Mallet finger injury: non-surgical treatment Information for patients from the East Kent Hand Service This leaflet provides general information about mallet finger injuries to the fingers and thumb and the treatment options available. It is not a substitute for your doctor s advice. What is a mallet injury? It is an injury to the end joint of the finger/thumb which means that you are unable to straighten the tip by itself (although you may still be able to push the joint straight with your other hand). The finger adopts a dropped position. It occurs when either the tendon that straightens the tip is torn, or a fracture occurs to the bone where the tendon attaches. If the injury is not corrected, the tendon will not heal and you will not be able to straighten the tip of that finger/thumb again. How is it diagnosed? Usually the diagnosis will be made by looking and feeling of the finger. Occasionally an x-ray is taken to determine if the bone is involved. 1 Mallet finger injury: non-surgical treatment (February 2018)
What are the symptoms? Pain Swelling over the end joint of the finger The end of the finger lies in a bent position Not able to hold the finger straight at the end joint. What are the treatment options? 1. Conservative management - most injuries are treated in a splint which holds the tip of the finger straight for a period of time without the need for surgery. Most often only the tendon is damaged or the fracture fragment is very small and an operation is not needed. 2. Surgical repair - in very few cases a small operation is needed to repair the cut tendon or bone fragment. Conservative management Please only follow these instructions if you have had a mallet finger injury and are being treated conservatively without surgery. Your finger will need to be placed in a plastic splint to keep it completely straight for six to eight weeks. Your doctor/therapist/nurse with tell you the length of time that you need to be immobilised. The splint must be worn all of the time, both during the day and night to allow the two ends of the torn tendon or bone to stay together and heal. Without the splint your finger drops, which can lead to it remaining in a dropped position. During this time you can continue to use your hand normally whilst wearing the splint. It is important not to let your other finger joint get stiff and they should be exercised each day. If the splint prevents the middle joint from moving, or if it is uncomfortable or loose, it should be refitted by your doctor/therapist. 2 Mallet finger injury: non-surgical treatment (February 2018)
What if I need to change my splint? Below is a step by step guide to show you how to self-manage your splint. Your splint will either be a ready-made splint or an individually made splint made for you by a hand therapist. If your splint is different from those shown, please discuss this with the person fitting it for you. You will need to change your splint or clean/dry your finger during your rehabilitation so it is important that you can do this safely without putting the tendon repair at risk. To remove your splint you need to remove the tape and splint safely without allowing the tip to be unsupported/drooping. The items you will need to complete your application are: your splint (provided by doctor/nurse or by a therapist) and tape 1cm width. Taping pre-splinting for safety This can provide you with some support and make applying the splint easier. 1. Cut a strip of tape about the same length of you affected finger and put on a hard surface, sticky side up. Put your finger tip onto the middle of the tape, making sure your tip remains straight or slightly hyper extended. 2. Wrap one side of the tape (sticky side down) diagonally across the top of the finger pulling the tip straight. 3. Do this with the other end of the tape to form a cross over the affected joint. You should feel that it is holding the tip of your finger straight or hyperextended. Applying the splint If your splint is off, your finger tip must be supported in a straight position at all times. Ready made splints. You may be measured and fitted for an off the shelf splint that is the correct size for you. You should be able to fit the tip of your finger to the end of the splint so it stays in full extension and still be able to bend the middle joint. 1. Slide your finger into the splint so that it is flush with the end without allowing it to be unsupported. 2. Wrap tape around the base of the splint securing it firmly to your finger. 3. Make sure that you are able to bend the middle joint of the finger without too much restriction. 3 Mallet finger injury: non-surgical treatment (February 2018)
Fabricated Dorsal splints The hand therapist may fabricate and fit an individual splint that is fitted to you in clinic. 1. With the finger pre-taped as above, place the splint on the top of your finger so the end of your finger is level with the end of the splint. Using one piece of tape, secure the splint onto the finger as shown. 2. Starting on the palm surface of the finger, stick some tape from the underside of the finger up and over the tip to stick firmly on the splint, taping the finger up to the splint to prevent it from drooping. Repeat this step so there is two layers of tape strapping the affected finger tip up to the splint. 3. Wrap some tape around the base of the splint securing it firmly to your finger making sure that the splint cannot lift away from the finger with movement. Make sure that you are able to bend the middle joint of the finger without restriction. How long will I need to wear the splint for? You will need to wear your splint continuously for six to eight weeks as advised by the therapist/ nurse/doctor. At the end of this time gradually wean off the splint, wearing at night and at risk times for the next month. Treatment is most likely to succeed with the following: 1. The splint is worn continuously for six and eight weeks depending on injury type. 2. The splint is always taped securely in place. 3. Extra care is taken when changing the splint not to let the fingertip drop. 4. The finger is kept dry. Exercises While wearing your splint you need to make sure all non injured joints do not get stiff. 4 Mallet finger injury: non-surgical treatment (February 2018)
How should I care for my finger and splint? At least once a day you should remove the tape from the splint and take it off to wash your finger and the splint. Remember the end joint of your finger must not bend. Either: a) put your hand flat on a table and slide off the splint so your finger rests straight on the table; or b) support the finger on your thumb and hold in a straight position while removing the splint and supporting the finger while cleaning. You may now gently wash your finger, supporting the tip all of the time and dry thoroughly. Reapply the splint. What problems can occur with splinting? 1. Swelling in your finger is likely to change regularly (both up and down) causing the splint to be either too loose and not supporting the finger, or too tight and uncomfortable. In both of these instances the splint should be altered or changed. 2. You may have difficulty putting on or taking off the splint. Please follow the step by step instructions in this leaflet. 3. When you take the splint off for washing, check your finger for red areas where the splint may be rubbing. What should I do as I work in a wet/dirty environment? If your hands are constantly exposed to a very wet or very dirty conditions you should try to protect them as much as possible, for example wearing gloves and reapply the tape as often as needed. Will my other finger joints start to get stiff and sore? The splints are designed to interfere as little as possible with the normal use of your hand. Normal use will prevent stiffness of the uninjured parts of your finger and the rest of your hand. What should I do if the splint becomes loose or painful? Contact the department who fitted the splint. You may need a different size or a remould of your custom made splint. What happens after my splint is removed? After your splint has stopped being used (usually around 10 to 12 weeks) it is important to keep gently moving the finger and gradually resume daily activities within the limits of discomfort. This will help improve any stiffness and make sure the safest return to normal function. What should I do if the splint gets wet or becomes damp? Safely remove the splint keeping the tip supported, dry your finger and reapply splint (see previous page). 5 Mallet finger injury: non-surgical treatment (February 2018)
What are the risks and possible complications from conservative management? By being informed, you may be able to help your doctor highlight complications early. Complications can include: It is quite common to be left with a slight loss of the ability to straighten the fingertip and slight stiffness at the end joint of the finger compared with the other fingers. In general, the more thorough you are about following the program, the more likely it is you will have a good result. A minority of patients need an operation if the tendon fails to heal with splinting. You may be left with a small bump on the top of the end joint of your finger and slight loss of bending of the joint but pain is rare and the finger normally works well. Swelling in your finger may go up and down throughout your recovery. Redness and tenderness of the skin on top of the end joint are common for three to four months after the injury, but usually settles with time. Contact the department where your splint was fitted if this becomes a problem. Occasionally stiffness may occur in the fingers. This is usually short-term and only occasionally needs therapy. But it is important that it stops quite quickly to avoid permanent stiffness (within three months). Chronic Regional Pain Syndrome (CRPS). This is a rare but serious complication. The nerves in the hand over-react, causing swelling, pain, discolouration, and stiffness and normally requires therapy to try to settle this. Further information If you have any questions or problems regarding your diagnosis or the surgery, do not hesitate to contact your GP or consultant. This leaflet has been produced with and for patients If you would like this information in another language, audio, Braille, Easy Read, or large print please ask a member of staff. Any complaints, comments, concerns, or compliments please speak to your doctor or nurse, or contact the Patient Advice and Liaison Service (PALS) on 01227 783145 or 01227 864314, or email ekh-tr.pals@nhs.net Further patient leaflets are available via the East Kent Hospitals web site www.ekhuft.nhs.uk/ patientinformation Information produced by the East Kent Hand Service Date reviewed: February 2018 Next review date: July 2020 Web 272 6 Mallet finger injury: non-surgical treatment (February 2018)