MANUAL MINORS
Mallet finger is an injury to the extensor tendon at the base of the distal phalanx, causing an inability to extend the fingertip. This injury typically occurs due to direct trauma, such as a blow to the tip of the finger, resulting in either a tendon rupture or, in some cases, an avulsion fracture of the distal phalanx where the tendon inserts. It is common in sports like basketball or baseball.
Diagnosis
Diagnosis is based on the trauma history, where the patient presents with an inability to actively extend the fingertip after an impact. There is pain, swelling, and sometimes bruising at the distal joint. X-rays are used to rule out avulsion fractures of the distal phalanx.
Differential Diagnosis
Condition | Key Differences |
|---|---|
Distal phalanx fracture | Pain and deformity with a visible fracture line on X-ray. |
Distal joint sprain | Pain without complete inability to extend the finger and no tendon damage. |
Flexor tendon rupture | Inability to flex the finger instead of extending it. |
Distal interphalangeal subluxation | Joint displacement without extensor tendon involvement. |
Emergency Management
Immediate immobilisation of the finger in extension with a Mallet finger splint to prevent tendon retraction.
Application of ice to reduce swelling and analgesics for pain relief.
X-rays to confirm or rule out avulsion fracture and assess the severity of the injury.
Avoid excessive manipulation of the injured finger.
Definitive Treatment
Most cases are treated conservatively with a splint that keeps the finger in continuous extension for 6-8 weeks. If there is a large fracture or a severe injury, surgical treatment may be required to repair the tendon or fix the fracture. After treatment, physical therapy is recommended to restore mobility and strength in the affected finger.
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