Mallet Finger

What is Mallet Finger

Mallet finger, medically termed “extensor digitorum tendon injury,” is a condition where the outermost joint of a finger becomes unable to extend voluntarily, resulting in a drooping appearance of the fingertip. The condition is caused by a disruption in the extensor mechanism of the finger, either from a tendon rupture or an avulsion fracture.

This injury is often associated with a specific incident where the tip of the finger is forced to bend further than its normal range of motion, such as when catching a ball. Though mallet finger is a common sports-related injury, it can affect individuals of any age who experience similar trauma to the finger. It can impair fine motor skills and finger coordination if left untreated.

Types of Mallet Finger

There are three main types of mallet finger, each with unique characteristics.

Tendon Damaged but No Fracture

This type represents a pure tendinous injury where the extensor tendon is stretched or torn, but no bone is broken. The damage occurs to the soft tissue connecting muscle to bone, resulting in the inability to straighten the fingertip without assistance.

Tendon Ruptures with a Small Fracture

In this variation, the tendon rupture is accompanied by a small avulsion fracture. A fragment of bone, attached to the tendon, gets pulled away from its position. This type is more complex due to the involvement of both soft tissue and bone.

Tendon Ruptures with a Large Fracture

This is a severe form where the tendon rupture is associated with a large fracture. A larger piece of bone is detached, often necessitating more complex treatment approaches. This type poses a greater risk of joint misalignment and long-term dysfunction if not appropriately treated.

Symptoms

Symptoms may vary in intensity and presence, depending on the severity of the injury and the type of mallet finger.

• Drooping of the Finger Tip
  The most characteristic symptom is the inability to straighten the distal end of the finger, leading to a noticeable droop.
• Pain and Swelling
  Immediately after the injury, the affected finger may exhibit pain and swelling around the joint. This is a response to the trauma experienced by the soft tissues and possibly the bone.
• Bruising
  In cases where there is an injury, bruising around the affected area may be evident.
• Tenderness
  The dorsal aspect of the finger joint may be tender to touch, indicating inflammation and irritation of the tissues.
• Redness
  Redness around the affected area can indicate inflammation and is a common response to injury.
• Crooked Appearance
  In addition to the drooping tip, the finger may appear crooked or misaligned, especially in cases involving bone fractures.
• Stiffness or Limited Movement
  Over time, if untreated, the joint may become stiff, and the range of motion can be limited due to the tendon’s inability to function properly.

Causes and Risk Factors

The development of mallet finger can be attributed to various causes and risk factors:

• Direct Trauma: The most common cause is direct trauma to the tip of the finger, often when an object forcibly strikes the finger, bending it excessively. This is typical in sports like basketball or baseball.
• Repetitive Strain: Repetitive activities that strain the extensor tendon over time can lead to mallet finger, especially in occupations requiring frequent manual labour.
• Degenerative Changes: In older individuals, degenerative changes in the tendons can predispose them to this condition.
• Rheumatoid Arthritis: Patients with rheumatoid arthritis are at increased risk due to chronic inflammation and weakening of the tendons.
• Osteoporosis: Osteoporosis, which weakens bones, can make individuals more susceptible to the fractures associated with mallet finger.
• Laceration: A laceration or cut on the finger can directly damage the extensor tendon, resulting in mallet finger.
• Hyperflexion of the Extensor Digitorum Tendon: Excessive bending (hyperflexion) of the tendon, beyond its normal range, can cause it to tear or detach from the bone.

Non-Surgical Treatment Options

Non-surgical interventions are often the first line of treatment, especially in cases without severe fractures.

Splinting

A splint is used to keep the distal joint in a straight position, allowing the tendon to heal. The splint must be worn continuously for several weeks, typically 6 to 8 weeks, and should not be removed, even during bathing, to ensure effective healing. Subsequently, for an additional 2 weeks, you will be required to wear the splint at night. During this period, the splint may also be used when engaging in activities posing a higher risk of injury, such as manual labour or sports.

Pain Management

Over-the-counter pain relievers such as acetaminophen or NSAIDs (e.g., ibuprofen) can be used to manage pain and reduce inflammation.

Rest and Elevation

Resting the injured finger and keeping it elevated helps in reducing swelling and pain.

Physical Therapy

After the splint is removed, physical therapy exercises are conducted to restore strength and flexibility to the finger.

Surgical Treatment Options

In cases where non-surgical methods are insufficient or the injury is severe, surgical intervention may be considered.

• Open Surgery
  Open surgery is employed in complex cases, such as when there is a large fracture or the joint is misaligned. During this procedure, the surgeon makes an incision to directly access the damaged tendon and bone. The tendon is then reattached to the bone, and if necessary, the bone fragment is repositioned and stabilised using pins or screws. This method allows precise correction of the injury but requires a longer recovery period.
• Percutaneous Surgery
  Percutaneous surgery is a less invasive option where small incisions are made. Through these, the surgeon uses specialised instruments to repair the tendon and, if needed, to stabilise the bone fragment. This technique is typically used for less complex injuries and offers the benefit of a shorter recovery time and less postoperative pain compared to open surgery.

Prevention Strategies

Preventing mallet finger primarily involves measures to reduce the risk of finger injuries.

• Protective Gear: In sports or activities where finger injuries are common, using protective gloves or guards can help prevent injuries.
• Safe Practices in Sports and Work: Proper techniques and awareness in sports and occupational settings can reduce the risk of finger injuries. For example, athletes should be trained in correct ball-handling techniques.
• Strengthening Exercises: Regular exercises to strengthen the fingers and hands can provide more stability and resilience, potentially reducing the risk of tendon injuries.
• Ergonomic Tools and Equipment: Using ergonomically designed tools and equipment that minimise strain on the hands can help prevent repetitive strain injuries.
• Education and Awareness: Being informed about the risks and symptoms of mallet finger can lead to earlier treatment and prevention of worsening conditions.