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Mallet Finger

Posted on May 10, 2017 at 3:25 PM

Mallet finger is a common finger deformity, that I just happened to recently experience. I have injured my fingers when I was younger and playing ball, but usually I experienced some pretty intense bruising and swelling without loss of function. That did not happen this time, so needless to say I was in a bit of denial at first.



Mallet finger is a disruption of the extensor tendon (back side of the hand) over the distal interphalangeal joint. When the extensor tendon is disrupted there is no structure left to extend the joint, resulting in a fingertip that does not straighten and remains in a flexed position. This occurs when the joint experiences trauma, forcing the joint into a flexed position and tearing the tendon. This is seen in athletics when a ball hits the ends of the finger tips (a kickball in my case). It can also be common for the tendon to remain intact, but instead to pull away at the bone resulting in an avulsion fracture. If this injury is left untreated, it will heal in the flexed position and cause difficulty with certain activities such as putting on gloves or putting your hand in your pocket.



In general, the treatment process consists of splinting in neutral or hyperextension for 4-8 weeks. Splints can vary depending on your provider. However, if there is an open injury (such as a cut or laceration), the structures may need stitches. Regardless if there is a fracture or dislocation, treatment will start with splinting and if the injury is deemed unstable or splinting options have failed, surgery may be an option.


Now I am not down and out for 4 to 8 weeks. I am not sitting around and hoping for the best. As long as the injury is properly splinted activity can resume as tolerated. Things like my grip strength have decreased because I am now gripping with two fingers and my thumb versus my whole hand which is not an issue until I try to pour from a gallon of milk or swing kettlebells around my waist. I am still working out and only have to modify a few exercises (but there are so many to choose from anyway that there is just not a reason to quit!). Always make sure your healthcare provider and you are on the same page. While many activities can still be maintained, proper modifications will be made based on how many structures were injured and how much grip the activity requires.


So the injury site is splinted, should it be massaged? Well, yes and no. The injured site right at the joint should not be massaged during the early stages of healing, as we need the scar tissue to be the natural glue to hold everything together. In the early stages of healing with the splint on, motion is restricted causing other joints and muscles to compensate. While I do not recommend the finger to be massaged, I very much recommend the hand ( with modification), wrist and upper extremity ( at least up to the shoulder) to be massaged. This will help bring in healing nutrients and keep the muscles balanced from both the trauma and compensation.

 

After initial splinting has ended, then your healthcare provider will help you to ween out of the splint. It will be determined which activities are ok and not ok out of the splint. Exercises will be given to regain normal motion. If everything goes well, you will avoid surgery. Always ask questions and understand where you are in your healing process. This is what your healthcare provider is for and your fingers are important. Take care!

Categories: athletic training, injury prevention, health

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