Mallet finger injury treatment programme

Who is the leaflet for? What is its aim?

This leaflet is aimed at providing information for patients and their families / carers about mallet finger injuries and treatment required to recover from the injury.

What is a mallet injury?

A mallet injury, resulting in a “mallet finger”, is damage to the extensor tendon in your finger. This tendon is responsible for straightening the tip of your finger.

There are two types of mallet injury

1. The tendon tears away from its attachment to the bone (called a soft tissue mallet injury)
2. A fragment of bone where the tendon is attached comes away from the main bone (called a bony mallet or avulsion injury)

The result of either type of mallet injury is the inability to straighten the tip of the finger, which is known as an extension lag. This is shown below;

When you try to straighten your finger, the tip of the finger stays bent: To treat your mallet injury, you will need to wear a splint to prevent your finger tip from bending to allow the tendon to heal. For a bony mallet injury, you will wear the splint all the time for six weeks. For a soft tissue mallet injury, it will be all the time for eight weeks. This time could be extended depending on your rate of healing.

You may have been fitted with a splint in the emergency department. If this doesn’t fit sufficiently, your hand occupational therapist may need to provide you with a custom-made splint.

Your splint will be made of a lightweight thermoplastic and will replace the splint given to you in the emergency department.

Care for your splint and skin

The splint must be worn at all times, other than to wash the skin. When you remove the splint, it is very important that the fingertip is supported and not allowed to bend. Placing it on a table top can be a good idea. To wash the finger, a damp cloth or baby wipe can be used, dry the finger thoroughly and place back into the splint.

Exercises

After six to eight weeks, your hand occupational therapist will show you some exercises to get your finger tip bending again.

Your tendon is similar to an elastic band and needs to be stretched gradually otherwise it can be injured again or overstretched. This can result in an on-going deformity which can become long-term.

You will be given three exercise guide splints set at 10, 20 and 30 degrees so you know how far to bend the joint without compromising the tendon healing. Guidance for using these splints, including when and how to progress, is set out below.

Week one of exercises

You will need to continue to wear your mallet splint at all times, removing it only to carefully clean the skin or complete your exercises when you will replace it with the guide splint. These will need to be completed every two hours during the day. You will need to remove your splint and hold the guide splint you have been given by your occupational therapist against the underside of your finger:

• Gently bend the tip of your finger into the 10 degree guide splint
• Hold the position for a count of five seconds
• Then fully straighten your finger
• Hold for a count of five seconds
• Repeat all of the above five times every two hours.

See the precautions below if you are worried that your finger does not straighten after exercising.

Week two of exercises

Continue to wear your mallet splint at all times except when carefully cleaning the skin or doing exercises:

• Gently bend the tip of your finger into the 20 degree guide splint
• Hold the position for a count of five seconds
• Then fully straighten your finger
• Hold for a count of five seconds
• Repeat all of the above five times every two hours.

See the precautions below if you are worried that your finger does not straighten after exercising.

Week three of exercises

Continue to wear your mallet splint at all times except when carefully cleaning the skin or doing exercises:

• Gently bend the tip of your finger into the 30 degree guide splint
• Hold the position for a count of five seconds
• Then fully straighten your finger
• Hold for a count of five seconds
• Repeat all of the above five times every two hours.

See the precautions below if you are worried that your finger does not straighten after exercising.

Precautions

If you are unable to straighten your finger tip while completing your exercises, stop exercising, put your mallet splint back on and contact the hand therapy department. It is not unusual for the tendon to fatigue and / or be painful. After a period of rest the tendon should function correctly. Over time with continued exercise, the fatigue and / or pain will settle and you will see improvement in the motion of the finger. If you continue to have concerns please contact your therapist.

Week four (after starting guided exercises)

You will be reviewed by your occupational therapist again who will check the motion of your finger. If no concerns are identified you will be instructed to remove your splint on a gradual basis during the day initially. It is expected that you will continue to wear your splint at night and for “at risk activities” (e.g. contact sports) for another three weeks.

Week seven (after starting guided exercises)

You will be reviewed by your occupational therapist again for a final review if no complications are identified. Your therapist may provide you with additional exercises to maximise your finger movement as well as the strength of your finger. Your therapist will advise you when to discard the splint and resume normal hand use.

Contact Information

If you have any problems or concerns during your treatment please contact your occupational therapist:

Name: ________________________________________

Contact number: 01223 216769.

References / Sources of evidence

NHS Conditions - Mallet Finger (opens in a new tab)

Clement R and Wray RC Jr (1986) Operative and non-operative treatment of mallet finger. Annals of Plastic Surgery 16, p 136-141.

Cozen L (2000) A simple splinting technique for the mallet finger. American Journal of Orthopaedics 29, p 657.

Handoll HHG and Veghela MV (2004) Interventions for treating mallet finger injuries. Cochrane Library, issue 3.

Groth GN, Wilder DM, Young VL (1994) The impact of compliance on the rehabilitation of patients with mallet finger injuries. Journal of Hand Therapy. 7, pp 21-241.