Overview
what it is and why it mattersMallet finger is what happens when the small tendon that straightens the tip of your finger tears off the bone. With the tendon disconnected, the fingertip droops downward and you cannot actively lift it back up, picture a tiny mallet hanging off the end of your finger. The classic mechanism: a ball or object strikes the very tip of an extended finger and forces it down. It's common in basketball, baseball, and football players.
There are two kinds. A bony mallet means the tendon pulled off a small chip of bone with it. A soft-tissue mallet is a pure tendon tear with no bone involvement. The X-ray tells you which kind you have, and that influences how it's managed.
Symptoms
what you may notice- Drooping fingertip. The tip of the finger hangs down and you cannot straighten it on your own, the hallmark sign.
- Pain and swelling at the last joint. Tenderness concentrates at the DIP joint (the joint closest to the nail).
- Immediate deformity after impact. A ball, mattress edge, or other object strikes the extended fingertip and forces it down, the droop appears right away.
- Passive extension is possible. You (or someone else) can gently push the fingertip straight, but it drops again as soon as it's released, because the tendon is disconnected.
Diagnosis
exam first, imaging secondThe diagnosis is obvious by exam, the tip of the finger droops and you can't lift it on your own. X-rays are essential to see whether a chunk of bone came off with the tendon, and if so, how much of the joint surface is involved (a large piece can change the treatment plan).
How We Treat It
what we try first, in orderThe good news with a mallet finger is that most heal without surgery. The whole plan rests on one idea: hold the fingertip straight, without interruption, long enough for the tendon to reattach. The steps below build on each other, splinting first, and a procedure reserved for the few situations where splinting alone won’t do the job.
1
DIP Extension Splinting
This is the cornerstone of treatment. A small splint keeps the tip of your finger straight and is worn 24 hours a day for several weeks. The one rule that matters most: the fingertip must never bend during the splinting period, even for a moment, even while you change the splint to wash your finger. If it bends, the healing clock resets to zero. Stack splints and aluminum-foam splints both work well for this.
Surgical Options
if non-operative care isn't enoughSurgery is rarely needed. Indications: a large bony fragment that's destabilizing the joint, or a failure of dedicated splinting to restore the tendon function.
Frequently Asked
questions we hear in clinicDo I need surgery?
Almost always no. Most mallet fingers heal without surgery, with full-time splinting. Surgery is reserved for a few situations: a large bony fragment that is destabilizing the joint, or a tendon that has not recovered after dedicated splinting.
How long do I wear the splint?
The splint is worn 24 hours a day for several weeks. The single most important rule is that the fingertip must never bend during that time, even for a moment, even while you change the splint to wash your finger. If it bends, the healing clock resets to zero.
Why do I need an X-ray if the diagnosis is obvious?
The droop makes the diagnosis clear by exam, but the X-ray shows what the tendon brought with it. A bony mallet pulled off a chip of bone; a soft-tissue mallet is a pure tendon tear. The X-ray also shows how much of the joint surface is involved, and a large piece can change the treatment plan.
If I can push my fingertip straight, is it really torn?
Yes. You (or someone else) can gently push the fingertip straight, but it drops again the moment it is released because the tendon is disconnected. Being able to straighten it passively does not mean the tendon is intact.
How does a mallet finger happen?
The classic mechanism is a ball or object striking the very tip of an extended finger and forcing it down. It is common in basketball, baseball, and football players.
Providers Who Treat Mallet Finger
sports-medicine team
Further Reading
authoritative sourcesExternal patient-education references and related OSI pages for additional background: