For all those rugby or basketball players out there you may have heard of mallet finger…or had your fair share of it! Mallet finger is a term used to describe a stretching, tearing or avulsion of the extensor tendon in the finger or thumb. This tendon helps keep the end joint of the finger or thumb straight. When injury happens to the terminal extensor tendon, a deformity occurs whereby you are unable to straighten the fingertip. Most commonly this injury occurs when an object (such as football or basketball) strikes the tip of the finger or thumb and forces it to bend further than it is intended to go, resulting in difficulty straightening the end of the finger or thumb. If left untreated these injuries can result in deformity, therefore a thorough assessment by a doctor or physiotherapist should be completed in the early stages of the injury.
So how is mallet finger diagnosed?
An assessment by a physiotherapist or doctor can be undertaken to determine the extent of the injury and the most appropriate treatment. The patient’s presentation including mechanism of injury, signs and symptoms are often the most useful in diagnosing mallet finger. Usually the incident will be traumatic in nature (i.e., forced backwards by the velocity of a ball) and the end of the finger/thumb is initially painful and swollen. Large swelling and tenderness may indicate a fracture is present. Most noticeably, however, the end of the finger is bent and cannot be straightened voluntarily. Sometimes an X-ray is warranted as a small fragment of bone can be torn off when the tendon ruptures (called an avulsion fracture) or if suspected that a larger fracture may be present.
How is mallet finger treated?
A systematic review conducted in 2018 evaluated the effects of therapeutic interventions for mallet finger. It concluded that both surgical and non-surgical treatment leads to great outcomes with interventions that are individually targeted to the patients’ presentation.
Physiotherapy or non-surgical treatment involves early splinting after the injury to immobilise the finger and keep it in a straightened position to prevent a flexion deformity. A splint will be worn continuously for 6-8 weeks to ensure the tendon or bone heals in the correct position and, therefore, involves the distal finger joint to remain extended/straight. Removal of the splint will impair healing and result in a flexion deformity (i.e. mallet finger). After 8 weeks the splint will be weaned and exercises aimed at improving range will be commence, later followed by strengthening the injured muscles and building tendon strength. If returning to sport it is a good idea to continue wearing a splint or use tape as an alternative when playing. Surgical treatment may be required if the injury is significant in nature and conservative management is less likely to improve outcomes.
Mallet finger? Early intervention is key to prevent complications. If you or someone else has mallet finger we would love to hear from you.
Written by William Lewis