Ask Dr. Geier – Mallet Finger
As those people who follow me on Twitter saw, I stayed up late watching the Super Bowl last night. I tweeted about all of the injuries that occurred, and I will try to find out more information so that I can explain the injuries here. For those of you who don’t follow me on Twitter, please check it out. If you like explanations of injuries during pro and college games or articles from a variety of sports medicine experts I follow, then you might enjoy my tweets.
From my year spent with the St. Louis Rams, I will say that hand injuries can and do occur in football. At that time at least, the Rams even had a hand surgeon as one of their orthopaedic surgeons. Today’s Ask Dr. Geier column addresses a fairly common hand injury in sports. As always, please refer to my disclaimer for giving specific medical advice via email or online.
David
Yvonne in Chapel Hill, NC asks:
I just injured my right middle finger 2 days ago and went to Urgent Care where I was diagnosed with a mallet finger. They put my finger in a splint. I understand that I need to keep the finger straight for the next 6-8 weeks. The finger does not hurt at all. I am an avid recreational tennis player (usually play 3-4 times per week). If I make sure the splint is securely on, can I still try to play tennis?
Let me start by saying that I typically send patients with hand and finger injuries, even if the injury occurred in sports, to one of my partners who specializes in hand surgery. Having said that, I feel comfortable discussing the basic principles of diagnosis and treatment of a mallet finger.
A mallet finger typically occurs when an object such as a ball strikes an athlete on the tip of one of the fingers, flexing the fingertip down. This injury can rupture the tendon that extends the tip of the finger. He or she will notice that the fingertip is bent down in a flexed position and that he or she cannot fully extend it. I do think that it’s important for an athlete with this type of injury to seek evaluation by a hand specialist within the first few days. While diagnosis is usually straightforward, it is important to rule out a fracture. X-rays will be obtained to ensure a fracture did not occur at the time of the injury, as a large fracture or a fracture with multiple small pieces might need surgical treatment.
A splint that will keep the tip of the finger extended, especially if it allows the finger to bend at other joints, can be used to help a mallet finger heal..
Occasionally surgery is needed to treat a mallet finger. Injuries that involve fractures, especially comminuted fractures, or tendon injuries that fail to heal might be good candidates for surgery.
As far as trying to play in a splint, it really depends on the type of sport or activity that the athlete is trying to perform. If the splint can be kept on the fingertip and can keep it extended, it might be possible to play. If there is any question about the ability to wear the splint, I would urge caution and try to get the injury to heal as quickly as possible. Again consultation with a hand surgeon to help make the decision about returning to sports is usually a good idea.
C. David Geier Jr., M.D.
30 Comments
Hello Dr Geier,
I am writing to ask you question, about your reading about “Mallet finger Injuries” as I recent busted up me thumb and now the tip droops down. I went to hospital and had a x-ray and they was not fracture,phew!
How effective is the “stack” splint in healing thumbs? As it’s the first time I have ever busted a finger to this extent, I got to it early so will it recover fully? As the nails have turn a nasty purple,and yellowish color and what do I with it to make it better?
That splint works well for mallet fingers if it fits properly and the patient wears it continually. If the tendon heals properly, patients can usually expect fully function.
Hello Dr. Geier,
My 11 y/o son has mallet finger from playing football and has been placed in a stack splint for 8 weeks. The Dr. said he recommended against continuing to play for the rest of the season. Is there anything safe to use to place on his finger on top of the splint to allow him to continue during the season? He is a starting defensive player.
Thanks for your input.
Athletes can pad splints to protect themselves and other players from injury with the splint. The problem that many football players have with finger splints is that they can’t grip anything because the splint does not allow that joint to bend. In theory, players at certain positions shouldn’t need to grip balls, jerseys, etc., but those splints can still make it difficult to play. Plus, the joint injured has to stay completely straight when the athlete plays. If it bends, the healing tendon can stretch back out.
Hello Dr. Geier,
Last week I got mallet finger from catching a football. I went to the ER, and the ER doctor said the x-rays showed no broken bones. My finger is in a splint and I’m seeing a Orthopedist in a few days for further diagnosis. To make matters more worse, I don’t have health insurance. If the tendon does heal, will the finger still be as strong as it was before the injury? Also, do you recommend any foods that help repair tendons? Right now I’m drinking pineapple juice.
Mallet finer injuries typically have no lingering issues if they heal properly – full extension and strength. As for foods, I am not familiar with any foods, vitamins, or other supplements that would have much effect.
Hello again Dr. Geier,
I visited a Ortho doctor a few days ago and he re splinted me and I have to wear it for 6 weeks. Before I was not having pain, but now I’m having tingling feeling in the finger? Also, my other fingers are feeling stiff from not being able to fully move the hand. Im not having any circulation problems. Is this part of the healing or should I consult my doctor?
Stiffness is not uncommon with these injuries. Working with an occupational therapist or hand therapist can be helpful to restore full motion. Occasionally the splint can be too tight, causing some transient tingling, but seeing the hand surgeon can ensure there is no nerve damage.
Hello again Dr D Geier,
I am wonder with my progress with my mallet thumb is I try to exercise the weaken tendon with squish ball after bathing and I have re-pack my band aid to hold the splint on ,plus clean it with a wet one as well as my finger as well and dry it properly.
I use the squish ball to exercise the thumb area where it was injured, after a few repetitions I can feel that the tip of my thumb wants to drop again, so I put the splint as soon as I feel it and tape up again.
is it normally for my thumb wanting to drop down again?Please explain.
Thank You.
snuffles.
To be fair, as it says on this blog, I cannot give specific medical advice. I would recommend that you check with your doctor. Having said that, lack of extension could be continued weakness, a tendon that never healed, or a number of other possibilities. Your surgeon can examine your thumb and offer you more specific information. Thanks for the follow up!
Hello Dr David G,
I had the splint on for a bit over six weeks on my mallet thumb and when changing the tape on before replace the splint I was using a squeeze ball to strengthen that thumb for quite a few weeks, after a few weeks.
Then for first time for a while, over a month I removed the splint for at most 2 days. Then to my disgust I noticed only this morning the tip was drooping down, I cursed under my breath as I thought I did everything right in the medical book and what my dr said and my thumb has failed me again.
Do you have any suggestions to make for me what to do next. As I am stumped for ideas….Only to keep the splint on and put up a stuffed thumb all my time or something, Any suggestions?
Puzzled
As I’ve said, I can’t really tell you what to do or what is going on since I haven’t examined you or treated you. I would suggest discussing it with your hand surgeon.
Hello again Dr D Geier,
I visited my Orthopaedic doctor a few days ago for a follow up after being in a stack splint for 6+ weeks. My finger is now straight, which he believes has healed. However, the finger tip is so stiff from splinting that I cant bend it. He told me to continue wearing the splint for 2 more weeks, but take it off a few times each day and practice bending and straightening. After 2 weeks, wear the splint on only at night.
I wish I would have asked him this at the time, but its now only come up. Is it best to stay in a stack splint or does it not matter? The reason I ask is because my stack splint requires tape, and its getting annoying having to take it off to practice and then re-tape it back up. Also, the stack splint is giving me skin peeling problems. I would much rather use a aluminum splint that can easily be taken off and put back on, is that ok?
I recently broke my right ring finger, bending it down. I wore a splint for 6 weeks, and the finger seemed to be healing well, although my dr said it was only about 80% healed. Two weeks after removing the splint, I rebroke the finger the same way…by bending it down. I was re-splinted for 3 weeks when I developed contact dermatitis and my dr removed the splint. he now says that surgery (pin for 6 weeks) is the only option for my “mallett” finger. any suggestions?
I really can’t tell you too much without examining your finger. If a patient’s finger heals in a flexed position, a hand surgeon often has to use surgery to restore the position, and that can involve a pin in the bone. I might ask your surgeon about other options or get an opinion from another hand surgeon. Thanks for the question!
Hello Dr.
I was diagnosed with mallet finger a few days ago. The Dr. taped a splint across the top of my finger. Since it is so vital that the finger stays straight, I am quite concerned when changing the bandage with this type of splint. Is there another type of splint I could consider? The one in the photo of the article looks like it would be much easier to change the bandage.
Thank you.
Brace shops that fit and sell braces, splints, and shoe orthotics have them. Physical therapy practices and hand therapists have them as well, but they might only have them for current patients. Hand surgeons usually have them in their practice as well, or they can recommend where to get them. Hope that helps!
Hi Dr. Geier,
Appreciate you taking the time to read this. I have recently been treated for my second mallet finger in two years. My last injury was to the right middle finger (my dominant hand). Because of the stress the splinting caused me on my last mallet injury- I opted to have a k wire inserted for six weeks followed by an additional 4 with a splint. I have gone to therapy twice which worried me a great deal. Was so scared of a recurring droop. Now my finger has a slight 5 degree droop. My doctor says that it is “as good as gets”. But I have heard other opinions that i could resplint to get that last bit of healing. Although, I don’t know if the therapy already stretched the healing tendon out. Would resplinting even possibly help get rid of the extensor lag at this point?
Thanks, for any feedback
To be fair, I can’t help you too much because I am not a hand surgeon and because I haven’t examined you. Splinting typically works very well for primary mallet fingers, but I don’t know if it helps much after surgical fixation. In general I doubt there is much harm with splint the DIP joint to see if full extension can be regained, but it is hard for me to say in your case.
Hi Doc I have a mallet finger and I can’t afford to sit out playing basketball can I still play with it taped up.
I have had basketball players play with a mallet finger in a splint or taped. The sport itself makes it difficult, in that dribbling and shotting can be challenging if the injury is on the dominant hand. Thanks for the question!
I injured my finger on Dec 17th. (Mallet Finger) Starting splinting that day and then the Oval8 splint on Dec 21st. No swelling or pain until about 3 weeks into splinting. The splint felt like it was digging in the top of the last joint. Very Raw! Worse than that, just below my middle joint is swollen and very tender. Went to the Dr. on the Jan. 24th and he said to only wear the splint at night. I had to ordered another Oval8 online because I can not get the first one on anymore. It feels like a lentil bean just below the middle joint attached to kite string that funs down to the first joint.
The finger dips just slightly. Not to bad. I can live with that. I tend to wear the splint more during the day because it starts aching so bad. I even take advil for the pain.
Is this continued swelling and pain normal and part of the healing? OR Is it scar tissue? Should I not wear the splint at all during the day? I’m really scared of re-injury.
Thank You so much!
I’m sorry but I really can’t give your specific advice. I think I would ask your hand surgeon and get his advice. Thanks for reading!
Hello Dr. Geier,
Do you have any estimate of often surgery must be performed in instances where the mallet finger has only a single small amount of bone broken off with it?
I’m waiting for my surgery consultation and was just curious how often surgery occurs in these instances. Because of the tight time window, they said I may have surgery immediately following my consultation if it is necessary, so I want to be mentally prepared if it is likely.
Thanks for reading this! Also thanks for the very informative article!
Honestly I can’t say without seeing it. In general, whether or not one of these injuries needs surgery depends on how large the bony fragment is.
Thanks for the input! I’m just being impatient since obviously I’ll know either way come Monday!
I’m still in denial since it doesn’t hurt that badly, so I don’t understand how it can be so severe as needing over 2 months to heal!
But this article definitely helped me understand everything a lot better!
Thanks again!
Hi,
I got malletfinger on my pinky two weeks ago during a soccer game when I played in net. It’s been splinted for the past 4 days and XRays have shown there is a small chip fracture. I am currently splinting with a popsicle sticks which seems to work better than any splints I have tried. My question is is it possible that I can play goalie next week or the week after with my splint on and my finger being taped up heavily? I’d hate to miss so many games
As I’ve said many times on this thread, I really can’t give you specific medical advice. Your hand surgeon would be able to tell you the risks and benefits of playing better than I can since he has seen your injury. Also, I am answering a question much like this on my show this weekend.
Hi,
I got a mallet middle finger yesterday playing basketball. Went to doctor immediately, who put finger in a stack splint for 8 weeks. My question: do you think is it OK to take finger out of splint every day or two for “fresh air” and to retape ? I think I can slide it out w.o bending the joint. Or, do you suggest sucking it up and only doing weekly or even less frequently ?
thank you. ps- great blog site.
In general, if patients can wash the finger and reapply the splint while keeping the finger fully extended, then there is little concern for rupturing the healing tendon. If there is a concern that the joint will flex, then keeping the splint on is typically the recommendation. Thanks. Glad you like the blog!