Mallet finger rehabilitation protocol conservative management. Sports injuries are a common cause of mallet finger. There are finger exercises that a hand therapist can teach you to strengthen your fingers, but you should be evaluated by a hand surgeon to make sue there are no correctable injuries. Johnson, md the mallet finger deformity is easy to diagnose because the patient is unable to extend the distal phalanx of a finger. This injury causes a characteristic dip joint extension lag.
Your finger will be placed in a plastic splint to keep it straight. A mallet finger is where the end of a finger is bent flexed towards the palm and cannot straighten. The extension block technique for the treatment of mallet finger fracture. At present, there are several treatment methods for mallet finger deformity, but the effects are different. Rehabilitation following mallet finger patient information what is mallet finger. Thus, the risk of poor outcome from illadvised open treatment far outweighs any risk of early dysfunction or late arthritis from splint treatment. Rehabilitation following mallet finger south tees hospitals nhs. Trigger finger diagnosis and treatment mayo clinic. Regardless of the treatment option, common sequelae include a slight extensor lag and a prominent bump on the dorsum of the finger. Treatment of mallet finger deformity with a modified. If the finger is cut, clean the cut under running water for a few minutes. It can occur in a number of ways, but most commonly when a straight finger is stubbed and forced to bend suddenly at the joint near the tip. Treatment of mallet fracture by extension block pinning.
A lateral radiograph of the finger usually shows whether this is a fracturetype mallet or a purely tendinous disruption. The splint well keep the finger extended to help the extensor tendon heal appropriately. Trigger finger treatment varies depending on its severity and duration. Results of treatment of mallet finger injuries vary. When a ball or other object strikes the tip of the finger or thumb and forcibly bends it, the force tears the tendon that. Feb 24, 2020 moreover, late osteoarthritis at the dip joint of an untreated mallet finger or a mallet finger that is treated without anatomic reduction of the fracture is rare, if not nonexistent. Mallet injury conservative management a mallet injury is a disruption of the terminal extensor tendon due to laceration, rupture or avulsion fracture. Discussion mallet finger usually results from forced flexion of an extended finger. Followup care is a key part of your treatment and safety. This can damage the tendon and bone, causing the finger to droop. There are several treatment options for mallet finger.
It is the most commonly used classification for outcome assessment after mallet finger. A mallet finger treatment outcome assessment classification was proposed by crawford. Conservative management of this injury is typically successful with. Also, cases are known where the patient falls onto the end of the finger or stubbing the finger doing household activities such as making a bed and causing a mallet finger injury. Treatment you have been given a splint to keep the joint straight while you are using your hand. Original article treatment of mallet finger deformity with a. Mallet finger patient information leaflet what is a mallet finger.
Original article a modified internal suture technique for. The injury tears the tendon that straightens extends the end of the finger. To determine if there is a superior orthosis and wearing regimen for the conservative treatment of mallet finger injuries. Mallet finger is an injury to the end of the finger. This video illustrates mallet finger nonsplint treatment with an exercise technique developed by valdas macionis, md, phd.
You may break the 1 hour time into several periods e. Objective this article discusses the current clinical assessment and appropriate management of mallet finger injuries. Pdf mallet finger is a common injury involving either an extensor tendon rupture at its insertion or an avulsion fracture involving the insertion of. Treatment of mallet fractures with a transverse twohole. Mallet finger causes, symptoms and treatment the hand society. The diagnosis and management of mallet finger injuries. You will not be able to straighten the end of your finger because the tendon connecting the muscle to the finger bone is stretched or torn.
Mallet finger treatment splinting is the treatment of choice for almost all mallet finger injuries. The first type is called a bony mallet deformity which involves a fracture of the bone. Mallet finger is where the tendon that straightens the end joint of your finger has been torn. Mallet finger rehabilitation protocol conservative management kelly holtkamp, m. Mallet finger rehabilitation protocol surgical management kelly holtkamp, m. Priority should always be given to conservative management of. The ishiguro technique for the treatment of mallet finger. A modified internal suture technique for treatment of the tendinous. The single article published exclusively hand surgery service, maimonides medical center and center, state university of new york, brookn. Although it is also known as baseball finger, this injury can happen to anyone when an unyielding object like a ball strikes the tip of a finger or thumb and forces it to bend further than it. A mallet finger is more than just a typical jammed finger. The hand with the injured finger should also be elevated. If the lump is associated with trigger finger, the lump will move as the finger moves because the lump is an area of swelling in part of the tendon that moves the finger. Without proper treatment, permanent deformity can be the result.
The ishiguro technique for the treatment of mallet finger fracture in adolescent. However, any injury that forces the end joint of a finger to overbend can cause it. Treatment can be difficult as patient compliance is essential, and if not treated. He presents with left, long finger pain and an inability to extend his middle finger at the distal interphalangeal joint.
This is a retrospective study to evaluate the outcomes of treatment of mallet fracture by extension block pinning with respect to range of motion, time of union and complications. In the european literature, if correction of the proximal interphalangeal joint is not needed, and surgery is to be done on the distal interphalangeal joint only, then the most. Although nonsurgical treatment for some small fragment cases without distal interphalangeal joint dipj subluxation is acceptable, many authors have considered restoring the joint surface with accurate reduction to be important to prevent secondary osteoarthritis, loss of movement, and poor cosmetic outcomes. This forcibly bends the fingertip further than it should go. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. Doctor answers on symptoms, diagnosis, treatment, and more. Many splint configurations and surgical techniques have been described over the past. This document is to help you understand your injury, and reinforce the treatment required to get the best results possible. Fortunately, most people can heal this injury with the proper use of a simple splint. The mallet finger splint is a simple splint and effective way to treat this injury. Epidemiology mallet finger injuries usually occur in the work environment or during sports participation. The splint is designed to keep the joint straight while the tendon heals. Mallet finger is a flexion deformity of the finger resulting from injury to the extensor mechanism at the base of the distal phalanx. Mallet finger rehabilitation protocol surgical management.
It is caused by traumatic rupture of extensor tendon at its insertion in the base of the distal phalanx. Then wrap the finger with clean gauze or a clean cloth. The extension block technique for the treatment of mallet. Most people regain full function of the finger with no longterm effects.
Although it is also known as baseball finger, this injury can happen to anyone when an unyielding object like a ball strikes the tip of a finger or thumb and forces it to bend further than it is intended to go. Racgp mallet finger management and patient compliance. Mallet finger why is physical therapy important to your. Mallet finger is a flexion deformity of the finger that results from injury to the extensor mechanism at the base of the distal phalanx. A mallet finger injury requires medical treatment to ensure the finger regains as much function as possible.
Mallet finger usually results from forced flexion of an extended finger. Mallet finger most often occurs when something hits the tip of your straightened finger and bends it down with force. When a ball or other object strikes the tip of the finger or thumb and forcibly bends it, the force tears the tendon that straightens the finger see figure 1a and 1b. Mallet finger therapy exercises things you didnt know. Use your other hand to hold down block the middle joint of the injured finger.
The technique is based on frequent holdrelax tiptotip power pinch. The tendon on the back of the joint snaps or pulls off its attachment to the bone. Aug 26, 2016 sports injuries are a common cause of mallet finger. This means that your fingertip now droops and you cannot straighten it properly.
Mallet injury conservative management baycare clinic. Most doctors recommend seeking treatment within a week of injury. The treatment of the mallet finger ranges from nonoperative with prolonged splinting and immobilization to open reduction and rigid fixation depending on the extent of the injury as well as the time from injury to presentation. Nov 17, 2019 a mallet finger is more than just a typical jammed finger. Jul 24, 2019 it is often caused by a ball such as a basketball hitting the end of the finger or even another player impacting with the end of the finger. A mallet finger refers to an injury whereby the extensor tendon to the tip joint distal interphalangeal of the finger is disrupted or torn. Splinting is the most common initial treatment method for soft tissue or bony mallet finger. In the european literature, if correction of the proximal interphalangeal joint is not needed, and surgery is to be done on the distal. Dec 11, 2018 mallet finger is an injury to the tip of the finger when something hard, like a baseball, jams it. Typically the treatment for a mallet finger is an extension splint such as what the reader mentions above. The treatment options for the softtissue mallet finger, both acute and chronic, continue to generate a certain degree of controversy.
Commonly an athletic injury, mallet finger occurs when the outermost joint of the finger is injured. An xray or mri may be used to determine if the tendon is torn if there is an avulsion or a fracture to the end bone of the finger if there is no avulsion or fracture, then a mallet finger. Mallet finger is a flexion deformity resulting from avulsion of the extensor mechanism from the dip joint. Not having proper treatment can lead to permanent deformity. Bend only the last joint down for a count of 10 and then straighten it for a count of 10. It is important to know that the splint must be worn all the time. Mallet finger causes, symptoms and treatment the hand. The technique is based on frequent holdrelax tipto. Nonsteroidal antiinflammatory drugs such as ibuprofen advil, motrin ib or naproxen aleve may relieve the pain but are unlikely to relieve the swelling constricting the tendon sheath or trapping the tendon. From february 20 to december 2015, 11 mallet fingers treated by the modified suture technique were.
In the 84 digits splinted there was a 45% rate of complications, mostly skin related. Mallet finger is an injury to the thin tendon that straightens the end joint of a finger or thumb. Mallet finger is an injury to the tip of the finger when something hard, like a baseball, jams it. You may need to wear a splint for different lengths of time.
Wearing a splint on your finger to keep it straight is the most common treatment for mallet finger. It occurs when an object most often a ball hits the tip of the finger. All the evidence we found was type iv mallet finger injury, based on the cebm classification. Treatment of mallet finger deformity with a modified palmaris. Apply ice to the injured finger joint to reduce swelling and tenderness. Apr 05, 2018 the aim of treating a mallet finger deformity is to rebuild the extensor tendon insertion and restore extensor tendon length to achieve balance of distal interphalangeal joint flexion. Having this injury evaluated and properly treated is critical to the successful recovery from a mallet finger injury. Mallet finger is a flexion deformity resulting from avulsion of the extensor mechanism from the dip joint synonyms for this injury are baseball finger and drop finger, and jamming injuries in ball sports are common the anatomy of the dorsal apparatus of the fingers is complex and has generated detailed descriptions. The aim of treating a mallet finger deformity is to rebuild the extensor tendon insertion and restore extensor tendon length to achieve balance of distal interphalangeal joint flexion. Mallet finger is an injury to the end of your finger that causes it to bend inwards towards your palm. Although several studies report excellent results arguinjuries. Mallet finger management and patient compliance racgp. Mallet finger is a common athletic injury that affects basketball and baseball players routinely jammed fingers, but the injury can occur because of a crushing accident on the job, or even because of a cut finger while working in the kitchen. Some people will develop a longterm deformity known as a swan neck, which involves all of the finger joints.
Mallet finger injury no splint treatment by hand exercises. A mallet finger is a deformity of the finger caused when the tendon that straightens your finger the extensor tendon is damaged. Mallet finger on demand focuses on recovery from week 0 week 12. If your tendon is only stretched, not torn, it should heal in 4 to 6 weeks if you wear a splint all the time. In the digits splinted there was a 45% rate of complications, mostly skin related.
Oct 24, 2017 your doctor will also feel your palm to see if there is a lump present. Sometimes the tendon does not tear but the injury causes a piece of bone to be pulled off the finger where the tendon is attached. Feb 25, 2014 however, the optimal treatment of each type of mallet finger injury remains controversial. Dec 23, 2015 this video illustrates mallet finger nonsplint treatment with an exercise technique developed by valdas macionis, md, phd. Original article treatment of mallet finger deformity with.
However, there have been cases in which treatment was delayed for as long as a month after injury and full healing was still achieved. The exercises may be suggested for a condition or for rehabilitation. Tendinous mallet finger, modified internal suture, anatomical fixation, treatment modality introduction mallet finger is a flexion deformity of the distal interphalangeal dip joint that results from dis ruption of the extensor tendon 1. This program is most beneficial for those that have not had any surgery and they are conservatively treating their mallet finger with a splint only, followed with progressive exercises. However, the optimal treatment of each type of mallet finger injury remains controversial. Complications and prognosis of treatment of mallet finger. The usual cause is an injury to the end of the finger. Open treatment can result in frequent complications, and the surgeon should resist the temptation to make good better by operating on these injuries. A radiograph after closed reduction and splinting is shown in figure a. Here are some examples of exercises for you to try. Best, md, phd, the ohio state university, columbus, ohio. Wrap the finger with a coban or coflex wrap while out of the splint gently flex the joint several times while the splint is off.
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