How do hand therapists conservatively manage acute, closed mallet. The result is the same, as the tendon then cannot pull on the bone. This condition is also known as baseball finger because it most often occurs when a ball or other object strikes the tip of a straight. The technique is based on frequent holdrelax tipto. This tendon injury can be difficult to treat and if.
This information leaflet is for people who have had a mallet finger injury. This results in the inability to extend the finger tip without pushing it. Sometimes the tendon does not tear but the injury causes a piece of bone to be pulled off the finger where the tendon is attached. The index pointing finger of your good hand should be underneath the tip of the problem finger. Mallet finger also referred to as baseball finger occurs when an incident causes the extensor tendon at the tip of the finger or thumb to be stretched, cut or ruptured. Although the recommended treatment for closed mallet finger is conservative, some authors proposed operative treatment for mallet thumb. Mallet finger why is physical therapy important to your. Keywords mallet finger, hand therapy, management, rehabilitation, exercise. Active pip flexion of affected finger with adjacent finger s held in extension. Mallet finger is an injury to the end of the finger.
This injury, which typically results from trauma, such as when the fingertip is hit by a ball, causes the tip of your finger to droop. Your finger will be put in a plastic splint, which keeps it straight, with the end joint slightly bent backwards. Bumping, jamming, crushing, or cutting the backside of the finger near the tip, can cause a tendon injury known as a mallet finger. An xray or mri may be used to determine if the tendon is torn if there is an avulsion or a fracture to the end bone of the finger if there is no avulsion or fracture, then a mallet finger splint may be worn for up to eight weeks. Summit medical group is making it easier than ever for patients to seek care while limiting exposure to covid19. The first step in treating a mallet finger is to apply ice to the finger immediately after injury and continue for about 15 minutes every two hours for the first few days. A mallet finger injury causes loss of movement, pain, and swelling. Wearing a splint on your finger to keep it straight is the most common treatment for mallet finger. Dip 100 hyperextension for tendinous mallet 68 weeks. It can involve either a bony avulsion injury of the distal phalanx or a rupture of the extensor tendon with no bony involvement figure 1. Exercises improve movement and strength of your finger after this injury. The patient with a chronic deformity is splinted longer than the patient with an acute deformity.
A mallet finger is where the end of a finger is bent flexed towards the palm and cannot straighten. Mallet finger is also known as baseball finger, however this injury can happen to anyone when an object like a ball strikes the tip of a finger or thumb and bends the finger further than it is supposed to go. It is usually caused by forced flexion of the tip or a laceration. The first type is called a bony mallet deformity which involves a fracture of the bone. There are no exercises, braces or equipment that will prevent mallet finger. Gently bend the injured finger with your other hand. Rehabilitation following mallet south tees hospitals nhs. Mallet finger patient information leaflet what is a mallet finger. Mallet finger is an injury to the end of your finger that causes it to bend inwards towards your palm. Acute finger tendonpulley injury management with dan mirsky and esther smith duration. Mallet finger is a flexion deformity of the finger that results from injury to the extensor mechanism at the base of the distal phalanx. Physical therapyinduced secondary bony mallet finger deformity.
A simple splint for baseball finger jama jama network. Chronic mallet finger may also reflect a failure of wellconducted initial treatment that resulted in a lengthened, ineffective tendon callus. Mallet finger injuries named for the resulting flexion deformity of the fingertip, which resembles a mallet or hammer. The treatment of the mallet finger ranges from nonoperative with prolonged splinting and immobilization to open reduction and rigid fixation depending on the extent of the injury as well as the time from injury to presentation. The expression mallet finger is inaccurate because the deformity is reducible in its acute. Although it is also known as baseball finger, this injury can happen to anyone when an unyielding object like a ball strikes the tip of a finger or thumb and forces it to bend further than it is intended to go. Although robb 1 wrote in 1959 about the treatment of mallet fingers. Just because you have a mallet finger does not mean you will develop a swan neck deformity there are lots of factors at play but its best to simply take care of the mallet finger. Most mallet finger injuries can be managed nonsurgically, but occasionally surgery is recommended for either an acute or a chronic mallet finger or for salvage of failed prior treatment.
Mallet finger occurs when there is a disruption in the tendon that straightens the tip of the finger. With your index finger, slowly push the tip of your problem finger up. It occurs when an object most often a ball hits the tip of the finger. Surgery to repair a mallet finger is required when the bone fragment is large, when the fingertip has moved position a little or when the cause is a laceration. Less often, the cause is a fracture at the bottom of the bone where the tendon attaches. The injury may occur when the extended tip of the thumb hits an object with forced flexion of the distal ip joint or due to a hyperflexion or hyperextension injury, resulting in either a tear of the extensor tendon or an avulsion of the bony attachment of the tendon from its. This means that your fingertip now droops and you cannot straighten it properly. Mallet finger refers to a condition in which the end joint of a finger bends but will not straighten by itself. Mallet finger rehabilitation protocol surgical management kelly holtkamp, m. The injury may occur when the extended tip of the thumb hits an object with forced flexion of the distal ip joint or due to a hyperflexion or hyperextension injury, resulting in either a tear of the extensor tendon or an avulsion of the. Treatment can be difficult as patient compliance is essential, and if not treated. Typically, a ball or some object strikes the distal phalanx and forces it into hyperflexion while the extensor mechanism is active. The principle may be useful in the treatment of hammer toe. Place your thumb just below the joint that is closest to your fingernail.
Splinting is the treatment of choice for almost all mallet finger injuries. The injury tears the tendon that straightens extends the end of the finger. Mallet finger is the result of a rupture of the extensor tendon at the tip of the finger, preventing the tip joint from straightening. Request pdf on mar 10, 2015, kristin valdes otd ot and others published conservative treatment of mallet finger. Mallet finger is a flexion deformity of the finger resulting from injury to the extensor mechanism at the base of the distal phalanx. Mallet finger recovery exercises answers on healthtap. Mallet finger injury no splint treatment by hand exercises. The purpose of this splint is to not allow the tip of your finger to bend at all. How do hand therapists conservatively manage acute, closed. It is made of aluminum, although duralumin, copper, brass, german silver or silver may be used. Youll still be able to bend your finger at the middle joint. Having this injury evaluated and properly treated is critical to the successful recovery from a mallet finger injury. Most people regain full function of the finger with no longterm effects. Mallet finger results from disruption of the extensor tendon at its insertion site at the dorsal aspect of the distal phalanx base, and mallet finger is the most common finger tendon injury in sports.
The usual cause is an injury to the end of the finger. Mallet finger rehabilitation protocol conservative management. Our telemedicine options include virtual video visits, telephone checkins, and patient portal communication. Acute posterior dislocation of the proximal interphalangeal joint. Four patients with open mallet injury and ten patients with open central slip avulsions were treated using the mitek mini bone anchors.
Mallet finger home program phase 2 exercises david gesensway, md notes. A mallet finger refers to an injury whereby the extensor tendon to the tip joint distal interphalangeal of the finger. Some people will develop a longterm deformity known as a swan neck, which involves all of the finger joints. Treatment of mallet fracture by extension block pinning. It can occur in a number of ways, but most commonly when a straight finger is stubbed and forced to bend suddenly at the joint near the tip. Then gently try to straighten out the injured finger with help from your other hand. Review of acute traumatic closed mallet finger injuries in adults. Either one results in an inability to extend the dip joint. The tendon on the back of the joint snaps or pulls off its attachment to the bone.
Pdf mallet finger is a common injury involving either an extensor tendon rupture at its insertion or an avulsion. However, any injury that forces the end joint of a finger to overbend can cause it. Results of treatment of mallet finger injuries vary. When you do try to straighten it, the tip of your finger remains bent toward your palm. Nov 17, 2019 a mallet finger is more than just a typical jammed finger. A mallet finger, also known as hammer finger, is an extensor tendon injury at the farthest away finger joint. You will not be able to straighten the end of your finger because the tendon connecting the muscle to the finger bone is stretched or torn. The protocol for treating mallet fingers is the same whether the patient has required open reduction and internal fixation, percutaneous pin fixation, or is being treated nonoperatively. Repeat slowly, holding for 5 seconds at the end of each. Mallet finger occurs when the tendon that straightens the last joint of your finger is torn. Middle finger right hand,wore a splint for 6 weeks,been out of splint now for about a month, finger still red and swollen and bending at the tip,not sure if i seen any improvement,trouble is in my line of work i use my hands alot and by the end of the day my finger looks worse then ever,also if i hit my finger it hurts,like its bruised,not sure. Mallet finger most often occurs when something hits the tip of your straightened finger and bends it down with force. A mallet finger is where the end joint of the finger bends towards the palm and cannot be straightened.
Adam holbrook, otrl, cht is a certified hand therapist and a member of the american society of hand therapists asht. To look for a fracture an xray is taken of your injured finger. The whole reason i wrote this is because when i got my mallet finger i couldnt find very many blogs with personal experiences, and the ones i did find didnt have any practical advice. Treatment of chronic extensor tendons lesions of the. Mallet finger splint care instructions in order to achieve the best result, you must wear your splint 24 hours a day without interruption. This leaflet sets out some exercises you should do each day to help your finger to heal. Mallet finger is a common athletic injury that affects basketball and baseball players routinely jammed fingers, but the injury can occur because of a crushing accident on the job, or even because of a cut finger while working in the kitchen. Splint weaning program for mallet finger deformity after you have worn the mallet splint all the time for the recommended period, usually eight 8 weeks or longer, depending on what you were instructed, you should follow the weaning schedule below. So i thought i would make my own experience available to anyone searching for tips on coping with mallet finger.
Mallet finger injury often occurs in ballcatching sports such as football, basketball, baseball, and softball. Treatment of chronic extensor tendons lesions of the fingers. It will take a further six weeks before you can return to heavy activities. Mallet finger is where the tendon that straightens the end joint of your finger has been torn. Mallet finger injury baseball finger physical therapy library. Rehabilitation following mallet finger patient information what is mallet finger. Learning to cope with mallet finger the pathless wood. Mallet finger in adults is a traumatic lesion of the terminal extensor band in zone 1, and is characterized by intact skin and division of the tendon insertion alone tendinous mallet or an avulsion of less than one third of the articular surface of the distal phalanx bony mallet 1,2,3. This is a simple splint which i have found very effective. Mallet finger occurs when you cannot straighten your finger.
Doctor answers on symptoms, diagnosis, treatment, and more. Racgp mallet finger management and patient compliance. Review of acute traumatic closed mallet finger injuries in. This forcibly bends the fingertip further than it should go. Mallet finger why is physical therapy important to your recovery. It is useful in the treatment of baseball finger, mallet finger 1 or drop phalangette, 2 and arthritic flexion of the end phalanx. If the finger is cut, clean the cut under running water for a few minutes. This document is to help you understand your injury, and reinforce the treatment required to get the best results possible. This research found hand therapists implement a diverse range of clinical skills in order to optimise outcome success. There is generally pain and bruising at the back side of the farthest away finger joint. Oct 25, 2014 mallet thumb unlike mallet finger, avulsion of the extensor pollicis longus epl tendon at its distal insertion mallet thumb is rare.
Most mallet finger injuries are treated with splinting. The injury can involve the tendon alone, or occur with a fracture at the tendonjoint interface fig. The splint is taped on and must be worn day and night for 6 to 8 weeks to allow the 2. It can occur in a number of ways, but most commonly when a straight finger is stubbed and forced to bend suddenly at the joint. Apr 25, 2016 from a high level competition to a weekend pickup game, any athlete can experience a hand injury. A mallet finger is a deformity of the finger caused when the tendon that straightens. The single article published exclusively hand surgery service, maimonides medical center and center, state university of new york, brookn.
The diagnosis and management of mallet finger injuries. This video illustrates mallet finger nonsplint treatment with an exercise technique developed by valdas macionis, md, phd. Basketball and baseball players routinely experience jammed fingers. Mallet finger is the term applied to extensor avulsion fractures or distal extensor tendon ruptures. Finger rehabilitation is an indispensable part of any method of treatment. Fortunately, most people can heal this injury with the proper use of a simple splint. This is a retrospective study to evaluate the outcomes of treatment of mallet fracture by extension block pinning with respect to range of motion, time of union and complications. Repair and rehabilitation pdf download flexor tendon repair pdf download extensor tendon repair and rehabilitation pdf download mallet finger pdf download finger sprain pdf download. Mallet finger is an injury to the tip of the finger when something hard, like a baseball, jams it. Open treatment can result in frequent complications, and the surgeon should resist the temptation to make good better by operating on these injuries. This can damage the tendon and bone, causing the finger to droop. Pdf physical therapyinduced secondary bony mallet finger.
Mallet thumb is not as commonly seen as mallet finger. Exercises and other interventions supplementary to splinting are commonly utilised in the therapeutic management of acute, closed mallet finger. Mallet finger therapy exercises things you didnt know. The second type is called a soft tissue mallet deformity. Treatment you have been given a splint to keep the joint straight while you are using your hand. The mean age for males is 34 compared with 41 in females. Treatment of mallet finger depends on the type of injury that the dip joint and extensor mechanism have sustained. Mallet finger advice on removal of your splint your tendon is becoming stronger but it is not fully healed. For uncomplicated mallet finger treatment involves splinting of the dip distal interphalangeal joint in slight hyperextension for a period of upto 8 weeks, with regular monitoring. Mallet finger mallet finger is an injury to the thin tendon that helps straighten the end of a finger or thumb. For complicated mallet finger injuries operative treatment has also been recommended. The tendon that attaches to the tip of your finger bone on the back. You may need to wear a splint for different lengths of time.
The inconvenience related to mallet finger may only be due to esthetics. The joint at the end of the finger is noted to droop. Sports injuries are the most common cause of mallet finger, particularly from catching a ball. Mallet finger usually results from forced flexion of an extended finger. Article information, pdf download for how do hand therapists. Mallet finger rehabilitation protocol conservative management kelly holtkamp, m. In this situation, the joint can be pushed straight, but will not hold that position on its own. There are finger exercises that a hand therapist can teach you to strengthen your fingers, but you should be evaluated by a hand surgeon to make sue there are no correctable injuries. Discussion mallet finger usually results from forced flexion of an extended finger. Aug 26, 2016 sports injuries are a common cause of mallet finger. This injury occurs because of forced flexion of the dip joint during extensor contraction. Mallet finger rehabilitation protocol surgical management. Mallet finger injuries are most commonly seen in young and middle aged male patients.
Rehabilitation after surgery for mallet finger focuses mainly on keeping the other joints mobile and preventing stiffness from disuse. Mallet finger is an injury involving the distal interphalangeal joint dip which is the last joint of the finger. If an open dislocation has occurred, care is taken to prevent wound infection. After 8 weeks of continuous splint wear, and keeping the tip joint of the finger straight 24 hour a day protecting it in a straight position when cleaning the finger as well, you are ready to start the 2nd phase of. Then wrap the finger with clean gauze or a clean cloth. Mallet finger is a flexion deformity resulting from avulsion of the extensor. Without proper treatment, permanent deformity can be the result. Tendon glide exercises ability rehabilitation youtube. Jun 05, 2016 mallet finger is a condition often seen after sports related trauma that causes the finger tip to droop, sometimes confused as a dislocation. Commonly an athletic injury, mallet finger occurs when the outermost joint of the finger is injured. Mallet finger doctor of physical therapy orange county. Feb 25, 2014 the incidence of bony mallet finger is well reported in the literature, but there is no published data regarding the incidence of soft tissue mallet finger. Rehabilitation following mallet finger south tees hospitals nhs. The efficacy of continuous splinting was retrospectively compared in two populations of 40 patients with soft tissue and bony mallet finger whose treatment was.
Recommendations for best practice and further research are presented. Objective this article discusses the current clinical assessment and appropriate management of mallet finger injuries. Pdf how do hand therapists conservatively manage acute, closed. This is one of the few clinical entities in which the overwhelming evidence favors nonoperative treatment, even if slight subluxation of the dip joint is seen on. Treatment of chronic extensor tendons lesions of the fingers prise en.
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