Robin R Varghese, PT.
"Mallet Finger". If you are a lover of ball games, this is not a new term to you. Need help?
It is an extensor avulsion fractures or distal extensor tendon ruptures
It leads to inability in extending the distal interphalangeal (DIP) joint.
The flexion deformity of the fingertip resembles a mallet or hammer and hence the name mallet finger.
Extensor mechanism of the phalanx at the level of the distal interphalangeal joint gets disrupted.
If the extensor tendon causes an avulsion of the distal phalanx, it leads to a mallet fracture.
When the distal phalanx of a finger is forced into flexion while being actively extended.
Usually occurs in the workplace or during sports-related activities
It is common in ball sports, as the ball hits the fingertip of an extended finger. This compels the distal interphalangeal joint into a forced flexion position and thereby causes an extensor tendon disruption.
Terminal extensor tendon injuries can also occur with lower injury impacts - such as an elderly person "jamming" their finger while performing activities of daily living such as pulling up socks or tucking in bedsheets.
The fingers most commonly affected are the long or middle finger and the ring finger of the dominant hand
If traumatic, the finger gets painful and swollen around the DIP
actual tendon is ruptured, the condition can be relatively painless.
If a piece of the bone is pulled off, it is normally a bit more swollen and sorer.
The DIP joint will be bent and patient cannot straighten it voluntarily, but can be straightened easily with help from the other hand.
Physical therapy management
Splint for 6-8 weeks
Continuous splinting for approximately six weeks followed by six weeks of night time splinting will allow healing and in extending the finger.
Education must be provided to the patient to maintain the DIP joint extension.
Patient must be able to notice any skin breakdown due to splinting as well.
The key is continuous splinting for the first six weeks.
If the splint is removed and the finger is allowed to bend, the process is disrupted and must start all over again.
The splint must remain on at all times, even in the shower.
The splint should hold the DIP joint in full extension and allow the ends of the tendon to move as close together as possible.
The splint may be weaned off when the tendon is strong enough to hold the fingertip straight.
There are many types of splinting methos for mallet finger. Your Physical therapist will help you with the right one.
Surgery to repair a mallet finger is required when the bone fragment is large, when the fingertip has moved position a little or when the cause is a laceration.
Rehabilitation after surgery for mallet finger focuses mainly on keeping the other joints mobile and preventing stiffness from disuse.
Lin et al (2018) reported that the average DIP joint extensor lag after surgical treatment is 5.7° and 7.6° after conservative management. This is important to include in patient education as it will help to ensure that patients have a realistic expectation of the treatment outcomes.
At Valley Healing hands, we provide the best physical therapy treatment for Mallet fingers. Our patients are completely satisfied with our services. You may learn about what they have to say about us here and get connected to us here. Our patients love us, you too will!