Signs and Symptoms
- The tip of the finger is bent (flexed) towards the palm
- Unable to fully extend the joint at the tip of the finger (Distal interphalangeal joint or DIPJ)
- May experience pain over the nail (dorsal) side of the distal interphalangeal joint
- Swelling over the nail (dorsal) side of the distal interphalangeal joint
Diagnosis
- The diagnosis is relatively straightforward with a history and physical exam
- X-rays are important to determine if there is an associated fracture at the distal interphalangeal joint. Fractures can have a big impact on treatment and outcome.
Background
- Sometimes referred to as a “jammed finger,” a mallet deformity typically occurs when the end of one’s finger makes forcible contact with an object (basketball, wall, someone’s body, etc). When this happens, the end of the extensor tendon at the backside-tip of the finger (near the fingernail) is ruptured, causing the finger tip to flex forward slightly. It can be passively straightened, but you will not be able to actively extend your fingertip. The most common treatment is non-surgical management, in which the finger tip is immobilized in a straight or slightly-extended position to allow the structures to heal.
- It is important to note that healing requires at least 6 weeks of uninterrupted immobilization with the fingertip in a straight position. If the fingertip is allowed to flex forward, even momentarily, it damages the tendon’s healing process. This “resets the clock,” and the 6 weeks start over again.
Treatment
Conservative (Non-Surgical)
- Splinting
- Hand therapy
Surgery
- This may be a more appropriate treatment for those whose lifestyle or profession may not be favorable to wearing a splint 24/7
- May be recommended for those with fracture involvement
Hand Therapy
Week 0-6: (Non-Surgical)
- A special splint will be created for you, which keeps the finger in a straight or slightly extended position. This should be worn at all times, for the entirety of the six weeks. Your hand therapist or physician may instruct you to remove it periodically for hygiene purposes, and to keep your skin clean and dry. Your therapist will demonstrate how to do this carefully and methodically, to prevent the fingertip from bending. Remember that inadvertently bending the finger will ruin any established healing.
- Depending on your situation, your therapist may also instruct you on select range of motion exercises to the other joints of the finger. Follow these instructions carefully, and always avoid motion to the fingertip.
Contact your therapist immediately if you have any “fit” issues with your splint. If it is sliding or moving, it will prevent healing. Your therapist can make adjustments as needed for splint comfort and effectiveness.
After 6 weeks: (Surgical and Non-Surgical)
- Your therapist will instruct you on gentle exercises involving the fingertip. These will be light, range of motion exercises. You will need to continue splint wear during the day (between exercise sessions) and at night. Do NOT use the finger for any gripping, squeezing, pinching, or any functional activities like cooking/gardening.
Week 7-8:
- Splint wear will start to be reduced gradually, depending on your progress and available range of motion. Continue exercises as prescribed.
- Your therapist may also be utilizing various modalities and manual techniques during therapy sessions to manage pain, swelling, or any other issues that arise.
Week 9-10:
- Your splint will most likely be discontinued sometime in this time period; follow your therapist and physician’s recommendations. Gentle strengthening will also be incorporated into therapy.
Avoid stretching your fingertip at any point in time, even toward the end of your recovery. Remain patient throughout rehab, as these injuries involve delicate structures, and they take time to heal. Healing cannot be rushed, and attempts to speed things up typically result in setbacks.
*This recovery timeline is generalized to apply to the average person. However, individual recovery time may vary depending on severity of pre-operative condition, prior level of function, age, health, lifestyle factors, tobacco/alcohol use, medical comorbidities, and other factors. Follow the personalized instructions your physician/ therapist provide.
