Mallet Finger – Symptoms and Management

  • Reference Number: HEY-602/2014
  • Departments: Orthopaedics

Introduction

This leaflet has been produced to give you general information about the symptoms and management of your injury.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.    If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is a mallet finger?

A mallet finger is where the tip of your finger becomes bent towards your palm and you are unable to straighten it.

It is usually caused by an injury to the end of the finger which causes it to bend further than normal. This results in a tear of the tendon that would usually straighten the end of the finger.

Mallet finger

Reproduced with the kind permission of Patient.co.uk

Sometimes the tendon will not tear but a small piece of bone it attaches to will be pulled off the finger. The result will be the same as the tendon is unable to pull on the bone.

What are the symptoms?

Due to the tear in your tendon your finger may become painful and swollen. You will be unable to straighten the end of your finger.

How is it treated?

A splint is usually fitted for you to wear which will keep the tip of your finger fully straight. It must be worn day and night for an 8 week period. This allows the ends of the torn tendon to stay together and heal.

Your splint should only restrict movement at the top joint and not at the middle joint of the finger. It is important you continue to move the middle joint as in the diagram below. Perform this exercise 10 times, 3 to 4 times per day.

How is it treated - 1

It is important that when the splint is removed for washing you ensure the finger remains straight at all times. To do this lay your hand palm down on a flat surface and slip the splint off. Wash the finger whilst the hand remains flat and then slide the splint back on.

If you find, as the swelling settles, your splint becomes too large for your finger contact your physiotherapist on the number at the end of this leaflet to discuss.

After 8 weeks you should continue to wear the splint for a further 4 weeks at night only. You can now start to gently bend and straighten your finger tip regularly during the day. We recommend performing the following exercise 2 – 3 minutes every few hours.

How is it treated - 2

It is very important at this stage that you do not force or stretch the tip of your finger.

If you do not comply with the use of the splint and the length of time it should be worn then it is likely that the ability to straighten the end of your finger will not return.

What should I do in the first 72 hours after sustaining the injury?

The most important initial treatment is aimed at controlling the pain and swelling
by following the principles of RICE:

R: Rest

By wearing the splint that your physiotherapist will issue you this will ensure that the tip of the finger does not move.

I: Ice

There are many different ways in which ice can be applied. Whichever method you choose, it is important that you wrap it in a damp towel to prevent ‘burning’ the skin. Ice should be applied for 20 to 30 minutes every 2 hours.

Please Note:
Only use an ice pack on areas that have normal skin sensation i.e. where you can feel hot and cold.
Do not apply ice to an open wound.
Do not apply an ice pack to an area that has poor circulation.
When you apply ice to your skin, check the skin every 5 minutes and stop using it if:

  • the area becomes white, blue or blotchy.
  • the area becomes excessively painful, numb or tingles.

C: Compression

This is not necessary in the initial stages of a finger injury.

E: Elevation

If you have swelling in your finger, sit on a chair and place your elbow on cushions so that it is level or slightly higher than your shoulder. In this position point your hand towards the ceiling then open and close your hand as this will help to reduce any swelling further.

Painkillers

To manage your pain it is advised that you regularly take painkillers which can be bought cheaply over the counter. If you have allergies or conditions which prevent the use of painkilling or anti-inflammatory medication, please seek advice from a pharmacist or your General Practitioner.

Is there anything I should avoid?

  • Do not try to examine how much your finger has healed by bending it.
  • Do not wear rings on the affected finger. If the finger is swollen it may well affect your circulation and interfere with the healing process.
  • Do not consume alcohol, massage the injured area or apply heat as all can be detrimental in the early stages of healing.

Outcome

Treatment in this way is successful for a mallet finger in 3 out of 4 people. Some patients may be left with a slight bend, however this will not usually affect the function of the finger and no further medical input is required.

If, following the 12 week splinting period described earlier in this leaflet, the finger remains slightly bent and interferes with your ability to function normally you should contact the telephone number noted below and request to speak with the named clinician that assessed you.

Telephone ……………………………..…  Clinician Name ………………………………

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

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We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

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