What Is A Mallet Finger?

  • Fatima Azam Master's degree, Biotechnology, The University of Salford

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Introduction

When an object strikes the tip of the finger or thumb, the force of the blow creates a tear near the insertion (attachment) of the extensor tendon at the digit's last joint, resulting in a mallet injury. While the power required to create this injury is normally enormous, a little action, such as tucking in a bed sheet, can occasionally result in a mallet finger (Handoll & Vaghela, 2004).

Definition of mallet finger

A mallet finger is a finger malformation that is often induced by injury. The end (smallest) joint of the finger immediately before the fingernail droops and appears crooked after the fingertip becomes stuck. This makes the finger look like a mallet or hammer (Pegoli & Pivato, 2019).

Importance of understanding mallet finger

Mallet finger is a prevalent condition, particularly among athletes. It can also happen while doing everyday tasks when you hit the tip of your finger on an immovable object like a door or a wall (Ramponi & Hellier, 2019).

Anatomy of the finger

Overview of finger structure

The hand has many bones, muscles, and ligaments, enabling it to move and dexterously perform many different tasks. The bones in the hand can be divided into three categories, which are as follows: Each hand's finger and each foot's toe contain 14 bones called phalanges. Although the thumb only has two phalanges, each finger has three. In the centre of the hand, there are five bones called metacarpals. The eight wrist bones are referred to as carpal bones. Linked to the ulna and radius bones of the arm are the two rows of carpal bones (Liu et al., 2016).

Role of tendons and extensor mechanism

Numerous hand movements and functions are made possible by the tendons and extensor mechanism of the hand. Tendons enable the bending and extension of the fingers and thumb by joining forearm muscles to the hand's bones. The extensor tendons on the back of the hand enable finger and thumb extension, allowing us to open our hand, point, and spread our fingers. The flexor tendons on the palm side facilitate grasping and gripping. To coordinate finger extension at different joints, the extensor mechanism, which consists of extensor tendons, dorsal hood, central slip, lateral bands, and terminal tendons, functions as a unit. These complex structures are essential to daily tasks and must be properly functioning to preserve hand dexterity and function (Silver et al., 2006).

Causes of mallet finger

Traumatic injuries

A traumatic injury to the finger is the most common cause of a mallet finger. This happens when a strong impact is applied to the fingertip, such as during sports (e.g., catching a ball) or in an accident (e.g., banging the finger on a hard object). The abrupt stress can cause the extensor tendon, which is responsible for straightening the fingertip, to rupture or avulsion. A little portion of bone may be avulsed along with the tendon in some circumstances. Mild sprains to severe tendon or bone avulsions can result from traumatic mallet finger injuries (Salazar Botero et al., 2016).

Non-traumatic causes

Non-traumatic variables that can lead to the development of a mallet finger are listed below. Degenerative alterations in the extensor tendon caused by repetitive strain or overuse of the finger, inflammatory disorders affecting the tendon, or certain medical conditions such as rheumatoid arthritis are examples of this. However, the non-traumatic mallet finger is less common than the traumatic mallet finger (Lee et al., 2023).

Types of mallet finger

Closed mallet finger

The injury in a closed mallet finger happens without an open wound or break in the skin. The more prevalent variety of mallet fingers is caused by a traumatic event in which the fingertip is forcefully bent, causing damage to the extensor tendon, which straightens the finger. The force can come from a variety of sources, such as catching a ball, jamming the finger violently, or slamming it against a hard object. The extensor tendon is partially or totally ripped or avulsed from its connection to the bone at the base of the distal phalanx in a closed mallet finger. As a result, the person is unable to actively extend the fingertip, which remains flexed or drooping (Alla et al., 2014).

Open mallet finger

Open mallet finger is a more severe variant of mallet finger in which there is an open wound or break in the skin over the back of the fingertip. A laceration or penetrating trauma that destroys not just the extensor tendon but also the skin and possibly the underlying bone causes this form of injury. There may be apparent tissue damage and bleeding from the wound in the exposed mallet finger. Because the injury is open, there is a higher risk of infection, and quick medical intervention is essential to clean the incision and address any tissue or bone damage in addition to treating the tendon injury (Vazquez, 2023).

Signs and symptoms

Visible deformity

Mallet finger is characterised by a noticeable malformation of the fingertip, which remains flexed and cannot be actively stretched (McGhee et al., 2020).

Pain and swelling

Mallet finger patients often experience discomfort and swelling around the wounded fingertip, which may be caused by the traumatic incident that resulted in the injury and subsequent tissue inflammation (McGhee et al., 2020).

Inability to fully extend the fingertip

One of the defining characteristics of a mallet finger is the fingertip's inability to fully extend on its own due to the disruption of the extensor mechanism, which causes the finger to be bent or dropped (McGhee et al., 2020).

Diagnosis

Physical examination

During a physical examination, a healthcare professional will evaluate the finger's appearance, range of motion, and the existence of any obvious abnormalities or swelling in order to diagnose a mallet finger (Lamaris & Matthew, 2016)

X-rays and imaging

In cases of suspected mallet finger, X-rays and other imaging methods may be performed to confirm the diagnosis, evaluate the severity of the injury, and look for any concomitant fractures or bony avulsions (Lamaris & Matthew, 2016).

Complications

Swan neck deformity

Mallet finger can cause a swan neck deformity, in which the finger's middle joint hyperextends, the fingertip bends backwards, and the middle joint coils forward if it is not appropriately treated (Kalainov et al., 2005).

Arthritis

Left untreated, mallet finger injuries can lead to persistent misalignment and joint instability, which increases the chance of developing arthritis in the affected finger joint (Kalainov et al., 2005).

Treatment options

Non-surgical treatments

  1. Splinting

Putting the finger in a splint for a few weeks will keep it immobile and allow the fingertip to straighten and the injured extensor tendon to heal (Kalainov et al., 2005).

  1. RICE (Rest, Ice, Compression, Elevation)

By implementing these strategies, you can help the wounded finger feel less painful and swollen (Kalainov et al., 2005).

  1. Medications

Mallet finger soreness and inflammation can be treated with over-the-counter painkillers (Kalainov et al., 2005).

Surgical options

  1. Indications for surgery

When non-surgical treatments are ineffective for large bone fragments, open wounds, delayed presentation, joint instability, or severe tendon damage, surgery may be an option (Valdes et al., 2015).

  1. Surgical techniques

Surgical options may include tendon repair or reconstruction, fixation of bony fragments, skin and soft tissue repair, and joint stabilization, chosen based on specific injury characteristics (Valdes et al., 2015).

Rehabilitation and recovery

Importance of rehabilitation

In order to enhance finger strength, range of motion, and function, prevent stiffness, and lower the risk of long-term problems like swan neck deformity or joint contracture, rehabilitation is essential for mallet finger recovery (Zolfagharian et al., 2020).

Exercises and therapy

To ensure a complete recovery and return to normal activities, rehabilitation frequently entails finger exercises, controlled movements, and hand treatment to progressively restore finger mobility and strength (Zolfagharian et al., 2020).

Prevention

Protective measures

Mallet finger can be avoided by wearing the appropriate hand protection while engaging in sports or performing any work that poses a risk of finger injuries. Additional support and safety can be provided by gloves or finger splints (Oetgen & Dodds, 2007)

Injury prevention tips

People should use safe hand movements, especially when engaging in activities like sports, physical labour, or any work that requires powerful strikes to the fingertips, to prevent mallet finger injuries. The risk of traumatic finger injuries can be decreased by being aware of how your hands are positioned and by refraining from rash actions (Oetgen & Dodds, 2007).

When to seek medical attention

If there is a noticeable deformity, excruciating pain, or significant swelling following an injury, seek medical assistance for a mallet finger. Any rapid loss of mobility or inability to extend the fingertip should also be evaluated right away. A timely medical evaluation is necessary if there is an open wound, bleeding, numbness, or tingling in the finger or hand in order to acquire an accurate diagnosis and treatment, avert any consequences, and guarantee the greatest recovery possible (Schneider, 2005).

Conclusion

Recap of key points

Mallet finger is a frequent hand injury that prevents the fingertip from extending due to traumatic or non-traumatic causes. Visible deformity, discomfort, and the inability to fully straighten the finger are all symptoms. Splinting, RICE, and medicine are examples of non-surgical treatments, although surgery may be required in extreme situations or for open wounds.

Emphasize the significance of early diagnosis and appropriate treatment.

Mallet finger should be identified and treated as soon as possible for the best results. An accurate diagnosis and prompt treatment, whether non-surgical or surgical, can help avoid long-term consequences such as joint contracture or swan neck deformity and facilitate a successful recovery. To regain finger function and avoid functional restrictions, adherence to rehabilitation and therapy guidelines is essential. People can lessen the chance of mallet finger injuries and maintain hand health in daily activities and sports by prioritising prevention methods, including utilising protective gear and practising safe hand movements

References

  1. Handoll H, Vaghela M. Interventions for treating mallet finger injuries. Cochrane Database of Systematic Reviews. 2004; doi:10.1002/14651858.cd004574
  2. Kalainov DM, Hoepfner PE, Hartigan BJ, Carroll C, Genuario J. Nonsurgical treatment of closed mallet finger fractures. The Journal of Hand Surgery. 2005;30(3):580–6. doi:10.1016/j.jhsa.2005.02.010
  3. Lamaris GA, Matthew MK. The diagnosis and management of Mallet Finger Injuries. HAND. 2016;12(3):223–8. doi:10.1177/1558944716642763
  4. Lee J-K, Kang S, Pak JW. Current concepts in traumatic mallet finger management. Archives of Hand and Microsurgery. 2023; doi:10.12790/ahm.23.0016
  5. Liu M-J, Xiong C-H, Xiong L, Huang X-L. Biomechanical characteristics of hand coordination in grasping activities of daily living. PLOS ONE. 2016;11(1). doi:10.1371/journal.pone.0146193
  6. McGhee S, Gonzalez J, Nadeau C, Ortega J. Mallet finger injuries: The signs, symptoms, diagnosis and management. Emergency Nurse. 2020;28(3):36–41. doi:10.7748/en.2020.e1996
  7. Oetgen ME, Dodds SD. Non-operative treatment of common finger injuries. Current Reviews in Musculoskeletal Medicine. 2007;1(2):97–102. doi:10.1007/s12178-007-9014-z
  8. Pegoli L, Pivato G. Mallet finger injuries. Sports Injuries of the Hand and Wrist. 2019;1–13. doi:10.1007/978-3-030-02134-4_1
  9. Ramponi DR, Hellier SD. Mallet Finger. Advanced Emergency Nursing Journal. 2019;41(3):198–203. doi:10.1097/tme.0000000000000251
  10. Salazar Botero S, Hidalgo Diaz JJ, Benaïda A, Collon S, Facca S, Liverneaux PA. Review of acute traumatic closed mallet finger injuries in adults. Archives of Plastic Surgery. 2016;43(02):134–44. doi:10.5999/aps.2016.43.2.134
  11. Schneider LH. A simple fixation method for unstable bony mallet finger. The Journal of Hand Surgery. 2005;30(3):626–7. doi:10.1016/j.jhsa.2005.01.011
  12. Silver FH, Freeman JW, Bradica G. Structure and function of ligaments, tendons, and joint capsule. Repair and Regeneration of Ligaments, Tendons, and Joint Capsule. 2006;15–47. doi:10.1385/1-59259-942-7:015
  13. Valdes K, Naughton N, Algar L. Conservative treatment of Mallet Finger: A systematic review. Journal of Hand Therapy. 2015;28(3):237–46. doi:10.1016/j.jht.2015.03.001
  14. Vazquez J. Baseball finger (mallet finger). Radiopaedia.org. 2023; doi:10.53347/rid-164683
  15. Zolfagharian A, Gregory TM, Bodaghi M, Gharaie S, Fay P. Patient-specific 3D-printed splint for mallet finger injury. International Journal of Bioprinting. 2020;6(2). doi:10.18063/ijb.v6i2.259

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Fatima Azam

Master's degree, Biotechnology, The University of Salford

I'm Fatima, a passionate and dedicated medical writer driven by a Master's in Biotechnology from the University of Salford. My expertise includes:
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