Ask Dr. Hildahl: Do I Have a Mallet Finger Injury?

Learn about the causes and treatment for this finger injury.

mallet finger

We use our fingers from the moment we throw off the covers to hit the alarm clock in the morning. Our fingers push the buttons on the coffee machine, pull on our shoes, scoop up the car keys, and take us through our workday. But a mallet finger injury changes the easy ritual of daily life. This painful injury affects thousands of people each year. And it can happen in a flash. Summit hand surgeon Dr. Blake Hildahl reviews the causes of mallet injuries, describes the injury, and explains how it is treated.

What is mallet finger?

“Mallet finger is an injury of the fingertip joint,” explains Dr. Hildahl. “It happens when your fingertip comes in contact with an unyielding object. The unexpected force tears the terminal tendon on the top, or nail side, of the finger. That thin tendon straightens the tip of your finger. When it is torn away from the connecting muscle, you can’t straighten your finger. As a result, the tip of your finger is bent down like a mallet.”

Axial loading is the culprit

“Any time a finger is subjected to significant axial load, it can be damaged,” says Dr. Hildahl. “Axial loading is a term that describes force directed downward through the tip of the finger.

This force causes two different kinds of mallet injuries: bony mallets and soft tissue mallets. With a bony mallet, the tendon rips away a piece of bone when it tears. Soft tissue mallets are also caused by ripped tendon, but the finger bone remains intact.

Causes of mallet injuries

“Mallet finger is commonly an athletic injury,” explains Dr. Hildahl. Basketball and baseball players are particularly vulnerable to the trauma that can cause mallet finger. But these injuries aren’t solely athletic in nature.

“A work or kitchen injury can cause trauma to the top of the finger,” Dr. Hildahl points out. “I have treated people who suffered a mallet because they reached into their purse and jammed their finger. Believe it or not, I’ve also treated a number of people who got mallets trying to put their shoes on. Finally, living in Minnesota, we all know that slippery winter conditions put our hands and fingers at risk.”

Don’t delay medical treatment

“A medical evaluation is important,” stresses Dr. Hildahl. “We want to know if the bone is broken, and we want to make sure there is no other soft tissue damage to the finger. When people come in within a few days of injury, damaged fingers respond well to treatment. But if you wait for a few months, the damaged bone and tissue will have healed—often crookedly. At that point, it is much more difficult to repair the injury.”

Nonsurgical treatment for mallet finger

“The good news is that mallet finger injuries don’t usually require surgery,” says Dr. Hildahl. “We treat it by straightening and splinting the injured finger for six to eight weeks. By keeping the finger in a constantly straight position, the bone or tendon is able to heal.”

No bending; no exceptions

“We put you in a splint full time,” states Dr. Hildahl. “For that six to eight weeks, your finger can’t ever bend. You can’t take that splint off when you go to bed, or shower, or at any other time. If you do take the splint off, you must keep the finger absolutely straight. If it does bend, it retears the tendon. Then, the healing process has to start all over again.”

Some mallet injuries do need surgical care

“If a bony mallet has broken off a large piece of bone, causing joint subluxation, you may need pins to hold the bone in position while it heals,” explains Dr. Hildahl. “The term ‘subluxed’ means the two joints aren’t lining up well or fitting together properly. When subluxations aren’t treated promptly, they make the finger more susceptible to early arthritis.

Rehabilitation of mallet finger injuries

Dr. Hildahl explains that when you follow doctor’s orders and keep the splint on for six to eight weeks, the injured tendon and bone heal straight. At that point, the splint comes off. Then, the next step is to loosen up the stiff finger joint. “Usually, you won’t need occupational therapy to reclaim function,” says Dr. Hildahl. “Over time, simply performing daily activities will help you regain motion in the injured joint. In a few weeks, that finger is usually good as new.” 

Summit Orthopedics provides personalized hand and wrist expertise

The function of our hands is integrated through our wrists and arms to our shoulders; a problem anywhere along our arm may have a significant impact on hand function and quality of life. If you experience an injury or uncomfortable symptoms, our fellowship-trained hand and wrist surgeons are here to help. Summit physicians receive the highest levels of training and exclusively provide individualized care for conditions of the hand, wrist, and elbow.

Start your journey to better function and less pain. Find your hand expert, request an appointment online, or call us at (651) 968–5201 to schedule a consultation.

Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MNPlymouth, MN, Vadnais Heights, MN, and Woodbury, MN, as well as additional community clinics throughout the metro and southern Minnesota. 

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  • Blake Hildahl MD

    Blake Hildahl, M.D., ATC

    “No operation should be carried out unless absolutely necessary… nor should a surgeon operate unless he would undergo the same operation himself in similar circumstances.” – John Hunter

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