The mallet injury is a tear of the long tendon that extends the tip of the finger. It may be just the tendon in isolation but also can be accompanied by a small fragment of bone being pulled off the point at which the tendon attaches, known as an avulsion.
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.
It can also be due to a laceration of the back of the finger (on the nail side).
WHAT ARE THE SYMPTOMS?
Symptoms include pain, swelling, and soreness of the top of the finger, and 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.
WHAT IS THE MANAGEMENT?
Initial management is to tape a popsicle stick to the finger to keep it straight, then see your physiotherapist or doctor 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.
Sometimes a slight droop of the fingertip, or a small bump on the back of the finger remain long term, but these do not usually cause any difficulties with using the hand normally.
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