What is a Mallet Finger Splint?
A mallet finger splint typically occurs due to a sudden impact to the tip of the finger or thumb, leading to an inability to straighten the fingertip. This sudden force can cause the tendon to tear (known as a tendinous mallet injury) or pull away along with a piece of bone (referred to as a bony mallet injury). As a result, the mechanism that normally straightens the finger is no longer functional.
How Do I Know I Have a Mallet Finger Splint Injury?
If you have a mallet finger splint injury, you will find that while the fingertip joint can be straightened when pushed, it won’t stay straight once the support is removed. Additionally, you might experience pain, tenderness, and swelling at the joint either immediately after the injury or shortly thereafter.
Can a Mallet Finger Splint Heal on Its Own?
A mallet finger requires treatment and won’t heal on its own. Self-managing by reinforcing the joint at home is not recommended due to the risks of causing pressure sores and damaging the skin. It is important to consult a hand therapist for proper care and treatment.
I Have a Mallet Finger Splint or Thumb Injury, What Should I Do Next?
If you have a fingertip that cannot straighten on its own, it is crucial to seek immediate consultation with a hand therapist. They can initiate splinting and provide guidance for your ongoing care. It is also recommended to undergo X-ray imaging of the finger to determine whether you have a bony or tendinous mallet injury. This assessment will help determine if you need further evaluation by a specialist or surgical intervention.
Treatment of a Mallet Injury
Understanding treatment expectations is crucial for managing a mallet injury, as compliance with splinting is essential for achieving a favorable outcome.
Your therapist will create a custom-molded thermoplastic splint, known as a mallet finger splint, designed to fit over the back of your finger. It will be secured with small strapping tape. The splint must be worn continuously as per your splinting plan, typically for 6-8 weeks. You should only remove it for hygiene purposes or if the fleece lining needs to be changed.
When removing the splint for hygiene or fleece lining changes, ensure your fingertip remains straight and supported by your other hand or the tabletop. Avoid bending the fingertip forward, as this could undo the healing progress, potentially requiring the splinting process to start over from the beginning. You’ll be encouraged to maintain movement in the unaffected joints of the finger to promote overall range of motion.
In certain cases, surgical intervention may be necessary, particularly if the bone fragment pulled away with the tendon is large or if there is inadequate joint alignment. Surgery might also be considered if wearing a splint is challenging or if there is a less-than-optimal outcome after 6-8 weeks of splinting. Your hand therapist or hand surgeon will discuss these potential outcomes and recommendations with you in detail as needed.
How Long Will I Wear My Mallet Finger Splint For?
For a bony mallet injury (avulsion fracture), you will wear the mallet finger splint full-time for 6 weeks. In the case of a tendinous mallet injury, the mallet finger splint will be worn full-time for 8 weeks. It is recommended to continue nighttime splinting for up to 3 months after the injury to prevent any drooping or “lag” in the fingertip joint.
Can I Continue to Play Sports with a Mallet Injury?
Returning to sports poses a risk of re-injury or loosening your splint during high-impact activities. If you cannot avoid participating in your chosen sports, it’s crucial to discuss this with your hand therapist. They can help establish a suitable plan to minimize these risks while ensuring that wearing your splint full-time aligns with the guidelines for the activities you wish to participate in.
Follow-Up Care and Continued Support for Mallet Finger Recovery
After completing the 6-8 weeks of splinting for your mallet finger splint, your hand therapist will schedule a follow-up appointment. During this visit, they will remove the splint and evaluate your ability to straighten your finger without support. You’ll likely be advised to continue nighttime splinting as previously mentioned, and ongoing splinting may be recommended for activities that pose a risk, such as playing sports. Your therapist will offer personalized guidance based on your specific needs in this regard.
Post-Splinting Expectations
After your splint is removed, your finger may not be completely straight despite diligent splinting. Some degree of slight bending at the tip can persist. When the splint is first removed, stiffness when bending the tip of your finger is normal and expected. It’s crucial not to force your finger to bend. Gradual improvement in movement will occur as you resume normal hand use and perform exercises recommended by your hand therapist.
Frequency of Hand Therapy Visits
The number of times you need to see your hand therapist can vary based on several factors. These include your comfort level with splint changes, the condition of your skin, your joint mobility, and your strength once the splint is removed (or wound management if surgical repair is needed).
Frequency of Appointments
In a typical presentation, you may require 2-4 appointments on average:
1. Initial Consultation: Includes splint fabrication and establishment of a treatment plan.
2. Second Appointment: Around 3 weeks into splinting, if necessary. This appointment involves checking the splint, which may need to be remolded to accommodate reduced swelling, and reviewing the technique for changing the splint.
3. Third Appointment: At 6-8 weeks of splinting, depending on whether it’s a tendinous or bony mallet injury. This visit focuses on transitioning from the splint and establishing a home exercise program, including movement exercises and a graded strengthening regime.
4. Fourth Appointment: This is likely the final consultation to review your progress, assess strength and range of movement, and provide education on ongoing self-management.
Precautions and Moving Forward
It is important to be aware of the following moving forward:
– If you notice a return or increase in lag or drooping of the fingertip after completing therapy, it is advisable to return to your hand therapist for evaluation.
– Untreated or unsuccessfully managed mallet finger splint can lead to a swan neck deformity. This condition involves hyperextension of the PIP joint and flexion of the DIP joint due to soft tissue imbalance.
– If necessary, your hand therapist may recommend a referral to a hand surgeon for further evaluation and potential management, including treatment.
Please let us know if you have any questions and do leave a comment
Contact us for more details:
Total Orthocare
59 A, MNR Complex,
Near Steel Factory Bus Stop,
Dodda Banaswadi Main Road,
Bengaluru-560043
Phone: 080-4370 1281
Mobile: 9591618833
