Your hand is made up of multiple tendons, like ropes, that enable your fingers to do remarkable things like hold a pen, play the piano, chop onions, or play tennis, for example.
But like ropes, when a tendon is damaged, it can no longer perform its role. This is what happens when you damage the extensor tendon at the end joint in your finger or thumb, the tendon that lets you straighten that digit. You end up with a deformity known as mallet finger.
You’ll know something isn’t right because your finger will look like this (image below) and you’ll be unable to straighten the tip of it. In some instances, you may also notice swelling, pain, and bruising.
To be fair, you’ll probably have a pretty good idea of how you did it because this type of injury most frequently occurs as a result of having the tip of your finger forcibly bent further than it’s meant to go, such as if it’s hit with a ball while playing sport. It can also happen when tucking in a bedsheet and your finger jams against the mattress.
Sometimes, if the force of the blow to the digit has been particularly firm, it may pull off a piece of bone with the tendon. This is known as an avulsion injury and it occurs because the attachment of the tendon to the bone is so firm.
It’s very important that this injury is treated. Do not leave it to settle on its own because it won’t, and you could easily end up with a permanent deformity of that fingertip.
First aid involves elevating the hand and applying an ice pack to the area. Your GP will send you for a plain x-ray of your finger to check you’ve not sustained a fracture or any misalignment of the bones in your finger.
Initial treatment is often non-surgical but requires a high level of commitment and dedication from the patient. A small thermoplastic splint must be diligently worn on the affected finger to keep the distal joint extended for eight weeks. It’s very important the splinting remains in place, full-time, for the entire eight weeks as this gives the tendon the chance it needs to repair. If the splint is removed before that time, you will have to start all over again.
After eight weeks, and if active extension of the distal joint is present, splinting can be reduced to being worn just when playing sport, sleeping, working or at any times where the finger may be at risk of getting bent.
What about surgery?
After six months, if it appears obvious that splint management has not worked, surgery may be suggested although there is a high risk of complications including infection, deformity to the nail, joint deformity and bone prominence.
Sometimes surgery is required, particularly if there is a large bone fragment or displacement of the joint. There are multiple approaches to surgery and different surgeons will have their preferred method. However, the principle is the same: attaching the tendon back on to the bone so it can once again perform its role.
No easy way out
Of course, surgery carries also means long rehabilitation. Despite being a small tendon, there is no easy way out of a mallet finger injury.
So, if you have an injury to the end of your finger and you can no longer straighten it, you may have a mallet finger. It’s important that you see your GP to check for a fracture before heading to a surgeon to discuss all your options.
Hopefully you won’t need an operation but it is important to understand the options you have on the pathway to recovery.