Mallet Finger Injuries and Treatment: Prevent Permanent Droop
Injuries to the hand can have a significant impact on daily life, but with a small body part, sometimes these injuries feel insubstantial. Many decide not to seek treatment, but the long term outcomes can be problematic when treated too late or not at all.
A common finger injury that I treat as a Certified Hand Therapist (CHT) is mallet finger. It is often sustained during sports, work, or simply through everyday activities when an object strikes the tip of the finger or when the finger jams into a firm object. The resulting injury can affect your ability to grip, type, dress, and perform countless small tasks that depend on healthy hand function.
What is Mallet Finger?
Mallet finger occurs when the extensor tendon that straightens the tip of the finger is damaged. The result? You can no longer straighten the tip of your finger and it droops down. When something forcefully strikes the fingertip, it bends forward further than it should and the extensor tendon tears. I’ve seen this happen when playing catch and the ball awkwardly hits the hand or when falling you jam your finger against a hard surface or the dog leash wraps around the finger when your pupper suddenly lunges for that squirrel.
The result is that the fingertip droops and cannot be actively straightened without assistance. Sometimes this injury is purely to the tendon; other times, a small piece of bone may break off at the joint, known as a bony mallet. It is usually accompanied by pain and swelling, but I’ve seen it as a non-painful injury.
In cases of large bone fragments, joint misalignment, or unsuccessful splinting, surgical intervention may be needed. This post describes non-surgical management of the injury.
Signs and Symptoms
Inability to actively straighten the fingertip
- Drooping at the end joint of the finger
- Swelling and tenderness around the injury
- Bruising in some cases
- If untreated, mallet finger can lead to long-term stiffness, pain, deformity, or arthritis in the affected joint.
Treatment Options
To fit your mallet finger, you need a well-fitting orthosis. The goal is to keep the fingertip fully extended while the tendon heals. The orthosis functions to place the torn ends of the tendon together and this allows the body to form a scar tissue bridge between the ends. The body essentially “Knits” the torn ends back together. Isn’t it cool that the body can do this? I know! But, the process takes time an patience. I call mallet finger a nuisance injury where meticulous attention is required despite a low level of pain.
Initial daytime management: A custom or prefabricated splint is worn 24/7, usually for 6–8 weeks. It is critical that the fingertip remains fully straight during this time. Yes, you need to wear it in the shower. Even a moment of bending can disrupt healing and set back recovery. Why? Separating those torn ends stretches the weave of the fibrous scar tissue. We need it to stay in a compact bundle for optimal strength.
Initial night time management: A second orthosis is useful to allow different pressure points on the finger and to allow the skin to breathe. Wearing a plastic orthosis full time is not friendly to the skin or joints, so I like to make a daytime orthosis that secures the top side of the finger and a second night time orthosis that secures the underside of the finger to maximize airflow to the skin and decrease friction over that sensitive joint at the end of the finger.
Weaning Phase: After the initial healing, you will be directed to gradually remove the orthosis for day time–but it you notice the droop, the support needs to be re-applied. Some people are able to wean from the daytime orthosis in a few days while others may take weeks.
Night Positioning: Wearing the orthosis to bed is recommended for several additional weeks. I tell clients that this phase is like wearing a retainer on your teeth after braces have been removed. The night time positioning helps the soft tissues reset to the correct length.
Hand Therapy: A Certified Hand Therapist (CHT) can fabricate a custom splint, monitor healing progress, adjust the splint for comfort, and provide exercises at the right time to restore safe motion without compromising healing.
What You Can Expect in Therapy
As an OT and CHT, my role is to:
- Fabricate a splint that holds the fingertip in the optimal position
- Educate you on proper splint care and skin protection
- Instruct in steps for protected hygiene, so as you care for your skin, you do not disrupt the healing
- Monitor progress at each stage, for example, if your orthosis was fabricated when you had swelling in the finger, it may need adjustment for a contoured fit when the swelling reduces
- Provide guided exercises once healing allows, to restore range of motion and strength
- Offer strategies for protecting your finger during daily tasks, work, or sports
Key Takeaways
- Mallet finger is common but requires consistent treatment to heal properly. Don’t wait to seek treatment!
- Orthotic use is highly effective when worn as prescribed.
- Certified Hand Therapists are uniquely trained to guide recovery and maximize hand function.
If you think you may have a mallet finger injury, it’s important to seek treatment promptly. Early intervention leads to the best outcomes and helps prevent long-term complications.
At Katherine Jackson Occupational Therapy, PLLC in Evanston, IL, I provide individualized hand therapy for mallet finger and many other upper extremity conditions. Together, we’ll work toward restoring function and confidence in your daily activities.
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