Mallet Finger

Mallet finger is an injury where the extensor tendon has been forcibly pulled off its insertion, or point of attachment, at the tip of the finger. As a result, the patient is unable to straighten the tip of the finger and usually has associated pain around the fingertip. The bent tip of the finger resembles a mallet, hence the name. The injury commonly occurs while playing sports, like baseball. The extended finger is forcibly flexed, which pulls the extensor tendon off of its insertion into the tip of the finger. Occasionally the extensor tendon gets pulled off with a fleck of bone, which is visible on x-ray.

The diagnosis is made by physical examination and patient history. The most characteristic diagnostic tool is the patient's inability to straighten the tip of the finger. The treatment of mallet finger may, or may not require surgery depending upon the injury. Nonoperative treatments will include placing the finger in a splint. The patient must wear the splint continuously, 24 hours a day 7 days a week for approximately 6 weeks. The splint is then worn at night for an additional 6 weeks. Mallet finger can be treated with a splint even when the diagnosis is delayed by several weeks. If the tip of the finger is subluxed (partially dislocated) as visualized on x-ray, surgical treatment of mallet finger may be required. Surgical treatment typically requires placing a wire across the joint at the tip of the finger to hold the finger extended (straightened). The wire is then removed after six weeks. Surgery is also necessary if the fleck of bone pulled off with the tendon is large and involves a significant amount of the joint. In either case, patients should expect recovery and motion within 12 weeks after treatment.

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