Display Patient Information Leafelts

Mallet Finger Injury

Date issued: June 2021 

Review date: June 2023

Ref: C-455

PDF:  mallet finger final June 2021.pdf[pdf] 287KB

Bony mallet injury

 A small piece of bone  is pulled off along with  the extensor tendon

Soft tissue mallet injury

 A tear/break in the extensor tendon the bone is not broken 

 What is a Mallet finger?

The extensor tendon attaches the muscle to the end of the bone. It straightens the end joint of your finger. When the extensor tendon is torn, you are unable to straighten the end joint of your finger and the tip of your finger droops.

Soft tissue mallet injury

A soft tissue mallet injury is when the extensor tendon is torn at the base of the end bone (distal phalanx).

Bony mallet injury

A bony mallet injury is when the extensor tendon pulls a piece of fragment off the base of bone (distal phalanx). The tendon remains attached to the small fragment of bone. The tendon is not torn in this injury.

Soft tissue mallet injuries take longer to heal than the bony mallet injuries.

Symptoms

  • You are unable to straighten the tip of your finger.

  • The tip of the finger stays in a bent position.

  • Swelling over the end of the finger.

  • Pain at and around the end joint of your finger.

  • You may feel a bump on the back of the end joint of your finger.

What can you do to reduce swelling in your finger?

It is normal to have swelling after the injury or surgery. Swelling can make your finger uncomfortable.  It can also delay the recovery process. The swelling after the mallet injury can last for several months.

You can keep the swelling down by elevating your hand above your heart as often as possible. You can rest your hand on a couple of pillows at night to keep it slightly elevated.

Regularly exercising your shoulder, elbow, wrist, thumb and the uninjured fingers will help the swelling to settle and prevent them from stiffening.

You can also try wrapping an ice pack or bag of frozen peas in a damp tea towel and putting on your hand in the first few days of your injury. Leave for 10 minutes or less and repeat 3 times a day. If you suffer from circulation problems, it is not appropriate for you to use a cold compress.

Treatment of mallet injury

Most mallet injuries are treated with splinting. Some require surgical treatment.

Mallet splints

Most mallet injuries heal well with splinting. There are different designs of mallet splints. They are made to support the end joint of your finger in a straight position to allow the bone/tendon to heal. 

Splinting instructions

  • The splint is worn continuously for at least 6 weeks with bony mallet injuries and at least 8 weeks with soft tissue mallet injuries or can be longer depending on the healing of the injury.

  • You must keep the end joint of the finger supported in a straight position all the time. You must not allow the end joint to bend.

  • If the end joint bends during the continuous splinting period, it will slow the healing. You will need to re-start splinting again from the beginning.

  • You need to wear your splint all the time including when you are in bath/shower and when you are in bed.

  • You can put a plastic bag over to keep your hand and splint dry.

  • At the end of continuous splinting the splint is worn for next 4 weeks at night and when the finger is at risk of injury.

  • When you remove the splint to clean your finger you must not allow the fingertip to bend or leave your finger unsupported.  You can place the hand on a flat surface/table, removing your splint to clean your finger. After cleaning, reapply the splint straightaway.

  • Redo the tapes on the splint if you feel pins and needles in the fingertip or if you feel the tapes are too tight.

Can you use your hand while you are still wearing a splint?

  • You may use your unaffected fingers for light activities.

  • You must not use your hand for heavy lifting or activities that require a tight grip.

  • Do not engage in contact sports.

How should you remove and put the splint back on?

Remove your splint once a day to clean and dry your finger.

  • When you remove your splint to clean your finger you must not allow the fingertip to bend or leave your finger unsupported.  You can place the hand on a flat surface/table, removing your splint to clean your finger. After cleaning, reapply the splint straightaway.

Splinting schedule

  • Please wear your splint all the time until______________.

  • From ________________________, remove your splint and check whether you can hold the end joint of your finger straight without supporting it.

  • If the end joint of the finger is not straight, please continue to wear your splint full time for another _______________ weeks until ____________________________.

  • If the end joint of your finger is straight, you may start to remove your splint and do the finger exercises as you are advised by the Occupational Therapist. You must put the splint back on your finger after you have done your finger exercises.

           From ______________________________, you wear the splint at night and when the finger is at risk of injury.

  • From ______________________________, you do not need to wear the splint anymore.

Important note:

If you lose any extension in the end joint after starting the finger exercises, please stop doing the exercises and put your splint back on for continuous splinting. Please contact your Occupational Therapist as soon as you can.

Exercises during the period of continuous splinting

Exercise your elbow, shoulder, wrist and any joints that are not included in the splint.

With the splint on, please do these exercises _______________­­­­­­­­­__ times a day.

For each set do ________­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­__________________­­­­­­­­­­­­­­­­­­ ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­repetitions of each movement.

  • Gently bend and straighten the middle joint and knuckle joints of your splinted finger (DO NOT bend the end joint of your splinted finger)

  • Using your other hand bend the uninjured fingers down into a fist, then straighten fingers up

When you don’t need to wear your splint all the time, you can do the following exercises

From _________________________, please remove the splint to do the following exercises.

Please exercise _________________ times a day, each time do _____________repetitions of each movement.

  1. Flat fist

  • Bend the fingers down to touch your palm but keeping the end joint of fingers straight.

  • Straighten your fingers.

       2. Isolated bending at the end joint of finger

  • Place your other hand below the top joint of your finger, keeping the rest of your finger straight.

  • Only bend the end joint of your finger.

  • Straighten your finger

      3. Hook fist

  • Only bend the end joints and middle joints of the fingers (keeping the knuckle joints straight).

  • Straighten your fingers.

      4. Full fist (but not to make a forceful fist)

  • Curl all the fingers into your palm

  • Straighten the fingers

When can you start using your injured finger?    

From _____________________________, you may use your hand as normal and go back to playing contact sports. However, boxing should be delayed for another 4 weeks.

When can you return to driving?

You should not drive while you are in a splint.  You should not return to driving if you have significant pain or if you have reduced grip function that affects your ability to drive safely and perform an emergency stop manoeuvre.

We cannot give you permission to drive. It is your decision. It is your responsibility to ensure that you are safe to drive and you are in control of the vehicle. Please refer to the DVLA website regarding fitness to drive.

You are advised to check with your driving/motor insurance provider before returning to driving.

What outcome can you expect after a mallet injury?

Most mallet injuries heal well with splinting alone. The aim of splinting is to return the end joint to as near normal as possible.  There could be a slight loss of full extension at the end joint of your finger at the completion of treatment.

It may take a few months for the swelling and tenderness to settle as well as the redness over the back of the finger. You may also find the skin of the finger may become more sensitive. You can massage the skin with a light moisturiser to help desensitise the skin.

Bony mallet injuries may leave a bump/deformity over the end joint of the finger due to the fracture. You may not regain full normal or pre-injury movement in the end joint of your finger. This generally doesn’t affect the overall function of the hand.

Occasionally the tendon may not heal at the completion of splinting. It may be necessary to do another course of splinting. If extension still does not improve and the finger remains painful, then you need to see the consultant/your GP for other options.

If you have any questions on this information leaflet, please contact your Occupational Therapist

Your Occupational Therapist is ___________________________                                                                           

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