A mallet finger is one of the more common hand injuries in sports. In this Ask Dr. Geier column, I discuss this finger injury and its treatment.

Yvonne in Chapel Hill, NC asks:

I just injured my right middle finger 2 days ago and went to Urgent Care where I was diagnosed with a mallet finger. They put my finger in a splint. I understand that I need to keep the finger straight for the next 6-8 weeks. The finger does not hurt at all. I am an avid recreational tennis player (usually play 3-4 times per week). If I make sure the splint is securely on, can I still try to play tennis?

Let me start by saying that I typically send patients with hand and finger injuries, even if the injury occurred in sports, to one of my partners who specializes in hand surgery. Having said that, I feel comfortable discussing the basic principles of diagnosis and treatment of a mallet finger.

What is a mallet finger injury?

A mallet finger typically occurs when an object such as a ball strikes an athlete on the tip of one of the fingers, flexing the fingertip down. This injury can rupture the tendon that extends the tip of the finger. He or she will notice that the fingertip is bent down in a flexed position and that he or she cannot fully extend it. I do think that it’s important for an athlete with this type of injury to seek evaluation by a hand specialist within the first few days. While diagnosis is usually straightforward, it is important to rule out a fracture. X-rays will be obtained to ensure a fracture did not occur at the time of the injury, as a large fracture or a fracture with multiple small pieces might need surgical treatment.

Treatment of a mallet finger

Typically the treatment for a mallet finger is an extension splint such as what the reader mentions above. The splint we’ll keep the finger extended to help the extensor tendon heal appropriately. It is important to know that the splint must be worn all the time. If he or she removes it and the fingertip flexes down, it could rupture the healing tendon. In this case the patient might have to start wearing the splint again, and the length of time will start over. The splint is worn approximately 6-8 weeks and then gradually worn less and less.

Occasionally surgery is needed to treat a mallet finger. Injuries that involve fractures, especially comminuted fractures, or tendon injuries that fail to heal might be good candidates for surgery.

Playing sports with a mallet finger injury

As far as trying to play in a splint, it really depends on the type of sport or activity that the athlete is trying to perform. If the splint can be kept on the fingertip and can keep it extended, it might be possible to play. If there is any question about the ability to wear the splint, I would urge caution and try to get the injury to heal as quickly as possible. Again consultation with a hand surgeon to help make the decision about returning to sports is usually a good idea.

A mallet finger would require the patient to wear a splint

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