The Tendon that allows the tip of your finger to straighten, is called the Extensor Digitorum Communis. This tendon anchors below the nail bed and can be cut or ripped from the bone. The Extensor tendon is a cable that runs from the forearm into your finger and inserts onto the Distal Phalanx (Medical name of the last bone in your finger tip)

The Extensor tendon acts like a pulley to pull the last digit backwards to straighten your finger.

In the thumb, the Extensor Pollicis Longus (EPL) is the replacement for the Digitorum Communis. Same function, different name.

When the last digit bends forward forcefully, it may cause the tendon to spontaneously rupture, which will leave the tip of your finger hanging forward. When the force is enough, it may rip out a small piece of bone instead of tearing the tendon.

Examples are: making up the bed and jerking on the linen or when you get your finger stuck in a jersey/jacket and you try to force your finger out. This type of finger injury is common in horse riding when the rider weaves the reins through their fingers and the horse suddenly pulls forward on the reins. The most Mallet fingers entail ball sports, when the ball hits the tip of your finger and forces it to bend forward.

A specific traumatic incident is the cause that happens suddenly. You will immediately see the tip of your finger hanging and it will remain that way until you have received a diagnosis & treatment has started.

Making up the bed and jerking on the linnen may hook your finger. You might get your finger stuck in a jersey/jacket and you try to force your finger out. This type of finger injury is also common in horse riding when the rider weave their reins through their fingers, and the horse suddenly pulls forward on the reins. The most Mullet fingers entails ball sports where the ball hits the tip of your finger and forces it to bend forward.

All of these scenarios will cause the Extensor tendon to rupture.

Symptoms of a Mallet finger

A Mallet finger is not usually very disabling. Patients do however often tell me that their finger hooks on their pockets when trying to put their hands in their pockets.

If only the Extensor tendon is severed, a conservative 8 week program will fix the problem.

If less than 30% of the connecting surface of the bones (Distal Interphalangeal joint) is involved, and the fracture is stable meaning the bone fragments are not moved out of their normal position, the best course of treatment will be splinting by a hand therapist.

When more than 30% of the joint surface is involved or the fractured pieces are displaced from its normal alignment, you will require surgery.

We pride ourselves in our experience with regards to testing the different types of problems that can cause a Mallet finger. Our specialists are able to detect the extent of the damage. We mainly test the three components of a Mallet finger. The Extensor tendon (tendon), the integrity of the Distal Phalanx (bone) and the Distal interphalangeal joint (joint).

We develop a certain dexterity to identify a fracture but in some cases an Ultrasound or X-rays may help with making a more accurate diagnosis.

How we test it

We will do a battery of tests to comprehensively screen the Extensor tendon’s ability to withstand any force. This includes active and passive testing. Isolated contraction of the Extensor Digitorum communis muscle will not extend the distal phalanx.

The Extensor tendon is not able to reconnect by itself, thus staying in this bent position. Splinting the tip of your finger in a straight position is the only way to allow the two loose ends to attach.

If a piece of bone is ripped out, it may cause the bone to heal in the wrong position, or not at all. If a separation of more than 3mm between the bone fragments are present the chances of reattachment is very poor.

When delaying treatment the tendon may never reattach or bone fragments will heal in an awkward position that can permanently deform your finger.

Delaying treatment for more than 2 months, might lead to a Swan Neck deformity. This is when the middle joint of the finger hyperextends and the tip of the finger stays bent. You will have considerable difficulty to use your hand, specifically to grab, hold, pull or grasp objects.

Generic braces may just make the situation worse if you don’t know what you are dealing with. Rather consult with us, to give you a clear diagnosis and prognosis.

We are usually confronted with patients that wait too long before seeking treatment. We cannot stress this enough, because this can significantly change the time to recover your finger back to its normal function.

Splinting – A custom splint designed and tailored for your finger, to allow optimal healing and ensure the tendon or bone re-attaches.

Passive Exercises – to maintain PIPJ movement

Active exercises – to regain and strengthen the EDC muscle.

Tendon gliding techniques – to ensure the tendon moves like it should

Scar tissue mobilizations – to guide and provent and abnormal scar tissue adhesions.

Sensory retraining – to reconditions the nerve endings in your finger.

Tendon ruptures and stable fractures start with an 8 week immobilisation period, followed by a 4 week rehabilitation protocol. Total time to full recovery: 3 months.

Displaced fractures and surgery start with immobilisation for 4 – 6 weeks using a K-wire, thereafter splinted for 4 – 6 weeks, followed by a 4 weeks rehabilitation protocol. Total recovery time: 4 months.

Pain medication may ease some of the pain, but will do nothing to solve the problem.

Well Health Pro is a medical group of professionals that treat a wide range of muscle, joint, tendon & nerve problems.