Home / Conditions / Mallet finger
The tip of a finger droops and will not straighten on its own, usually after it is jammed or struck — by a ball, a door, or even tucking in a bedsheet. The tendon that straightens the fingertip has torn or pulled away from the bone. Most heal in a splint without an operation, as long as the splint stays on.
A drooping fingertip can come from three slightly different injuries. They look the same from the outside; an X-ray tells them apart, and it decides the treatment.
| Tendon only | A small bone flake | A large fragment | |
|---|---|---|---|
| What has happened | The tendon has torn or stretched away from the fingertip bone | The tendon has pulled off a small piece of bone with it | A large piece of the joint surface has broken off |
| On the X-ray | No break | A small flake at the base of the tip bone | A large fragment; the joint may have slipped out of line |
| Usual treatment | A splint, worn continuously | A splint, in most cases | A splint, or surgery if the joint has slipped |
| How long | Six to eight weeks, then nights | About six weeks, then nights | Eight to twelve weeks to recover after surgery |
Some fingertip injuries need seeing the same day: blood under the nail, a nail that has come loose, or a cut over the joint, since these can mean the nail bed is torn or the break goes through the skin. So can a child's fingertip injury with bleeding around the base of the nail. Call the clinic and come in, or go to an emergency department if we are closed.
A thin tendon runs along the back of each finger and attaches to the base of the last bone, at the fingertip. When it pulls tight, the fingertip straightens. If it tears away, or pulls a flake of bone off with it, nothing holds the tip up, so it droops.
What a picture cannot show is why the splint has to stay on. Holding the tip straight keeps the torn ends together so they can knit. Bending the tip even once, before they have healed, pulls them apart again — which is why the splint is not taken off, even to wash.
It also explains why it is worth treating. Left alone, the imbalance can slowly pull the middle joint of the finger backwards into a "swan-neck" shape, which is harder to correct later.
Most mallet fingers heal in a splint. It works well, but only if it is worn exactly as advised — which is the part people most often find hard.
A small splint holds the fingertip straight, day and night, for six to eight weeks. It stays on while you wash and sleep. If it has to be adjusted, the fingertip is kept flat on a table so it does not bend, even for a moment.
Once the tendon has healed, the splint is usually worn at night for a few more weeks while you gradually return to using the finger during the day.
Many people wait, because it does not hurt much. One that is several weeks old can often still be treated with the same splint, so it is worth being seen even if time has passed.
An operation is kept for a large fragment with the joint out of line, or a droop that persists and troubles you despite splinting. The bone or tendon is fixed, often with a fine wire, and recovery takes eight to twelve weeks.
Mallet finger here is seen by Dr Palanisamy Arul Murugan, an orthopaedic surgeon whose practice covers the hand and wrist, and who treats the full range of hand conditions with both non-surgical and surgical techniques. He holds the MRCS (Edinburgh), a Master of Medicine and the FRCS in orthopaedics, and consults in English, and in Tamil or Hindi if preferred.
Not during the first six to eight weeks. The fingertip must not bend at all, even for a moment, so the splint stays on while you wash. If it gets wet or needs changing, keep the fingertip flat on a table while you do it.
Yes. It is often not very painful, but without a splint the tip usually stays drooped, and the finger can slowly bend out of shape at the middle joint.
Often not. One that is several weeks old can frequently still be treated with a splint, so it is worth being seen.
Usually six to eight weeks worn continuously, then a few more weeks at night. It is a long time for a small injury, but it is what gives the tendon the best chance to heal.
Most fingers end up straight or very nearly so. A slight droop sometimes remains, but it rarely affects how the hand works.
No. Bring any hand X-rays, and be ready to say how and when the injury happened.
Be ready to say when the injury happened. Even an older injury is often still worth treating.
