mallet finger

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Mallet Finger

 

Definition

Mallet finger refers to the involuntary flexion of the distal phalanx of a finger caused by the disruption or tearing of its extensor tendon.

Description

Tendons are the strong "cables" between muscles and bones that help control movements of the body. They consist of white, glistening, fibrous cords, of various length and thickness, either round or flattened, and lacking in elasticity. In mallet finger, which often occurs as a sports-related injury, the tendon on the back of the finger becomes damaged or torn near the outermost joint. Without the support provided by the tendon, the short bone at the tip of the finger drops downward at an awkward angle. This bone, referred to as the "distal phalanx" of a finger, is the one furthest from the palm. In addition to tendon damage, mallet finger may involve a fracture of the distal phalanx. Mallet finger is sometimes called baseball finger.

Causes and symptoms

Mallet finger usually occurs while playing a sport that involves a ball—for example, reaching out to catch a hard pass in basketball or bare-handing a baseball. Instead of landing on the palm of the hand, the ball accidentally hits the tip of an extended (or partially extended) finger. This straight-on impact causes instantaneous stretch of the tendon, which may overextend or tear away. Mallet finger can also result from hitting the hand against a hard object or receiving a cut from a sharp edge such as a knife.
Symptoms of mallet finger include pain and swelling around the top part of the finger, near the outermost joint. These symptoms occur right after the injury. Redness and swelling develop soon afterward. The tip of the finger has an abnormal-looking downward droop, and it may be difficult to fully extend the finger.

Diagnosis

Mallet finger is usually diagnosed after a relatively brief physical examination conducted by an emergency care physician or by an orthopedist, the type of doctor who specializes in such injuries. The downward droop of the fingertip is the major indication of mallet finger, along with the tenderness and pain that occurs in the affected area. X rays will be taken to determine if the bone at the top of the finger has been fractured. Mallet finger is typically covered by medical insurance.

Treatment

If symptoms of mallet finger appear, the affected individual should consult a physician or seek emergency care. In the meantime, ice (wrapped in a towel or cloth) can be applied to the affected area to help reduce swelling and alleviate pain.
Treatment usually involves wearing a splint around the top of the affected finger in order to keep it extended and allow the injury to heal. The splint must be worn at all times for six to eight weeks, though it may be briefly removed to wash the finger, but with extreme care so as not to allow the fingertip to bend. For the next six to eight weeks after that, the splint need only be worn during sleep or athletic activities.
If the bone at the top of the finger has sustained a large fracture, surgery may necessary. If the tendon was damaged due to a cut, stitches may be required both to repair the tendon and to adequately close the wound.
Over-the-counter (OTC) or prescription pain medication can be used to alleviate pain.

Alternative treatment

Acupuncture, therapeutic massage, and yoga are believed by some practitioners of alternative medicine to have generalized pain-relieving effects. Any of these therapies may provide additional comfort while the finger heals.

Prognosis

With proper treatment, most people regain full use of the affected finger.

Prevention

Caution should be used when playing ball sports or using knives or other sharp implements.

Resources

Books

Brukner, Peter, et al. Clinical Sports Medicine: McGraw-Hill, 2000.

Periodicals

Lester, B., et al. "A simple effective splinting technique for the mallet finger." American Journal of Orthopedics March 2000: 202-6.
Takami H, et al. "Operative treatment of mallet finger due to intra-articular fracture of the distal phalanx." Archives of Orthopaedic and Trauma Surgery 120 (2000): 9-13.

Organizations

American Academy of Orthopaedic Surgeons. 6300 North River Road, Rosemont, IL 60018-4262. (800) 346-AAOS. http://www.aaos.org.

Key terms

Distal Phalanx — The outermost bone of any finger or toe.
Fracture — A break in bone.
Orthopedist — A doctor who specializes in disorders of the musculoskeletal system.
Phalanx — Any of the digital bones of the hand or foot. Humans have three phalanges to each finger and toe with the exception of the thumb and big toe which have only two each.
Tendon — A tough cord of dense white fibrous connective tissue that connects a muscle with some other part, especially a bone, and transmits the force which the muscle exerts.

finger

 [fing´ger]
one of the five digits of the hand.
baseball finger mallet finger.
clubbed finger one affected by clubbing.
hammer finger mallet f.
index finger forefinger.
mallet finger partial permanent flexion of the terminal phalanx of a finger caused by a ball or other object striking the end or back of the finger, resulting in rupture of the attachment of the extensor tendon. Called also baseball or hammer finger.
webbed f's syndactyly of the fingers.

mal·let fin·ger

an avulsion, partial or complete, of the long finger extensor from the base of the distal phalanx, resulting in the inability to fully extend the distal interphalangeal joint actively.

mallet finger

mallet finger

A flexion deformity of the terminal phalanx of a finger caused by striking the dorsal surface of the finger tip against a hard surface. Mallet finger (MF) is due to a partial or complete rupture of extensor tendon of the terminal phalanx, or fracture and/or avulsion of a bony fragment of the extensor insertion at the dorsal base of the distal phalanx, which occurs in a background of closed hyperflexion-type blunt trauma.

Mallet finger injuries
▪ Type I—Closed with or without avulsion fracture.
▪ Type II—Laceration at or proximal to the DIP joint with loss of tendon continuity.
▪ Type III—Deep abrasion with loss of skin, subcutaneous cover and tendon substance.
▪ Type IV
   A. Trans-epiphyseal plate fracture in children;
   B. Hyperextension injury with fracture of the articular surface of 20-50%; and
   C. Hyperextension injury with fracture of the articular surface, usually > 50% and with early or late palmar subluxation of the distal phalanx.

Management
▪ Type I—Continuous splinting of the DIP joint in extension 24/7 for six weeks, followed by two weeks of night splinting.

Complications
Dorsal skin irritation or necrosis over the DIP joint due to excessive pressure of the splint, probably exacerbated by a hyperextension posture of the joint.

▪ Type II—Surgery required; either a simple figure-of-eight suture through the tendon alone or a roll-type suture incorporating the tendon and the skin in the same suture. The DIP joint is splinted in extension for six weeks, followed by two weeks of night splinting.

▪ Type III—Because of lost tendon substance, these injuries require immediate soft tissue coverage and primary grafting or late reconstruction using a free tendon graft.

▪ Type IV
   A. Best treated with closed reduction followed by splinting for 3–4 weeks;
   B. No palmar subluxation; good results with six weeks splinting followed by two weeks of night splinting;
   C. These have palmar subluxation of the distal phalanx, best managed surgically with open reduction and internal fixation using Kirschner wire and possibly a pull-out wire or suture. This should also be protected with a splint for six weeks, after which the wire is removed and motion started. A proximally displaced bone fragment not in continuity with the distal phalanx may require open reduction and internal fixation.

mallet finger

Orthopedics A flexion deformity of the terminal phalanx of a finger caused by striking the dorsal surface of the finger tip against a hard surface; the MF is due to a partial or complete rupture of extensor tendon of the terminal phalanx, or fracture and/or avulsion of a bony fragment of the extensor insertion at the dorsal base of the distal phalanx, which occurs in a background of closed hyperflexion-type blunt trauma

mal·let fin·ger

(mal'ĕt fing'gĕr)
1. Flexion deformity of a distal phalanx due to avulsion of the extensor tendon by forceful passive flexion of the phalanx.
2. Synonym(s): baseball finger.

mallet finger

rupture of the extensor tendon from the distal phalanx as a result of a sudden forced flexion, which results in an inability to extend the joint. It may even cause bony avulsion. Common in catching sports, especially when the ball is caught with a partially closed hand. Treatment is by splinting (Stack splint) with the finger held in full extension for about 6 weeks. Surgery is rarely required. Syn hammer finger, baseball finger.