The Challenging Mallet Finger: Extensor Tendon Rehabilitation
Often, patients consider mallet finger injuries (sometimes called “baseball finger”) to be a minor injury; however, without proper care, function can be lost. For the best outcomes following a mallet finger injury, patient adherence to the recommended treatment plan is required.
To treat mallet finger, the distal interphalangeal joint (DIP) must be held in full extension for six to eight weeks. If the digit flexes during this time, the six- to eight-week time period must begin again. Many different types of orthoses are available to treat this condition conservatively, but some have more compliance issues than others.
Treating a Mallet Finger Conservatively
A mallet finger injury occurs when the extensor tendon is cut or torn from the insertion on the distal phalanx. The patient is then unable to extend the distal interphalangeal joint, which droops into a flexed position. Conservative treatment requires an extension orthosis full time for at least six to eight weeks to allow the tendon to heal in the proper position.
Treating a mallet finger can be challenging to both the therapist and the patient. The therapist must choose the best orthosis, monitor for skin issues, and instruct the patient to avoid any flexion of the distal interphalangeal joint during the immobilization period. The patient must be motivated to comply with the orthosis program and, if fit with a removable orthosis, learn how to support the distal interphalangeal joint in extension during skin care.
All of this occurs in a healthcare environment that wants to minimize the amount of therapy visits—and your patient may feel this is a lot of effort for a finger injury.
Casting the Mallet Finger
Casting the mallet finger is a conservative treatment that can facilitate patient compliance because:
- The patient cannot remove the cast, increasing compliance
- Casting distributes the pressure to the digit circumferentially, which may decrease skin irritation
- Because the casting needs to be changed at least weekly, these additional therapy visits allow the therapist to monitor the patient’s skin and, if the patient is not responding to treatment, may help to determine if they need to be seen again by the surgeon.
Weaning Off the Orthosis
After the patient achieves full distal interphalangeal joint extension, weaning from the orthosis can begin. A variety of removable orthoses are available to the therapist for the weaning process. A survey study by Cook, et al., that reviewed conservative treatment options for mallet finger found that weaning with a removable orthosis was standard practice among surveyed hand therapists.1
Conservative treatment of a mallet finger can be challenging to both the patient and the therapist. Casting the distal interphalangeal joint with at least weekly cast changes can help ensure compliance and may improve outcomes. A successful outcome may possibly avoid the cost of surgery in some cases. You can learn more about managing this tricky condition in my MedBridge course, “Extensor Tendon Rehabilitation Update: Zones I–II.”
