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mallet-finger

Mallet Finger

Mallet finger, also commonly referred to as “baseball finger” or “drop finger,” is a finger deformity that occurs when the extensor tendon on the back of the finger is injured. This tendon is responsible for straightening the last joint of the finger (the distal interphalangeal joint, or DIP). When it is damaged or torn, the fingertip cannot be actively straightened and instead droops downward. Mallet finger is one of the most common finger injuries, particularly in athletes and individuals engaged in activities that involve catching or handling balls, but it can also happen during simple everyday tasks.

Causes and Mechanism of Injury

Mallet finger usually occurs as a result of a sudden force applied to the tip of the finger while it is in an extended position. This force can either stretch or rupture the extensor tendon, or in some cases, pull off a small piece of bone where the tendon attaches (an avulsion fracture). The most common scenarios include:

  • Being struck on the tip of the finger by a ball (as in baseball, basketball, or cricket).
  • Accidental jamming of the finger against a hard surface.
  • Minor household injuries, such as tucking in a bedsheet or catching a finger in clothing.

The injury may involve only the tendon or both the tendon and the bone. When the tendon alone is damaged, it is called a tendinous mallet finger, while when a fragment of bone is pulled away, it is referred to as a bony mallet finger.

Tendon Problems

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Clinical Features

The hallmark sign of mallet finger is the inability to actively extend (straighten) the fingertip at the DIP joint. The fingertip droops and remains flexed unless it is manually straightened with the other hand.

  • Pain and tenderness over the back of the DIP joint.
  • Swelling and bruising around the joint soon after the injury.
  • In bony mallet finger, there may be noticeable deformity due to displacement of the bone fragment.
  • Stiffness or difficulty with finger movement if left untreated.

Diagnosis

Diagnosis of mallet finger is primarily clinical, based on the appearance of the drooping fingertip and loss of active extension. However, imaging studies are often performed to rule out associated fractures.

  • X-rays: These help detect whether there is a bone fragment avulsion and whether the joint is subluxed (partially dislocated).
  • Physical Examination: The doctor assesses the degree of tendon injury, joint stability, and range of motion.

Treatment

Treatment of mallet finger depends on the severity of the injury, the presence of a fracture, and the alignment of the joint. In most cases, non-surgical management is effective.

1. Non-Surgical Management

  • The primary treatment is continuous splinting of the DIP joint in full extension or slight hyperextension.
  • The splint must be worn 24 hours a day for 6–8 weeks, followed by part-time splinting for another 2–4 weeks.
  • The goal is to keep the tendon ends or bone fragment in place to allow healing.
  • Several types of splints are available, such as stack splints, aluminum foam splints, or custom-made thermoplastic splints.
  • Compliance is crucial. Even a brief lapse in splinting can delay healing.

2. Surgical Management

  • The bone fragment is large and involves more than one-third of the joint surface.
  • The joint is unstable or subluxed.
  • Non-surgical treatment has failed.

Complications

  • Permanent droop of the fingertip due to chronic extensor lag.
  • Stiffness and reduced range of motion at the DIP joint.
  • Swan-neck deformity, where the middle joint of the finger hyperextends while the fingertip remains flexed.
  • Cosmetic deformity, which can be a concern even if the finger remains functional.

Prognosis

Treatment of mallet finger depends on the severity of the injury, the presence of a fracture, and the alignment of the joint. In most cases, non-surgical management is effective.

Prevention

  • Wearing protective gloves or finger guards in high-risk sports.
  • Practicing proper techniques in ball-handling games.
  • Taking care during daily activities that may jam the finger.

Conclusion

Mallet finger is a common finger injury caused by damage to the extensor tendon at the fingertip, often resulting in an inability to straighten the last joint of the finger. Though painful and functionally limiting, it is highly treatable with simple splinting in most cases. Surgical intervention is rarely required but may be necessary for severe injuries with fractures or joint instability. Early recognition, proper diagnosis, and consistent treatment are critical for optimal outcomes. With appropriate management, most patients recover well, regaining both function and appearance of the injured finger.

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