Treatment Options for Mallet Finger
Will the end of your finger not fully straighten? If so, a mallet finger could be the culprit. This condition occurs when the extensor tendon, which helps to straighten your finger, is injured. This specifically occurs at the end of the finger (distal phalanx) in which there is a lack of extension at the distal interphalengeal joint (DIP) joint.
This DIP joint is just below your finger nail and can be seen as the small crease closest to the end of your finger. With this injury, the DIP joint can passively be straightened, however, limitations arise in the ability to actively extend the end of the finger.
There are essentially two ways in which this generally occurs which are (1) rupture or soft tissue injury to the extensor tendon itself or (2) an avulsion fracture (when the tendon pulls part of the bone). The soft tissue injury of the extensor tendon is often referred to as tendinous mallet finger and a fracture resulting in this injury is often referred to as bony mallet finger.
Effective Treatment Options for Mallet Finger
Nonoperative treatment includes splinting, pain and symptom management, and hand therapy. Splinting is often the first case of action for nonoperative management with 6-8 weeks of splinting keeping the DIP joint in a fully extended or slightly hyperextended position in order to allow for the torn extensor tendon to adequately heal. For bony mallet finger, splinting may occur in a neutral extended position or slight flexion.
Along with this, modality usage such as ice can often be utilized to improve edema management. In regards to surgical intervention, surgery is generally only completed in cases in which there is severe joint misalignment or large bone fragment fractures (~50% or more). One of the most common procedures is called pin fixation when k-wires are used to align the joint as well as securing the bone back into the appropriate position.
Therapeutic Management and Rehabilitation
Physical or occupational therapy is often recommended following mallet finger injury and splinting in order to facilitate improved range of motion, increase strength, prevent stiffness and deformity, and maintain or improve functional use.
Following immobilization through splinting, therapy may include aspects such as therapeutic exercise, edema and pain management, patient education, and functional training. Through a combination of these components, the therapist will help to ensure appropriate healing and ability to return to everyday activities. Early intervention along with consistent adherence to therapy recommendations are important to promote return to function and appropriate functional outcomes.
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References
[1] Khera, B., Chang, C., & Bhat, W. (2021). An overview of mallet finger injuries. Acta bio-medica : Atenei Parmensis, 92(5), e2021246. https://doi.org/10.23750/abm.v92i5.11731
[2] Rubin, G., Ammuri, A., Mano, U. D., Shay, R., Svorai, S. B., Sagiv, R., & Rozen, N. (2023). Outcome Differences between Conservatively Treated Acute Bony and Tendinous Mallet Fingers. Journal of clinical medicine, 12(20), 6557. https://doi.org/10.3390/jcm12206557
