Mallet Finger Treatment
Mallet finger is a rupture of the tendon that straightens the fingertip, sometimes with a small piece of bone. Most patients heal with continuous splinting.
Mallet finger is when the tip of a finger droops and cannot be straightened actively. It is caused by a rupture of the tendon that straightens the fingertip, or by the tendon pulling off a small piece of bone where it attaches. It usually happens when a ball strikes the fingertip, or when the fingertip is jammed while making a bed or putting on socks.
Symptoms
- The fingertip drooping downwards
- Being unable to straighten the fingertip yourself (it can be straightened with the other hand)
- Pain, swelling and redness over the top of the fingertip
- If left untreated for long, the middle joint can bend backwards (swan-neck deformity)
Diagnosis
The diagnosis is made on examination. An X-ray shows whether a piece of bone has come off with the tendon and whether the joint is in place. This guides treatment.
Treatment
Splinting
Most mallet fingers are treated with a splint that holds only the fingertip joint straight or slightly extended.
- The splint is usually worn continuously for 6-8 weeks.
- If the fingertip drops even once during this time, healing may have to start again. When changing or cleaning the splint, the fingertip should be kept straight on a flat surface.
- The splint is then worn only at night for a few more weeks.
Splinting is often effective even when treatment starts a few weeks after the injury.
Surgery
Surgery may be needed for:
- A bone fragment involving a large part of the joint surface
- The joint slipping out of place (subluxation)
- Being unable to keep the splint on, or failure of splinting
- Open injuries
The bone fragment is fixed with fine wires or small screws, or the tendon is repaired.
Recovery
After the splint comes off, the finger is used gradually. A slight droop or a small loss of movement at the tip may remain; this usually does not affect daily function. Swelling and redness can take a few months to settle completely.
Why continuous splinting?
The tendon that straightens the fingertip heals with its ends brought together while the finger is held straight. During healing, if the fingertip bends down even for a moment, the healing tendon is stretched again and can come apart. This is why wearing the splint continuously for weeks is the most important factor in success. When the splint must be removed (for cleaning or skin care), the fingertip should be kept straight against a flat surface such as a table and the splint put back immediately.
Types of splint
Ready-made plastic splints, aluminium splints or custom-made splints can be used. The splint should hold only the fingertip joint, leaving the middle joint free to move. Check regularly that the splint is not pressing on the skin, and see your doctor if redness or a sore develops.
What happens without treatment?
Without treatment the fingertip stays permanently dropped. Over time the balance of the tendons changes and the middle joint can bend backwards, producing a swan-neck deformity. This affects both appearance and finger function. Splinting can be tried even in late cases; if it fails, surgical options are considered.
After surgery
After surgery in which the bone fragment is fixed with wires, the wires usually stay in for a few weeks and are removed once the bone has healed. The finger is protected with a splint during this time, and controlled movement exercises start after the wires come out.
Regaining fingertip movement
After the splint comes off, fingertip bending exercises are started gradually. Gentle, controlled movements are preferred to forcing the finger. Range of motion usually improves over a few weeks.
Frequently asked questions
How long must I wear the splint?
Usually 6-8 weeks continuously, then a few weeks at night only. Continuous use is essential for success.
Can I shower with the splint?
The splint can get wet, but the fingertip must be kept straight whenever it is changed. You will be shown exactly how.
I came late. Can it still heal?
Even a few weeks after the injury, splinting works well for most patients. Surgical options are considered for later cases.
Can I drive or work with the splint on?
Many patients carry on with daily tasks and desk work in the splint. In jobs that use the hand heavily, take care to protect the splint.
Why doesn't the swelling and redness at my fingertip go away?
Swelling and redness over the top of the fingertip can last for months with mallet finger. It usually eases over time.
Will my fingertip be completely straight after treatment?
The fingertip improves clearly in most patients. A slight droop of a few degrees may remain in some, which usually does not affect function.
Is mallet finger different in children?
In children, a fingertip injury can involve the growth plate, so an X-ray is especially important and treatment is planned accordingly.
Can I move my finger while wearing the splint?
As long as the fingertip stays still, the middle joint and other fingers can move freely. This prevents stiffness.
How long does mallet finger surgery take?
It is a short procedure, usually done under local or regional anaesthesia, and the patient goes home the same day.
The information on this page is general and does not replace an examination. An examination is needed to decide which treatment suits you.