Mallet Fingers


Mallet Fingers: why do we spend so much time treating this injury?

  • Without proper treatment the injury can not heal properly
  • The fingertip or distal interphalangeal joint (DIPJ) will not be able to straighten
  • An untreated mallet injury can cause long term changes to the finger – Swan Neck Deformity (SND)
  • SND can be very irritating and annoying for the patient

What is a Mallet finger?

  • Avulsion of the terminal extensor tendon at the dorsal lip of the distal phalanx
  • Can be bony or tendinous in nature.
  • All mallet injuries require an x-ray to determine if they are bony or tendinous.
  • The knowledge of bony v tendinous can determine the length of treatment. Bony mallets heal faster.
  • Large bony fragments can cause the DIPJ to sublux & require a surgical consultation.

What do hand therapists do for a mallet finger?

  • Educate the patient on treatment options
  • Refer the patient for an x-ray if they have not had one
  • Measure the initial lag – if patient presents without already being in a splint.
  • Fabricate a custom made splint for optimal position and comfort – very important as the splint must be worn 24/7.
  • Monitor skin condition at regular appointments
  • Assist patients to continue normal activities during splinting (e.g. waterproofing for swimming/ surfing)
  • Ensure unaffected joints continue moving well
  • Guide patient through splint weaning after full-time splinting ceases
  • Return patient to maximum range of motion, function and strength

Why refer to a hand therapist and not use a pre-fabricated splint?

  • Pre-fabricated splints do not allow for customised positioning
  • They can include the proximal interphalangeal (PIPJ), which needs to be unrestricted and regularly moving
  • Customised splints are comfortable
  • Hand therapists monitor the patients skin condition during splinting
  • Hand therapists can teach patients how to safely change their splint without allowing any DIPJ flexion

Swan Neck Deformity (SND)

  • SND occurs when the terminal extensor tendon remains unattached, such as in an untreated mallet finger injury.
  • The extensor tendon then overpulls the middle finger joint (PIPJ) into hyperextension while the DIPJ remains in a flexed position
  • B. SND can also occur from other conditions such as Rheumatoid Arthritis, and the treatment for these can differ.

What do Hand Therapist’s do for a SND post mallet injury?

  • Prevention: by treating mallet finger as an acute injury.
  • For long standing untreated mallet injuries a splint is made to prevent hyperextension of the PIPJ
  • A sterling silver ring can be measured and ordered to provide a long-term and durable option

Case study

  • Patient attended hand therapy after seeing their regular physiotherapist for a mallet finger.
  • The patient had had a pre-fabricated splint taped-on for six weeks.
  • The tip flexed immediately on removal of the splint.

Our treatment

  • Education on our treatment process, importance of splint wearing.
  • X-ray: determine if tendinous or bony. X-ray showed no bony involvement, therefore tendinous in nature and splinting time increased.
  • Thermoplastic splint fabricated and taped on: Splinted 24/7 for eight weeks.
  • Regular reviews to check skin and splint selection.
  • Encouragement to keep moving PIPJ.
  • Active extension checked at eight weeks.
  • Splint weaning process for four weeks to gradually allow flexion and maintain extension after full time splinting completed.


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