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 sportsrelated 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 be 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.
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>.
Greg Annussek
KEY TERMS
Distal Phalanx—The outermost bone of any finger or toe.
Phalanx—Any of the digital bones of the hand or foot. Humans have three phalanxes 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.
