Also known as a mallet finger, is a condition that we commonly see. It occurs when the extensor tendon that attaches to the base of your finger (just underneath where the nail is) is no longer able to straighten the end joint of your finger. This can occur for number of reasons but usually is a result of a knock to the tip of your finger or having your finger forced bent while you were gripping something. It can occur during sport or even doing household chores!
The usual presentation is a droop of the tip of your finger and an inability to straighten it. It can be sore and swollen with an area of redness at the back of the joint where your top finger joint creases are. This injury can at times involve an avulsion fracture, where the tendon pulls a piece of bone away from where it attached (‘bony mallet injury’) or it may just involve the tendon itself (‘tendinous mallet injury’).
The good news is, that it can usually be effectively treated conservatively. Your therapist may suggest having an X-ray to exclude a fracture fragment and if there is a large fragment or your therapist is concerned regarding the joint alignment they may suggest a surgical review, which they will be able to assist you with organising.
If (and for the majority of clients this is the case) conservative treatment is recommended it will involve education and fitting of a custom-made thermoplastic splint/orthosis which will hold the tip joint of your finger straight. You will be required to wear this splint full time and the length of time your therapist may advise you to wear this can vary but is usually between six to nine weeks. The length of time is dependent on a variety of factors, such as, the type of injury (bony versus tendinous) and length of time from injury to splinting.
The splint is usually secured to your finger with sports tape and is designed to stay in place full time. Yes, including showers and at night! If the splint is removed and your finger is not kept completely straight for the full period it can delay your healing and further prolong the time needed to wear the splint. Your therapist will teach you how to safely remove the splint to clean your finger to ensure your skin stays hygienic and healthy.
(Photo Copyright Canberra Hand Therapy Pty Ltd)
After the designated six to nine weeks in your splint, your therapist will commence a weaning program with you, as your tendon will not be strong enough at this stage to completely discontinue with the splint. It usually takes another two to four weeks from this point to be completely splint free. Once you have commenced weaning from your splint your therapist will prescribe you some exercises to help to restore your movement and strength as appropriate.
This may seem like a really long time but we do get excellent results and many happy clients that can attest to this. If you think you have a mallet finger, even if it is an old injury get in contact with us to discuss options.