Mallet Finger

Mallet FingerWhat is Mallet Finger? Just think about how much we used our hands and fingers, then you’ll have no problem understanding why injuries to our finger are common. Fortunately, majority of finger injuries heal by itself. One such injury is an injury to the distal interphalangeal, or DIP, joint of the finger. During sporting activities like the joint is commonly injured. If the tip of the finger is struck with the ball, causing injury to the tendon that attaches to the small bone underneath. If left untreated, it can cause the end of the finger to fail to straighten completely, a condition called mallet finger.

Mallet Finger Facts:

 

What parts of the finger are involved?

Our finger joints work like hinges when it comes to bending or straightening of the fingers. The main knuckle joint is the metacarpophalangeal joint (MCP joint). It is formed by the connection of the metacarpal bone in the palm of the hand with the first finger bone, or proximal phalanx. Each finger has three phalanges, or small bones, separated by two interphalangeal joints (IP joints). The one closest to the MCP joint (knuckle) is called the proximal IP joint (PIP joint). The joint near the end of the finger is called the distal IP joint (DIP joint).

The extensor tendon is attached to the base of the distal phalanx. When it tightens, the DIP joint straightens. Another tendon, the flexor tendon, is attached to the palm of the finger. When it pulls, the DIP joint bends.

 

Causes of Mallet Finger

How do these injuries of the DIP joint occur? This happped when the extensor tendon is cut or torn from the attachment on the bones. At times, a small fragment of bone may be pulled from the distal phalanx. The result is the same in both cases: the end of the finger droops down and cannot be straightened.

 

What are the signs and symptoms of do mallet finger injuries?

The end of finger is bent and cannot be straightened voluntarily. Pain and swelling will experienced and seen around the DIP joint. You can straighten the DIP joint easily with help from the other hand. If the DIP joint gets stuck in a bent position and the PIP joint (middle knuckle) extends, swan neck deformity may develop.

 

Diagnosis

Physical examination is enough evident but X-rays are required to see if there is an associated avulsion fracture since this may change the recommended treatment. No other tests are normally required.

 

Mallet Finger Treatment Options:

Non-surgical treatment is the normal option for mallet finger. If there is no fracture, then it is assumed that there is a rupture at the end of the tendon, allowing the end of the finger to droop.

 

  • 6 weeks splinting & 6 weeks nighttime splinting will result in satisfactory healing & allow finger to extend.

The key to healing is continuous splinting for the first six weeks. The splint holds the DIP joint in full extension and allows the ends of the tendon to move as tightly together as possible. As healing occurs, scars are formed to repair  the tendon. Removing the splint means the finger is allowed to bend, hence interrupting the healing process and must start all over again. The splint must remain on at all times, even in the shower.

A simple homemade splint will work, though there are many splints that have been designed to make it easier to wear at all times. In extreme cases where the patient has to use the hands daily, a metal pin can be placed inside the bone across the DIP joint to act as an internal splint. This allow the patient to continue to use the hand and the metal sprint will be removed after six weeks.

 

  • Surgery 

 

Surgery is reserved for unique cases only. First being that nonsurgical treatment did not produce desired results. If the finger droops too much, the tip of the finger gets caught as you try to put your hand in a pocket. If this nuisance occurs, the tendon can be repaired surgically, or the joint can be fixed in place. A surgical pin acts like an internal cast to keep the DIP joint from moving allowing the tendon to heal. The pin is removed after six to eight weeks.

Fracture Pinning

When there is a fracture associated with the mallet finger and it involves enough of the joint, it may need to be repaired. This may require pinning the fracture. If the damage is too severe, it may require fusing the joint in a fixed position.

Finger Joint Fusion

Finger joint fusion if the damage cannot be repaired using pin fixation. Joint fusion is a procedure that binds the two joint surfaces of the finger together, keeping them from rubbing on one another. Fusing the two joint surfaces together eases pain, makes the joint stable, and prevents additional joint deformity.

  • Nonsurgical Rehabilitation

For new injury, the DIP joint is splinted nonstop in full extension for six to eight weeks. A mallet finger that is up to three months old may require splinting in full extension for eight to 12 weeks. The splint is then worn for shorter periods that include nighttime splinting for six more weeks. With prolonged splinting, skin problems can develop and patients are advised to monitor their skin condition to avoid skin breakdown. A new splint may be need if problems arise. Finger splinting for a length of time can cause nearby joint stiffness. In this case therapy and exercise may be needed to assist in finger range of motion and to reduce joint stiffness.

  • After Surgery

Rehabilitation for mallet fingers after surgery focuses mainly on keeping the other joints mobile and preventing stiffness from disuse. A physical or occupational therapist may be consulted to teach you home exercises and to make sure the other joints do not become stiff. After the surgical pin has been removed, exercises may be instituted gradually to strengthen the finger and increase flexibility.

 

The Cure For Mallet Finger:

Treatment usually non-surgical. Our doctor has to examine the patient and recommend conservative treatments initially. Splinting may even work when the injury is quite old. Our doctor will splint the finger for 8 to 12 weeks to see if the drooping lessens to a tolerable amount before considering surgery. So make an appointment with us today. The sooner you start seeking consultation with our experienced doctor, the sooner you’re recover from  Mallet Finger. 

 

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