A mallet finger happens when the tendon that holds the end of the finger straight is torn from its attachment on the bone.
Sometimes, a piece of bone is taken with it, and this is called a mallet fracture.
The result is the same in both cases--the end of the finger droops down and cannot be straightened. With a fracture, the finger is painful and swollen around the end joint.
Treatment for mallet finger is usually nonsurgical. If there is no fracture, then the assumption is that the end of the tendon has torn off the bone, causing the end of the finger to droop. Usually continuous splinting for six weeks followed by six weeks of nighttime splinting will result in satisfactory healing and allow the finger to extend.
The key is continuous splinting for the first six weeks. The splint holds the end joint straight and allows the ends of the tendon to move as close together as possible. As healing occurs, scar formation repairs the tendon. If the splint is removed too early and the finger is allowed to bend, the process is disrupted and must start all over again.
The splint must remain on AT ALL TIMES--even in the shower.
Surgical treatment is reserved for unique cases, such as when there is a fracture associated with the mallet finger. If the fracture involves enough of the joint, it may need to be repaired. This may require attaching the fractured piece to the bone with a pin. If the damage is too severe, it may require fusing the joint in a fixed position.
Rehabilitation during and following treatment for a mallet finger focuses mainly on keeping the other joints mobile and preventing stiffness from disuse. Once the mallet finger has healed sufficiently, exercises may be instituted to strengthen the finger involved and increase flexibility.
Ligaments are similar to tendons in that they are both made of collagen. However, ligaments join one bone to another bone, while tendons join muscle to bone.
The joints in the hands and wrist are supported by ligaments. These ligaments can get stretched or torn with injuries to the joints. This is also referred to as a sprain. Physical exam findings of a sprain to the ligament include swelling, pain, joint instability or stiffness.
A common ligament injury to the hand is an ulnar collateral ligament injury of the thumb. This is sometimes referred to as Skier’s thumb. Some people have had this injury for a long time, and then it is called a Gamekeeper’s thumb.
This is a thumb with a torn ulnar collateral ligament. The ligament provides stability to the joint. Without it, the joint becomes unstable. The thumb should not bend this far. Surgery is done here to reconnect the ligament and restore stability to the joint.
Kirschner wires, or K-wires, are commonly used in hand surgery to fix fractures. They are named after Martin Kirschner, a German surgeon who introduced them in 1909. They are made of stainless steel and have a sharp tip.
Here is a photo of a broken hand bone, the metacarpal.
K-wires can be driven into the bone through the skin (percutaneous pin fixation) using a power or hand drill. They help to hold the bone straight and allow the fracture to heal better.
Sometimes the end of the wire is left sticking out of the skin; other times, they are cut so that they are beneath the skin. This is a photo of a different patient with two K-wires in her finger.
After the fracture has healed, the pins can be removed. Here is a photo of one of the pins that have been removed.
A joint is the space between two bones. The ends of the bone are covered by cartilage. This cartilage secretes a fluid that lubricates the joint. Where your fingers, thumbs and wrists bend are joints. There are also joints in the hand that are harder to see moving, but they also have important function. There are many conditions that can affect the joint.
Arthritis: This occurs when the cartilage on the bone starts to wear away. The bone ends start rubbing directly on each other, which can be quite painful. This is also known as osteoarthritis, which is different from rheumatoid arthritis. Arthritis can be treated with medications, splints, therapy, and sometimes surgery. Surgery involves removing the joint or replacing it.
This photo below is of the trapezium, a bone in the hand that is removed in patients with thumb arthritis.
Rheumatoid Arthritis: This is an auto-immune condition, which means that the body mistakenly attacks healthy cells. Here the cells lining the joint are attacked, and they become inflamed and swollen.
Gout: This condition is caused when salt deposits build up in the joints. The joint will be very painful, swollen and red. It may sometimes be confused with an infection.
Infections in the hand can cause serious compromise to function if not treated in a timely fashion. Infections can be superficial on the skin or nail area, or they can go deeper, such as into the joint or along the tendons.
Not all infections create pus. This is an infection caused by a bacteria called Mycoplasma. It creates a collections of rice bodies that need to be surgically removed.