Why Can’t I Straighten My Finger?
⌚️ read time: 4 minutes
Call it ‘baseball finger,’ call it ‘mallet finger,’ or call it the least painful but most annoying injury you’ve ever had, let’s talk about your droopy finger.
And if you think you’re immune?
Think again. I’ve had patients who get this injury while making the bed. Or folding laundry. I’ve even had a patient just wake up with it.
If you get this injury, you will be unable to straighten the tip of your finger (the joint just below your nail). Fortunately, it is easily treatable and rarely needs surgery.
Here’s the four-minute rundown.
1. Mallet fingers are relatively painless
A mallet finger occurs when the tendon responsible for straightening the very tip of your finger ruptures (see below).
Typically, this is the result of a jammed finger (think, catching a baseball), but as I mentioned above, I have seen it from ridiculously low-energy injuries.
And if the tendon at the end of your finger is no longer attached? The end of your finger will droop!
The tip of the finger just hangs there, no matter how hard you try. This makes your finger look like a tiny little mallet (photo below).
Hence the name.
As with many tendon injuries (eg, Achilles rupture, biceps rupture), this is oftentimes a (relatively) painless injury. Unless you have an associated fracture.
Which brings me to my next point…
2. Mallet fingers need an x-ray
Mallet fingers come in three types:
Soft tissue mallet (no surgery)
Bony mallet (no surgery)
Bony mallet with joint subluxation (surgery!)
The only way to differentiate among these is with an x-ray.
A soft tissue mallet is the most common, where the tendon separates from the bone. A bony mallet occurs when the small corner of bone where the tendon attaches breaks off. The result is the same (a droopy finger), but these typically hurt a bit more.
The last type, a bony mallet with joint subluxation, is the only type that needs surgery. In this case, such a big piece of bone breaks off that not only does the tendon not function, but the entire joint destabilizes. Not good.
And if you never get an x-ray, you have no way of knowing.
Until the finger becomes stiff and painful a few months later and there’s nothing to do to fix it then…
3. Surgery is rarely needed. But splinting is no joke.
So. In the majority of cases, you don’t need surgery! Congratulations.
But what’s the catch?
The treatment for these injuries is 8 weeks of 24/7 finger splinting.
24 hours a day, 7 days a week. If you take your splint off and let that finger bend even just one time, the 8-week clock starts over.
And with worse results.
This makes sense if you think about it. Splinting the finger puts the ruptured tendon (or bone fragment) back in contact with its place of origin. Over 8 weeks, your body will create enough scar tissue to stick things back together and return function to the finger.
So. Even just one bend of that finger during healing will pull that scar tissue back apart. Envision pulling off a scab — and the wound starts to bleed all over again.
4. What happens if you don’t treat a mallet finger?
Does the non-operative treatment option sound like something that’s not your cup of tea?
Well, the truth is, you don’t have to go through with it.
One of the best surgeons I ever trained with had multiple mallet fingers that he just decided not to treat. And yes, he has droopy fingers. They don’t heal on their own.
But you know what? There is very little in life that we do with our fingers completely straight (other than putting our hands in tight jean pockets).
Most of our hand use relies on gripping. “Flexion is function.”
I still would recommend that most people buckle down and commit to the 8 weeks of splinting. It’s 8 annoying weeks for a lifetime of a fully functional finger.
But. The negative consequences of a droopy finger are relatively mild in the grand scheme of things.
One caveat: in some cases, the underlying tension in your finger’s extensor mechanism can stretch out over time and cause some dysfunctional tendon imbalances in the finger. If you decide not to treat your mallet finger, be sure to see a hand surgeon right away if anything seems unusual with your finger function as time goes on.
And there’s no way to predict if you’ll get this imbalance — which is why I still recommend treatment in most patients.
5. A “perfect outcome”
This is particularly important in the context of my previous point.
Even with perfect treatment, where you wear the splint for a full 8 weeks…a perfect finger isn’t guaranteed.
Now don’t get me wrong. Many people do end up with a perfectly straight finger.
However, it is fairly normal for the finger to still have a 10-20 degree droop. Nothing nearly as bad as when you started. But not perfect.
This is because the scar tissue heals back together, but not necessarily at the same tension and consistency as the tendon with which you were born. This results in a slightly less-than-perfect outcome.
Again, this isn’t a huge deal and shouldn’t impact your function. But it is important that you know this before embarking on the 8-week journey to healing.
Takeaways:
A mallet finger results when the tendon that straightens your finger is no longer attached to bone
Though relatively pain free, this injury makes it impossible for you to straighten the end of your finger
Always get an x-ray if you get a mallet finger — a rare few of these injuries require surgery and an x-ray is the only way to know
I would classify this injury as extremely common and not life-changing. But the healing from it certainly is annoying, and it will take a two- to three-month bite out of your desired function and activity level.
Once it heals up, you’ll be on your way!
