Mallet Injury

What causes it:

It is usually caused by the finger being hit on the tip by a ball during sports such as basketball or netball, or occasionally by a household job such as tucking sheets under the mattress.

What is happening in the body?

The tendon that straightens the finger has been torn, possibly with a small fragment of bone being pulled off the point where the tendon attaches also.

Signs and symptoms

Pain, swelling, and soreness of the top of the finger

An inability to fully straighten the tip of the finger without helping it.

Even though it can look initially like an insignificant injury- if left untreated, the fingertip will remain unable to straighten.

How can Physiotherapy help?

You can tape a popsicle stick to the finger to keep it straight until you can get to your physiotherapist for further assessment and treatment.

An Xray is usually recommended to check if the injury is an avulsion (fracture) or soft tissue only.

Successful treatment consists of wearing a customised finger splint for 6-8 weeks, which can be made by your physiotherapist for best fit and comfort. Great care is needed not to bend the finger when removing the splint to wash the finger, to let full healing occur.

The middle and bottom joints of the finger can be exercised to maintain good range of movement while the splint is being worn.

Once the 6–8-week period is over, it is followed by 3-4 weeks of exercises whilst gradually weaning off the splint, to restore range of movement and full function, including return to sports.

Finger or wrist fracture

What causes it?

A fracture is often caused by a fall onto the hand, or a direct blow to the hand.

What is happening in the body?

One or more of the small bones in the hand or wrist may have been broken, causing pain, swelling and possibly bruising.

An X-ray is usually needed to check for the type and location of the fracture. You can tape the finger next to the neighbouring finger initially for support until you can get to your physiotherapist for further assessment and treatment.

How can Physiotherapy help?

Your hand therapist can make a finger, thumb or wrist splint to rest the digit and will explain how to keep the bone protected while the fracture heals. This usually takes 3-6 weeks depending on the location of the fracture.

You will be taught specific hand exercises to maintain range of movement and help restore function and strength once the fracture has united.


What causes it?

Repetitive activities, especially in new or unaccustomed activities can start to cause pain in tendons or muscles.

Signs and symptoms

Pain on certain activities, often twisting movements

Tenderness at certain points of the tendon or muscle

Pain on stretching the muscle.

What is happening in the body?

The tendon may have become fatigued and irritated with the overloading, leading to pain every time it is loaded or stretched.

An example of this is De Quervains tendinopathy which affects two of the tendons in the thumb.

How can Physiotherapy help?

Research shows that a careful graded loading exercise program can lead to good tendon healing.

You may also need a period of rest within a splint, or possibly some taping.

Your physiotherapist can also treat your affected muscles with soft tissue release or dry needling to assist recovery.

Carpal Tunnel Syndrome

What causes it?

Swelling in the tunnel of the wrist can sometimes cause pressure on the median nerve that runs through the tunnel.

Signs and symptoms:

Pins and needles, tingling or numbness in the thumb, index and middle finger, often worse at night.

How can Physiotherapy help?

Your hand therapist can recommend a wrist splint in a neutral position to reduce the pressure on the nerve.

You can perform some exercises to help glide the tendons in the tunnel, which also help to relieve pressure on the nerve, as well as nerve gliding exercises to mobilise the median nerve.

Trigger Finger

What causes it?

Often caused by an overuse of one of the tendons that bends the finger or thumb, leading to some swelling in the tunnel it moves within, impeding its smooth motion in and out of the tunnel.

Signs and symptoms:

Clicking, or “triggering’ of the finger when trying to bend or straighten it.

The triggering can sometimes worsen until the finger or thumb has to be manually straightened as it will not extend on its own.

You may feel a thickening or a nodule on the tendon.

It can be a painful condition and is often worst in the mornings on waking.

How can Physiotherapy help?

You may need a specific type of finger or thumb splint to allow movement without the triggering occurring. This may be needed for several weeks, until the swelling on the tendon has settled enough for the tendon to move in and out of the tunnel smoothly.
Finger exercises are then advised to restore smooth gliding of the tendons.

Osteoarthritis of the hand joints

What causes it?

Wear and tear of any of the finger or thumb joints can occur but is most common in the base of the thumb (the carpo-metacarpal joint).

Signs and symptoms

Pain in the joint or the surrounding tissues

Difficulty in certain activities, especially those involving a pinch grip

Weakness or clumsiness in the hand

How can Physiotherapy help?

There are several self-management techniques you can try at home: use of hot packs (wheat bags are a good option), gentle massage around the thumb muscles, massaging in Voltaren gel once or twice a day.

You can also try to modify certain heavier or more strenuous tasks- aim to find different ways of carrying out an activity if it causes you pain in your hand.

Pacing your activities to avoid overloading the joints is also a good strategy, and allows you to find a balance of rest and exercise.

Your physiotherapist will educate you on what is happening within the joint, and may suggest certain splints or support gloves that can help reduce your pain.

Strengthening exercises are also usually necessary to build up the support of the joint using the surrounding muscles.

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