Mallet Finger in Sports

ExitCare ImageMallet finger is an injury to the finger, in which you cannot straighten your finger without assistance. Mallet finger is caused by an injury to the extensor tendon in the finger that helps the muscles straighten the finger. Often, the tendon is pulled from the bone, and may also pull off a piece of bone with it. This is called an avulsion fracture. Mallet finger most often occurs in the middle, ring, and little fingers.

SYMPTOMS

  • A "pop" or rip felt in the finger, at the time of injury.

  • Pain with movement of the finger.

  • Finger, that is bent at the last joint, unable to straighten under its own power.

  • Full passive motion of the finger (can be straightened with assistance).

  • Tenderness, swelling, and warmth of the injured finger, especially on the back of the injured finger or joint.

  • Bruising after 48 hours.

CAUSES

Mallet finger is a traumatic injury, caused by a force applied to the extensor tendon that is greater than it can withstand. The injury usually occurs when the finger is forced into being bent (flexion) from a straight position (extension). Less commonly, mallet finger is caused by a cut (laceration).

RISK INCREASES WITH:

  • Sports that involve catching (softball, baseball, basketball, football, volleyball).

  • Poor hand strength and flexibility.

  • Previous or concurrent finger sprain.

  • Previous or untreated mallet finger.

  • Adolescent or young adult males.

  • Middle aged and older women.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain appropriate conditioning:

  • Hand and finger flexibility.

  • Muscle strength and endurance.

  • Taping, splinting, or protective strapping may be advised, before practice or competition.

PROGNOSIS

Mallet finger will typically heal with immobilization.

RELATED COMPLICATIONS

  • Repeated rupture of the tendon.

  • Pain with gripping.

  • Death of the skin, if the finger is splinted too tightly.

  • Prolonged disability.

  • Arthritis of the finger, especially if there is an associated fracture.

  • Permanent deformity (inability to straighten finger).

  • Stiffness of the finger.

  • If untreated, hyper-extended middle finger joint with the last joint bent, causing a "swan-neck" deformity.

  • Risks of surgery: infection, injury to nerves (numbness, weakness), bleeding, stiffness.

TREATMENT

Treatment first involves ice and medicine, to reduce pain and inflammation. The finger should be restrained for 6 to 12 weeks, to allow for healing. For serious injuries, such as the tendon pulling off a larger piece of bone, the finger being out of alignment, or if the injury is due to laceration, surgery may be needed. After restraint (with or without surgery), stretching and strengthening exercises are advised, to help regain strength and a full range of motion. Exercises may be done at home or with a therapist. If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised. Do not take pain medicine for 7 days before surgery. Prescription pain relievers are usually prescribed only after surgery. Use only as directed and only as much as you need.

SEEK MEDICAL CARE IF:

  • Pain increases, despite treatment.

  • Any of the following occur after surgery:

  • You experience pain, numbness, or coldness in the finger.

  • Blue, gray, or dark color appears in the fingernails.

  • You develop signs of infection: fever, increased pain, swelling, redness, drainage of fluids, or bleeding in the affected area.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)