Mallet Finger: Causes, Symptoms, and Treatment Options

Mallet finger is a common injury that affects the finger’s extensor tendon—the one responsible for straightening the fingertip. This injury usually happens when the fingertip is suddenly jammed or bent forcefully, like when a ball hits an outstretched finger. It's also known as "baseball finger" because it often occurs during sports, but it can happen in other everyday activities as well.

What is Mallet Finger?
Mallet finger occurs when the tendon that straightens the tip of the finger (called the extensor tendon) is torn or stretched. In some cases, a small piece of bone is pulled away with the tendon. This results in the fingertip being unable to straighten on its own.

Causes of Mallet Finger
Mallet finger is caused by direct trauma to the tip of the finger, forcing it to bend more than it should. This can result from trauma (e.g. a ball banging onto the tip of the finger), or in simple daily tasks (e.g. pushing sheets under mattress or pulling on socks).

Symptoms of Mallet Finger
The key symptoms include:

• The fingertip droops and cannot be straightened.
• Swelling near where your finger nail grows.
• In some cases, bruising may occur.
• The finger may feel tender when touched.

Treatment Options:

1. Non-Operative Treatment
Non-surgical treatment is often the first step in managing a mallet finger injury, especially if the tendon is torn without a significant fracture.
Splinting

• The most common non-operative treatment is wearing a splint. This holds the fingertip straight (in extension) to allow the torn tendon to heal. Custom made splints are more comfortable and effective.
• Duration: The splint is usually worn full-time for about 6-8 weeks. It's essential not to remove the splint, as even a slight bend can re-injure the tendon.
• After 6-8 weeks, the splint is gradually worn less, but continued part-time use (for example, at night) is often recommended for an additional few weeks.
• Pros: This method has a high success rate, especially for simple mallet finger injuries. It avoids surgery and complications.
• Cons: It requires strict compliance. The splint needs to stay in place, even during bathing or other activities, to ensure healing.

What to Expect: Swelling and tenderness may gradually improve with time. Although the finger may not look exactly the same as before, most people regain normal function.

2. Operative Treatment
Surgical intervention is considered if:

• There is a large fracture that involves a portion of the bone where the tendon attaches.
• Non-surgical treatment fails to correct the finger after the splinting process.
• There is an open wound or the joint is misaligned.

Surgical Procedures There are several techniques used, depending on the injury's severity:

• Pinning the Joint (K-wire): This involves placing a small pin to keep the joint straight while the tendon or bone heals.
• Tendon Repair: In cases where the tendon is severely damaged, the surgeon may stitch the tendon to the bone.
• Bone Fragment Fixation: If a bone fragment has been pulled off, the surgeon may reattach it with tiny screws or wires.
• Pros: Surgery can fix more severe injuries, particularly those that involve fractures or tendon ruptures.
• Cons: There are risks associated with surgery, such as infection, stiffness, or complications with the pin or wire.

Recovery and Rehabilitation

• Non-operative Recovery: After wearing the splint, some stiffness is normal, but hand therapy or exercises may be recommended to regain motion.
• Operative Recovery: Depending on the procedure, hand therapy may be necessary to restore movement and strength. Recovery time may be longer than non-operative treatment, depending on the injury's complexity.
  

Conclusion
Mallet finger, is a reasonably common finger tip injury which can usually be treated successfully with non-operative methods like splinting. However, for more severe cases, surgery may be necessary to restore function. If you suspect a mallet finger injury, seek prompt medical attention to ensure the best outcome, whether through splinting or surgery.