Mallet finger is an injury to the end of the finger. It is sometimes also called “baseball finger.” It occurs when an object (most often a ball) hits the tip of the finger. This forcibly bends the fingertip further than it should go. This causes damage to the extensor tendon. This tendon allows the finger to extend (straighten). When the extensor tendon tears, the fingertip cannot straighten.This tendon often pulls off a piece of bone when it tears. This is called a bony mallet (Picture 1).
Sometimes there is no bone involved. When the injury is only to soft tissue it is called soft tissue mallet (Picture 2).
Mallet finger is the most common closed tendon injury seen in athletes. It can occur in non-athletes with certain activities such as tucking in a bedspread or forcefully taking off socks. The long, ring, and pinkie finger on a person’s dominant hand are most likely to be injured.
Sign and Symptoms
All mallet finger injuries have an injured fingertip that is drooping or sagging (Picture 3).
This is called an extensor lag. The child is unable to straighten the fingertip. The fingertip can only be extended when it is pushed up with help.
Often the injured finger will be painful, swollen, and bruised. This is especially true if it is also fractured (broken).
Your child’s health care provider will ask a lot of questions about the injury (full history). He or she will do a physical exam. X-rays (Picture 4) are usually ordered to check for a possible fracture (break).
Put ice on the injured finger right away. Use ice 2 to 3 times a day for 10 minutes at a time with a cloth over the finger. Continue this 2 to 3 days after the injury.
If the injury is mallet finger, a splint will be put on the fingertip at the clinic. This splint keeps the finger straight (Picture 5). It must be worn at all times, even when bathing, for about 6 to 8 weeks. Your child may need to wear it for an even longer time.
This will give the tendon (and bone, if broken) time to heal. The splint may be briefly removed after taking a bath or shower to dry the finger. However, the fingertip must be kept completely straight while out of the splint.
Your child will need to wear the splint full time (24 hours a day) for several weeks. After this time, your child will need to continue to use the splint at night for 2 more weeks.
Mallet finger injuries typically can be treated without surgery. Surgical repair of the mallet finger may be considered in some cases. It is rare, but a mallet finger may have large bone fragments or the joint may not line up properly.
If surgery is needed, your child’s hand surgeon will discuss the best option with you.
After the tendon is healed and the splint use is no longer needed, you may notice that the finger cannot be fully extended. This is common and not unexpected. A bump on the joint (the appearance of swelling) might remain. You will be shown some hand exercises to help your child regain motion and return to normal activities.
When to Call the Doctor
Call your child's doctor right away if there is:
Your child should not do athletics or high energy activities until the doctor says it is ok. He or she will have follow-up appointments to make sure the finger is healing properly.
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