Mallet finger: the aftermath

In My Humble Opinion
1

From the Stupidest Injuries Ever Department:

One night back in the middle of August, I was sitting here at my computer, reading the Dope, eating a bowl of flavored almonds, using my left hand. I suddenly got a nasty itch in my side. I had gunk from the almonds on my thumb, index and middle fingers, and not wanting to smear it into my clothing, I jammed my left pinky into my side. There was a popping sound, but I didn’t pay it any mind until I happened to look at my hand… my pinky was bent weirdly, and I couldn’t straighten it out. There was never any pain involved.

Mallet finger: the top extensor tendon broke.

Almost nine weeks of wearing a finger splint later, this past Friday I went in to see the orthopedic specialist, who pronounced my finger healed. It’s not perfectly straight anymore, but apparently that’s just the way this kind of injury heals.

The doctor told me I now need to “wean myself off of the splint.” When he took it off on Friday, he told me to put it back on after an hour. Then take it off for two hours on Saturday, three on Sunday, and so on. After 24 days, it comes off the final time.

I didn’t think to ask the doctor, so now I’m asking here: why? What is the purpose of doing this?

Because I wasn’t bending my finger at all for almost nine weeks, the other tendon, on the bottom of the finger, wasn’t being used, and has now deteriorated a bit. I can’t bend my finger very well when the splint is off. So I need to exercise my finger to build strength back into the tendon, and gain my motion back.

But if I’m still wearing the splint a good deal of the time, isn’t that counter-productive?

I’d like to point out that I am following the doctor’s instructions, and I intend to keep following them. I am not looking for justification to abandon the “weaning period.” I’m just curious about the reasoning for it.

2

You weren’t kidding - that is one of the stupidest injuries ever!! :smiley:

Seriously, totally something I would do. An orthopedist and nine weeks + 24 days of therapy! Wow! Just for scratching your side with almond gunk hands!

3

Here is a paper with more than you ever wanted to know about “mallet finger”. Interestingly, scratching an itch is not listed as a common cause of this injury. :wink:

The reason for the gradual discontinuation of the splint is because of a tendency to re-injure the newly healed tendon. The gradual schedule is easy to remember and works adequately for most people with this type of injury.

4

My wife has a finger like that. The idiot PA she was seeing clearly didn’t know how to treat it, so it is now permanently bent at 90 degrees.

5

Thanks.

I did ask the doctor how fragile my finger is at this point, like - am I going to break it again by shoving my hand in my pocket the wrong way, or something? He said that my finger is healed, and the risk of it happening again is the same as it was before I injured it. Revisiting this exchange in my mind was what led me to post my question… it seems odd to me that the weaning period is necessary if my finger is fully healed.

I’ll say this… each day I get to have the splint off longer, and each day it gets harder to put it back on when time’s up. :slight_smile:

6

Hey, now I have a name for it! Though I don’t have fingers stuck in the position, I can just make all my fingers do it. My index fingers’ middle knuckle tendons stand out so much I can actually hold a penny upside down between them.

7

Huh. Yeah, I can totally do this on purpose with any of my fingertips. It was always one of my “gross my classmates out” parlour tricks.

8

IMHO and that of my GP/GS – muscle/tendon/ligament injuries sometimes “never heal” - you always have a sort of weakness or tendency to re-injure. I wouldn’t worry about going for your wallet but until you find out just what kind of mileage your model gets, I would be aware of it.

(I have injured things most people don’t even know they have. It keeps my doc on her toes. :slight_smile: )

9

Mallet Finger: the Aftermath sounds like the title of an upcoming MCU movie.

10

Hey, I’m in the splint weaning mallet finger phase now myself. For me, it was my dog. A little squirt, I was playing with him and reaching to grab him and I jammed my finger hard against the damn ottoman. Ring finger. Distal joint bent and unstraightoutable. I thought it was just jammed. Done that many times back in the day and figured it’d get better on it’s own directly. Didn’t. By the time I went in it was beyond the usual protocols. PA said let’s try the splint anyway. Eight weeks later it’s looking OK. My MF PT was to take the splint off, hold the middle joint fast, and flex the distal back and forth. Do 10 reps 3 times daily for two weeks, then 10 reps 6 times daily for two weeks (just finished that), then night splint only for two weeks, then, well, I guess I’ll be healed. So far so good. Damn little squirt!

In my case the tendon was intact, but the bone onto which it was attached had been avulsed off the distal phalanx. It was floating off to the side and could not be reapproximated. So the immobilization via splinting was intended to allow scar tissue to form in between the fragment and the bone and effectively reattach them. Seems to have worked.