Mallet Finger

About

We use our hands frequently everyday. Considering the manner we put them to use, it is not surprising that our hands are often prone to injuries. However, it is reassuring to know that most hand injuries can be healed completely through simple treatments that are now easily available.

Mallet finger is a deformity that occurs when an injury disrupts a tendon at the joint near the tip of a finger and prevents it from straightening. A mallet finger involves the extensor tendon which, when tightens, straightens the finger.

Mallet finger can be due to disruption of the tendon alone or it can involve a small fragmentation of the bone. In most cases, the injury may seem to be a "closed" injury, where the skin is intact. If the blow is severe, an "open" injury could occur.

Mallet finger can be caused by a simple action or it may be the result of a direct blow on the finger. It is mostly caused during sports, such as a baseball game, and hence is also known as "baseball finger." In many, the deformity can be corrected by wearing finger splints.

In children, the injury may involve the growth plate, the growing part of the bone while in adults it may involve the joint surface. Doctors must exert great care while treating children so that the finger does not become deformed or stunted.

Mallet finger - Causes and Symptoms

A mallet finger is caused when an object strikes the tip of an outstretched finger with force and damages the extensor tendon located near the fingertip.

A mallet finger is caused when a ball, or any other object, strikes the tip of an outstretched finger with force and bends it. This causes damage to the extensor tendon, located at the distal inter phalangeal joint (DIP - the joint near the finger tip), which plays a role in straightening the finger. It commonly occurs during sports, especially while catching a ball during games such as soft ball, baseball, cricket or volley ball.

Mallet finger - Symptoms

The following are the symptoms of mallet finger-

• Pain, which is more in the case of bone injury
• Numbness
• Swollen and bruised finger tips
• Blood collection under nail
• Detached nail
• Finger or thumb cannot be straightened
• Swan neck deformity - Fingertips remain bent or drooped, facing the palm. The deformity which forms make the finger look like the shape of a swan's neck.

Mallet Finger - Diagnosis and Treatment

Physical examination and X-ray of the injured finger help in establishing diagnosis of mallet finger.Wearing finger splints is the most common treatment for mallet finger. If deformity persists or if the tendon has become detached, a surgery may have to be carried out.

Mallet Finger Diagnosis

Physical examination and the case history help to diagnose mallet finger. Symptoms of mallet finger, such as pain and drooped fingertip, establish the diagnosis.

However, in most cases, the doctor will order X-ray tests of the injured finger to look for an avulsion fracture or mal alignment of the joint.

Mallet Finger Treatment

Immediately after injury occurs, ice must be applied to the finger and the arm must be kept at a level elevated from the heart to reduce blood supply to the finger and minimize inflammation and damage.

The injured person must be taken to a doctor at least within a week of the injury. However, medical attention must be sought immediately if the nail has been detached or if there is blood collected in the nail bed, as these may be indicative of laceration.

Treatment options include -

• Splints - Wearing finger splints (for 6-8 weeks) is the most common treatment for mallet finger. A splint holds the finger straight until the finger heals. Splints used commonly on a mallet finger are dorsal aluminum splint and commercial splint. Although the patient may have regained a certain level of function in the injured finger, wearing splint does not guarantee a complete recovery of finger extension. You may have to wear splint for a longer time if you have delayed seeking medical help. If your tendon is stretched, you may have to wear splints for 4-6 weeks; if it is torn or ripped off the bone then you may need to wear splint for 6-8 weeks. Splint must be worn correctly; it must be snug and not too tight to avoid cutting off blood flow.

• Extension block k-wire - This is another support that is used until finger heals. It must be worn for 4 weeks.
• Surgery (within a week of injury) - If the extensor tendon has become detached from the finger bone, surgery may have be carried out to reattach the tendon. This must be done within 10 days of the injury. Surgery for mallet finger is usually done when injury is severe and cannot be repaired by non-surgical means. Surgery is also considered when the mallet finger presents with an open injury or if more than 30% of the articular surface of DIP is involved in the injury. The surgical procedure either tightens the stretched tissues of the tendon, makes use of tendon grafts or fuses the joint.

• Depending on the severity of the injury, antibiotics may be prescribed to prevent infections. Pain killers may also be prescribed as required.

After the stipulated period of time, you will be able to resume normal activities without hindrance.

Self - care

• When you remove the splint for cleaning, make sure you keep your fingers straight and not drooped.
• While showering, cover your finger and splint in plastic. Do not wet them.
• Use an ice pack to cope with pain. Apply ice pack 20 min each hour (while awake) for two days at a stretch. After that, repeat the procedure for 10-25 min thrice a day. This helps greatly to reduce swelling and pain

• In case of excessive pain, use medications after consulting a doctor
• Do a follow up to ensure that the injury has healed completely. If it has not healed well, you may have to wear splint for a little longer.

References:

1. Mallet finger - aftercare - (http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000538.htm)
2. Mallet finger - (http://en.wikipedia.org/wiki/Mallet_finger)
3. Orthopedics and Sports Medicine - (http://www.methodistorthopedics.com/mallet-finger-injuries)

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