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Mallet Finger

A mallet finger, also known as a baseball finger or dropped finger, is caused by an injury to the extensor tendon on the back of a finger or thumb. The tendon attaches bone to muscle and is necessary for straightening the finger. If the tendon is damaged at the point of attachment to bone, just behind the fingernail, the ability to straighten the finger at the joint is lost and the fingertip will droop down.

Often a small fragment of bone, and occasionally a large piece, will be torn off with the tendon at the time of injury.

An athletic injury is the most common cause of a mallet finger, although other circumstances can produce the same damage. A ball or other object striking your fingertip and forcing it down, while you are trying to straighten the finger, can stretch or tear the tendon.

  • Pain at the moment of injury, lessening with time.
  • Swelling around the injured joint.
  • Bruising.
  • Tenderness at the site of injury, just behind the base of the fingernail.
  • Drooping of the fingertip. The finger may be straightened with assistance, but is unable to hold the position unaided.
  • Sometimes there might be blood under the nail.
  • Sometimes the nail might be detached from the nail bed, under the skin at the base of the fingernail.
If there is blood under the nail, or a detached nail, seek medical assistance immediately as there may be an open cut, or possibly a compound fracture, which is when a broken bone has pierced through the skin. Infection is a grave danger in such circumstances.

It is important to see a doctor and get treatment for a mallet finger because, although it may not be terribly painful, without treatment the injury may be made worse, and could result in permanent disability. An injury older than three months will not improve without surgery. Make an appointment to see your doctor within one week of the injury. If the injury has happened to a child, bone-forming cartilage may have been damaged. Treatment will be essential to avoid possible stunting or deformity of the finger.

Before your appointment, there are some first aid treatments that you can carry out to improve symptoms and begin the healing process.

Self-help options:
  • Temporarily splint the finger, using something like an ice cream stick taped to the finger, until you can see the doctor. Immobilizing the joint is very important.
  • Apply ice, crushed in a bag and wrapped in a towel, to the finger for 15-20 minutes at a time, 3-4 times a day, for the first 1-2 days.
  • Keep the finger elevated above the heart whenever possible. This will help reduce swelling, which will ease pain. When sitting or lying down, prop the hand up on a pile of cushions or pillows.
  • Over the counter medications such as acetaminophen (Tylenol) or NSAIDs such as ibuprofen (Advil), naproxen (Aleve) or aspirin, will help reduce pain and swelling.
Your doctor or other health care provider will order an x-ray to see if any pieces of bone have been pulled away with the tendon and if surgery will be necessary. In most cases surgery is not required.

Treatment for a mallet finger usually consists of splinting the finger continuously for 6-8 weeks, followed by a gradual reduction in the use of the splint. Rehabilitation exercises might be required to restore mobility in the joint. Such treatment is normally very successful, although full extension of the joint may never be regained.

Keeping the joint immobilized for the full course of treatment is essential. If the tendon is allowed to stretch at all during this time, treatment has to begin all over again. The splint will only immobilize the injured joint, so the rest of the finger will be allowed to bend normally. Try to avoid getting the splint wet as the skin underneath the splint might suffer if unable to dry.

Surgery might be required if there is a large bone fragment present, severe joint misalignment, or if non-surgical treatment has failed. The procedure might include using pins, wire or small screws to repair the joint and reattach the tendon. Sometimes the joint might have to be fused.

Rehabilitation exercises:
Any exercise to restore mobility to the injured joint is only to be undertaken after complete healing has taken place. Get your health care provider’s permission before removing the splint or doing exercises in order to avoid having to begin treatment again. When it is allowable, the following exercises will help rebuild strength and flexibility.

Passive range of motion:
Gently try to straighten the fingertip. If it needs assistance, hold it with your other hand and carefully straighten it as far as it will go. Don’t force it. Hold it in position for 5 seconds, then release. Repeat 10 times, 3-5 times a day.
Try to make a fist with the injured hand. If this is difficult, use the other hand to help, but be gentle. Hold the hand in a fist 5-10 seconds, then release. Repeat 10 times.
Pick up:
With the injured finger and your thumb, practice picking up small objects. Repeat several times.
With your hand on the table, palm down and fingers outstretched, try to lift one finger up. Hold the extension for 5 seconds, then rest. Repeat for each finger. Repeat 10 times a day.
Ball grip:
Hold a rubber ball in your hand and gently squeeze it. Hold the squeeze for 5 seconds, then slowly release. Repeat 10 times for 1 set. Do 3 sets.

What to look for in a splint:
As your finger will be in the splint continuously for up to 8 weeks, comfort is very important. The splint should be attached firmly enough to prevent any movement of the joint, but not so tight that the finger feels constricted. The material of the splint should allow the skin to breathe, and it should be constructed to avoid chafing. Ease of cleaning is another aspect to consider when choosing a splint.

Wear protective gloves when playing ball sports, if possible.

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