Mallet Fingers - Dr Shreedhar Archik

Dr Shreedhar Archik - Orthopedic Surgeon Mumbai Dadar

(\"Baseball Finger\" or \"Extensor Tendon Injury\")

General Information

Mallet finger, also known as baseball finger, is the most common injury to the extensor tendon, the tendon that straightens the end of the finger. The tendon attaches to the distal phalanx, the bone at the tip of the finger. When the flexor tendon separates from the distal phalanx, the tip of the finger is no longer able to straighten. Sometimes, in this separation, the flexor tendon will take a piece of the bone with it.


Causes of Mallet Finger?

Mallet finger is caused by a blow or jamming injury to the tip of the finger. The injury is the result of sharp sudden force on the distal interphalangeal joint (DIP joint), the top joint in the finger. This causes the extensor tendon to rupture. The tendon will often pull off a piece of the bone to which it is attached in the fingertip.

The type of accident that results in mallet finger usually cannot be prevented by means of precautionary measures. As the name “baseball finger” indicates, this condition is often the result of a sports accident. It may occur during basketball or volleyball, when a ball hits the point of the finger with enough force to cause it to flex strenuously at the tip.

Symptoms of Mallet Finger?

If a fracture of the bone at the tip of the finger (the distal phalanx) has occurred, the finger will hurt and appear swollen. If the tendon has ruptured but the bone is intact the injury may be quite painless. In both cases it is impossible to extend or straighten the finger. Failure to seek medical care soon enough after the injury may result in permanent loss of the ability to straighten the finger.

Treatment

As in the case of any injury involving swelling, it is wise to apply ice to limit the flow of blood to the injured area. Seek medical attention as soon as possible, so that a doctor can evaluate your symptoms and begin to limit damage to the fingertip joint. An X-Ray will reveal whether there has been a fracture to the distal phalanx.

Your doctor will straighten the finger and place it in either an aluminum or commercially made splint to be worn for at least 6 weeks. If the injury is old, the splint should be worn for a minimum of 8 weeks. Limiting movement of the finger allows the tendon to reattach to the finger bone, which will also need time to heal if it has been fractured. In most cases surgery is not required.

It is important to keep the splint on as advised. During the first 2 or 3 days after injury, ice packs should be applied to the finger for 20 to 30 minutes at 3 to 4 hour intervals throughout the day or until pain subsides. Use a pillow to elevate your hand when you are lying down, or elevate it on the back of a chair or couch when sitting.

Your doctor will instruct you to hold the DIP joint in extension even when removing the splint for cleaning. If the fingertip droops at any time after treatment has begun, the period of splinting must start over. A follow-up visit 4-5 days after the splint has been applied allows your doctor to check the skin on the finger for pressure spots and swelling. If the joint is not fully extended by this second visit, your doctor may suggest that the tendon be surgically pinned. A surgical evaluation should also be done in those cases where the patient’s occupation makes splint wear difficult.

Weekly follow-up visits help monitor the healing process and usually produce a better outcome than if the splint is applied and the doctor is not seen again for 6 to 8 weeks. At the end of the splinting period, your ability to extend the finger will be evaluated, and guarded active flexing of the fingertip may begin. The splint should be worn at night for an additional 2 to 4 weeks.

The goal of rehabilitation is to safely return you to your sport and normal activity as soon as healing is successful. If you stress the fingertip before this process is complete, there is increased risk of permanent damage. People recover from injury at different rates, and return to normal and sporting activities should be determined by how well the finger has recovered rather than by how many days or weeks have passed since the injury occurred.
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