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Mallet Finger Injury - Baseball Finger

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A mallet finger injury occurs when the tip of a finger or the thumb is forcefully flexed.  The force injures the tendon that straightens the fingertip joint.  A mallet finger injury is also referred to as a baseball finger injury because it commonly occurs during the sport of baseball. 

A mallet finger injury causes loss of movement, pain, and swelling.  The joint at the end of the finger is noted to droop.  Most mallet finger injuries are treated with splinting.  In cases of fracture or malalignment, surgery may be necessary to treat the condition.

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Introduction

A mallet finger injury occurs when the tip of a finger or the thumb is forcefully flexed.  The force injures the tendon that straightens the fingertip joint.  A mallet finger injury is also referred to as a baseball finger injury because it commonly occurs during the sport of baseball. 

A mallet finger injury causes loss of movement, pain, and swelling.  The joint at the end of the finger is noted to droop.  Most mallet finger injuries are treated with splinting.  In cases of fracture or malalignment, surgery may be necessary to treat the condition.

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Anatomy

Your fingers are made up of three bones called phalanges.  Two joints separate the phalanges.  The distal interphalangeal (DIP) joints are located near your fingertips.  The proximal interphalangeal (PIP) joints are located in the middle of your fingers. 

Extensor tendons are attached to your phalanges . The extensor mechanism covers the entire finger.  The extensor tendons allow your fingers to extend (straighten).  
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Causes

A mallet finger injury occurs when the tip of a finger or the thumb is forcefully bent down (flexed).  The force tears the extensor tendon that is attached to the distal phalanx.  This can happen during sports, such as baseball.  If the force is great enough, the tendon may remain intact, but a small piece of bone can be pulled away where it attaches to the phalanx.  This is called an avulsion fracture.  A mallet finger can also occur if the extensor tendon is cut.
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Symptoms

A mallet finger injury will cause pain and swelling at your DIP joint.  You will not be able to straighten the end of your fingertip.  The end of your finger will droop down. 
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Diagnosis

Your doctor can diagnose a mallet finger injury by examining your finger.  You should tell your doctor about how you sustained your injury.  X-rays will be used to identify an avulsion fracture, joint malalignment, or associated injuries. 
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Treatment

The majority of mallet finger injuries are treated with splinting.  You will wear a finger splint full time for about six weeks.  It is important not to remove the finger splint at any time, even while you shower.  If the finger splint is removed, even for the shortest amount of time, the treatment is disrupted and the process must start all over.  The full time splint schedule is followed by a part time splint wearing schedule for another three or four weeks.
 
The splint should be removed, however, in a certain way, to allow observation and care of the skin.  The finger must be kept in extension by resting it on a flat surface whenever the splint is removed.
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Surgery

Surgery may be necessary for mallet finger injuries with fractures and joint malalignment.  Surgical hardware, such as pins, wires, and screws, are used to hold the bones in place while they heal.  In rare cases, the extensor tendon may be tightened or repaired with a graft.
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Recovery

Splinting and surgical treatments are usually followed by hand therapy rehabilitation.  A hand therapist will show you exercises to stretch and strengthen your joints.  The other joints in your fingers may become stiff and benefit from hand therapy exercises as well.  It can take a mallet finger injury several months to heal fully.  Healing is an individualized process.  Your doctor will let you know what to expect.
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Prevention

If you receive a mallet finger injury, you should elevate your hand above the level of your heart and apply ice intermittently until you can get to your doctor’s office.  You should receive medical attention if you experience bleeding beneath your fingernail.  Mallet finger injuries that receive prompt treatment tend to have better outcomes. 
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.

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