Mallet Finger
A drooping fingertip from a damaged extensor tendon
Quick Facts
- Type: Hand and tendon injury
- Common cause: Forceful blow to the fingertip
- Main sign: Bent fingertip that won't straighten
- Usual treatment: Continuous splinting for 6-8 weeks
Overview
Mallet finger is a common injury of the end joint of a finger. It happens when the extensor tendon, the cord that straightens the tip of the finger, is stretched, torn, or pulled away from the bone. Sometimes a small piece of bone is pulled off along with the tendon, which is called a bony mallet injury.
Because the tendon can no longer hold the fingertip up, the tip droops downward and cannot be straightened by the person without help. It is nicknamed "baseball finger" because it often occurs when a ball strikes the end of an outstretched finger. With prompt and consistent splinting, most mallet fingers heal well and regain good function.
Symptoms
The hallmark of a mallet finger is a fingertip that hangs down and cannot be fully straightened actively, though it can usually be pushed straight with the other hand. Other features include:
- Pain, tenderness, and swelling at the end joint of the finger
- Bruising or redness over the back of the fingertip
- Inability to straighten the very tip on your own
- Occasionally blood collecting under the fingernail or damage to the nail if the injury was forceful
Causes
Mallet finger is caused by a sudden force that bends the straightened fingertip down against resistance, overloading the extensor tendon. Common scenarios include:
- A ball or other object striking the end of an extended finger
- Jamming the fingertip while playing sports or doing chores such as tucking in a bedsheet
- A cut or laceration over the back of the fingertip that divides the tendon
- A crush injury that fractures the bone where the tendon attaches
Risk Factors
- Playing ball sports such as baseball, basketball, and volleyball
- Activities and jobs with frequent hand impacts
- Older age, as tendons become more fragile over time
- A previous finger injury at the same joint
Diagnosis
A doctor usually recognizes mallet finger from the typical drooped fingertip and the inability to straighten it actively. An X-ray is commonly taken to check whether a fragment of bone has been pulled off (a bony mallet) and whether the joint is properly aligned, since this affects treatment. Open wounds are examined for a cut tendon.
Treatment
Most mallet finger injuries are treated without surgery using a splint:
- Continuous splinting: A splint holds the fingertip straight, or slightly extended, around the clock for about 6 to 8 weeks, followed by gradual weaning. The end joint must not be allowed to bend during this time, even while changing the splint, or healing restarts.
- Surgery: Considered when a large bone fragment is involved, the joint is out of place, the tendon was cut, or splinting fails. Options include pins or small wires to hold the joint.
It is important to keep the rest of the finger and the hand moving normally to avoid stiffness. Recovery of full strength can take several months, and a slight permanent bend at the tip is possible even with good treatment.
Prevention
- Use proper technique and protective gloves in ball sports
- Keep play areas and walkways clear to avoid jamming fingers
- Treat any finger injury promptly rather than waiting for it to worsen
When to See a Doctor
See a doctor promptly, ideally within a few days, if your fingertip droops and you cannot straighten it after an injury, since early splinting gives the best result. Seek urgent care if there is an open cut over the joint, severe deformity, the finger looks crooked or out of place, or there is bleeding under the nail with intense pain.
Frequently Asked Questions
Can mallet finger heal on its own without a splint?
It rarely heals well on its own. Without a splint holding the tip straight, the tendon cannot reconnect properly and the fingertip may stay permanently bent. Continuous splinting for several weeks is the standard treatment and gives the best chance of recovery.
How long do I have to wear the splint?
Most people wear the splint continuously for about 6 to 8 weeks, then gradually for a few more weeks at night and during activity. The end joint must stay straight the entire time, including during splint changes, or the healing clock resets.
Will my finger be normal again?
Many people regain near-normal function, but a small permanent droop or slight stiffness at the tip is common even after correct treatment. Starting splinting early and keeping the joint straight improves the outcome.
Do I need surgery for mallet finger?
Most cases are treated with a splint alone. Surgery is usually reserved for injuries with a large bone fragment, a joint that is out of place, a cut tendon, or cases where splinting has not worked.
References
- American Academy of Orthopaedic Surgeons (OrthoInfo). Mallet Finger.
- American Society for Surgery of the Hand. Mallet Finger.
- MedlinePlus, U.S. National Library of Medicine. Finger injuries and disorders.