Robert J. Snyder, MD
While the world of Orthopaedics is often exciting and the surgeries I get to perform are mostly major, like knee and hip replacements, I also have to treat the everyday things, like corns, bunions, sprains and diagnoses like Mallet Finger. In this article, I will discuss what mallet finger is, why it is caused, its symptoms and how it this not-so-glamorous malady is treated.
Mallet finger is a term used to describe an injury to the extensor tendon (opposite the palm side) of the finger’s outermost joint. It can be caused by playing a sport, for example, where a basketball hits the fingertip and causes a “finger-jam”, or by a crushing accident at a job site or simply by being cut in a kitchen accident. It usually happens to the middle or index fingers but can happen to any finger. The tendon alone may be injured without a bone fracture, the tendon may be ruptured with a small fracture, or the tendon may be ruptured with a large fracture.
The symptoms are pain, swelling, redness and tenderness at the outermost joint of the affected finger and the inability to extend the finger without assistance. Medical attention should be sought immediately, especially if there is a laceration or if a fracture is suspected. Mild cases of mallet finger are sometimes ignored because the patient can use their hand and they just opt to “rub some dirt on it”, rest and tape their finger until it feels better. My recommendation would be to get it checked out and at least have x-rays performed to rule out a fracture, which is common for this injury.
Mild mallet finger injuries can be splinted, and the patient can use ice and OTC anti-inflammatories for pain relief. If the patient has a laceration, that may need stitches. Simple fractures may be able to be reduced without surgery, splinted and the patient sent home. Splints will typically need to be worn for at least six weeks. More extensive fractures and tendon ruptures may require surgical tendon repair/reconstruction and/or fracture fixation.
If the patient’s injury is very severe, the patient may need to go to the emergency room and have a consult with a hand specialist, especially if they have extensive lacerations or crush injuries that would require reconstructive surgery and a lengthy recovery and rehabilitation process. Sometimes if non-operative treatment results in a permanent deformity a later surgery may be required to allow full extension of the fingertip.
Most people who have mallet finger injuries will return to full function and use of their finger without any complications.
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