Mallet Finger: Diagnosis, Treatment, and Rehabilitation at Palms Physiotherapy & Allied Health

What is Mallet Finger?

Mallet finger occurs when the extensor tendon at the tip of the finger is injured or torn. This tendon is responsible for straightening the distal phalanx, which is the last bone in the finger (the fingertip). When the tendon is damaged, the finger cannot be fully straightened, and the tip of the finger often droops downward. The condition is usually caused by a sudden blunt force injury, such as when the tip of the finger is forcefully bent downward by an object, causing the tendon to tear or the bone to break.

In some cases, mallet finger may also involve a small bone fracture at the base of the tendon, called an avulsion fracture. However, even without a fracture, the injury still impairs the function of the finger.

Symptoms of Mallet Finger

The symptoms of mallet finger are primarily related to the inability to straighten the finger tip. Common symptoms include:

1. Drooping Finger Tip

• The most obvious sign of mallet finger is a drooping or bent fingertip that cannot be straightened voluntarily.

2. Pain and Swelling

• Pain and swelling at the tip of the finger, particularly after the injury, is common. The area may also feel tender to the touch.

3. Bruising

• Bruising may appear around the injured area, particularly if there is an accompanying fracture or contusion.

4. Limited Range of Motion

• The finger may be stiff and have a limited range of motion at the affected joint, making it difficult to perform tasks requiring finger dexterity.

5. Finger Deformity

• In severe cases, the finger may appear visibly deformed or have an abnormal bend at the tip, especially if there is an associated fracture.

Causes of Mallet Finger

Mallet finger is typically caused by a sudden impact or trauma to the tip of the finger. The most common causes include:

1. Sports Injuries

• Mallet finger is particularly common in sports such as basketball, volleyball, or baseball, where a ball may strike the fingertip, causing it to bend forcefully downward.

2. Accidents or Falls

• A fall or accident, such as tripping or hitting your finger against an object, can also lead to mallet finger.

3. Direct Trauma

• Any direct trauma to the fingertip, including a forceful blow from an object like a door or a heavy item, can cause the tendon to tear.

4. Occupational Risks

• Certain occupations that involve manual labor, such as construction, can also pose a risk of mallet finger due to repetitive or sudden impact on the hands.

Diagnosis of Mallet Finger

The diagnosis of mallet finger typically involves a physical examination followed by imaging tests to confirm the extent of the injury. A healthcare provider will:

1. Physical Examination

• A doctor or physiotherapist will carefully examine the finger, assessing the bent position, swelling, and pain in the injured area. They will also test the finger’s ability to straighten and check for signs of tendon damage.

2. X-Ray

• An X-ray is often performed to determine if there is an avulsion fracture (small bone fragment torn away with the tendon) at the base of the affected finger, which can affect treatment options.

3. MRI or Ultrasound

• In some cases, an MRI or ultrasound may be recommended to assess the soft tissue damage more thoroughly, especially if the diagnosis is unclear.

Treatment Options for Mallet Finger at Palms Physiotherapy & Allied Health

At Palms Physiotherapy & Allied Health, we offer a range of treatment options to address mallet finger, focusing on pain management, tendon healing, and rehabilitation to restore full finger function. Treatment typically depends on the severity of the injury, whether there is a fracture, and the stage of healing.

1. Splinting

• The first line of treatment for mallet finger is usually splinting. A custom-made splint is worn to keep the affected finger in an extended position for 6-8 weeks, allowing the tendon to heal and preventing the finger from bending. The splint is typically worn at all times, even during sleep, until healing is complete.

2. Anti-Inflammatory Medications

• Anti-inflammatory medications, such as ibuprofen or paracetamol, may be recommended to help manage painand reduce swelling in the affected finger.

3. Physiotherapy

• After the initial splinting phase, physiotherapy will play a key role in restoring range of motion, strength, and function to the finger. Treatment may involve:

  • Gentle stretching exercises to improve flexibility.

  • Strengthening exercises to rebuild tendon strength and prevent stiffness.

  • Massage therapy to promote healing and reduce swelling.

4. Surgery (for severe cases)

• In cases where the tendon is completely torn, or if there is an associated bone fracture that prevents proper healing, surgery may be required to repair the tendon and/or bone. A tendon repair or pinning of the bone may be performed to restore normal finger function.

5. Rehabilitation

• Following surgery or splinting, a rehabilitation plan will be provided to help you regain finger movement and strength. This may include:

  • Progressive hand exercises to restore full range of motion.

  • Functional training to help return to daily activities like typing, gripping, or playing sports.

Recovery and Rehabilitation

The recovery from mallet finger depends on the severity of the injury, how well the finger responds to treatment, and the type of rehabilitation involved. For most individuals, the following timeline can be expected:

1. Splinting Phase (6-8 weeks)

• During the initial splinting phase, the finger must remain in a straightened position to allow the tendon to heal. This phase is crucial for preventing further injury to the tendon and promoting healing.

2. Post-Splinting Phase

• After the splint is removed, range-of-motion exercises will be essential to regain full mobility and function in the finger. In some cases, the finger may remain stiff, but with consistent therapy and exercise, most individuals will see significant improvement.

3. Return to Activities

• Gradual return to activities that require hand strength and dexterity, such as typing, writing, or sports, will be an important part of rehabilitation. It's important to avoid overloading the finger during the early stages of recovery to prevent re-injury.

Conclusion

Mallet finger is a treatable condition that, with appropriate care, can lead to a full recovery. At Palms Physiotherapy & Allied Health, we are dedicated to providing personalized care, from splinting and pain management to rehabilitationand exercise therapy, to ensure the best possible outcomes for your finger injury. If you are experiencing symptoms of mallet finger, such as pain, swelling, or difficulty straightening your finger, contact us today for an assessment and personalized treatment plan.

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