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Woman dealing with mallet finger

Treatment for Mallet Finger: Will I Need Surgery?

Dec 6, 2023

Mallet finger, or baseball finger, is a common injury that occurs when the tip of the finger is hit or jammed, which causes the extensor tendon on the back of the finger to be pulled off the bone. Since this tensor is in charge of straightening the finger’s end joint, you might have difficulty extending that finger and the tip of your finger will droop.

The reason why it’s also called baseball finger is because it often happens due to getting hit, head on to the finger, by a ball; however, any trauma of the finger may have the same effect. As you may have guessed, this type of injury is a fairly common baseball injury

Now, the biggest issue here is the treatment for mallet finger injury. Do you have to treat it actively, or will it heal? More importantly, will you need surgery, and what would this surgery look like? Here’s what you need to know on this subject. 

What is a mallet finger?

So, what is a mallet finger? The extensor tendon (on the back of the finger) straightens the finger’s end joint. This is the distal interphalangeal joint (DIP joint). When it’s damaged, this will affect the finger’s DIP joint, and you won’t be able to extend your finger fully. 

What are the causes of mallet finger?

The most common causes of mallet fingers are different types of trauma, unlike other finger ailments (like trigger finger) that can be caused by over-use. This means:

  • Sports injuries
  • Workplace injuries
  • Falls
  • Jamming the finger
  • Accidental trauma 

Still, these are just some of the causes, and the full list goes on and on.

What are mallet finger symptoms?

The main symptom of this injury is the inability to straighten your fingerPain is sometimes also present, but the type of pain (as well as its origin) may vary. While in some scenarios, the pain is immediate, in other scenarios, it develops over time. Some people actually do not have any pain.

Since this is a standard hand trauma injury, you may also experience some:

  • Bruising
  • Swelling
  • Tenderness
  • Redness

Still, the inability to straighten your finger will most indicate the injury. 

Still, you always want to have your finger examined by a specialist. No internet-assisted self-diagnosis will ever be as good. A specialist will take an x-ray to evaluate for fracture. Sometimes, the extensor tendon pulls off a bone fragment, which is termed a “bony mallet finger.” These are treated identically to pure soft tissue mallet fingers (most common). However, if the joint looks dislocated, surgery is needed to treat it.

Can a mallet finger heal on its own?

Yes, a mallet finger can heal without surgery but will need immobilization - in the form of a stax splint, alumafoam splint, or a figure-of-8 splint. Keeping the finger fully straight for eight weeks (six weeks if it is a bony mallet) will allow it to heal. 

This means that you must have the finger fully straight while showering, sleeping, working, and doing errands. Do not “test it out” because if you flex the finger at the DIP joint too soon, you may rip any healing tissue and re-injure the finger. Usually, you will be provided with two or three finger splints so that you can change them out while keeping your finger fully straight daily. I 

How to know when a mallet finger is healed?

So, how do you tell if the mallet finger is healed? Generally speaking, the most important thing is that there’s a resolution of symptoms and that your finger now has active extension. It may still droop a little, but not as much as before.

What if a mallet finger goes untreated?

It’s important to understand that, unless you take this seriously, a mallet finger can permanently deform the finger. This means that you will never be able to fully straighten your finger, which is a huge problem on its own. In addition, it may cause other joints of the finger to develop a deformity known as “swan neck deformity,” as the flexor and extensor tendons are imbalanced if the mallet finger is not healed, and this imbalance may cause the middle knuckle of the finger to hyperextend.

Surgical treatment for mallet finger

Surgery is a rare treatment for mallet finger, and usually involves pins to keep the DIP joint immobilized in extension, or possibly some hyperextension, until the tendon or bone heals.

The duration of the procedure depends on several things, like the complexity of the injury, the experience of the surgeon, as well as some circumstantial factors. Most commonly, however, it’s all done in 30-60 minutes

Also, the patient will be allowed to go home on the same day.

Also, after the surgery, you will be assigned some physical therapy, and following these mallet finger exercises may speed up your recovery. 

The stitches are usually removed in 10-14 days, and you’re supposed to keep the area immobilized for 4-8 weeks. Full recovery, however, may take several months. Recovering from hand surgery is never easy, but you can affect the recovery rate quite drastically. 

When do you need a surgery for mallet finger?

This is a decision that your doctor should be making, but the general rules are that:

  • If there’s a large avulsion fracture.
  • There’s an extensive tendon injury
  • There’s joint subluxation or dislocation
  • Conservative treatment failed
  • Mallet finger is chronic

In these scenarios, the best mallet finger treatment is usually surgery. Just keep in mind that the majority of doctors won’t suggest mallet surgery as a first-line treatment. Still, you shouldn’t dismiss it further down the line.

Wrap up

Ultimately, treatment for a mallet finger is usually very easy but annoying - finger splint for 6-to-8 weeks. If you suspect you’re suffering from a mallet finger, visit your doctor and ask them for an opinion. Most likely, they’ll suggest conservative treatment first, but if this doesn’t help, you may have to go to the surgery.

This article was reviewed and approved by an orthopedic surgeon as we place a high premium on accuracy for our patients and potential patients.