movement exercises for uninvolved joints
  • A supportive splint to maintain correct alignment of the affected joint.  Waterproof options are available
  • Instruction in a careful weaning process to ensure the tip of the finger stays straight one the splint is removed
  • Graduated strengthening exercises
mallet splint side slit E

Circumferential Splint

taped splint straight

Dorsal Taped Splint

dorsal splint PIP E

Dorsal Velcro Splint

Orficast E male

Orficast Cylinder Splint

Surgical Treatment
Surgical review may be required depending on the size of fracture fragment.  Your therapist can discuss with you and your GP and arrange a referral to a surgeon if required.

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