Today’s article will go over the basics of yet another very common hand & upper extremity condition I treat known as a ‘mallet finger.’ Some may know this injury by its other name of ‘baseball finger.’

This is a condition that hampers your ability to straighten the tip of your finger (the joint just below your nail). Fortunately, it is easily treatable and rarely needs surgery. The only thing between you and a good outcome is your commitment to immobilization (more on that to come).

Let’s get started.

1. Mallet finger is a relatively painless injury with a funny name

Of all the bizarre names given to medical conditions, this is one of my favorites. A mallet finger occurs when the tendon responsible for straightening the very tip of your finger ruptures (see Figure 1).

Typically, this is the result of a jammed finger (think, catching a baseball), but I have seen it from ridiculously low-energy situations like folding laundry or making the bed!

Figure 1 - A ‘soft tissue’ mallet finger where the tendon ruptures off the last bone in your finger.
*Davplast, CC, via Wikimedia Commons*

And what does a ruptured extensor tendon cause?

The end of your finger to droop!

The tip of the finger literally hangs there…and it makes your finger look like a tiny little mallet (see Figure 2). Hence the name.

Figure 2 - Mallet Finger
*Photo: Clappstar, CC, via Wikimedia Commons*

No matter how hard you try, you will be unable to straighten that finger. The tendon has separated from the bone (see Figure 1 above).

Believe it or not, this is oftentimes a (relatively) painless injury. Unless you have an associated fracture.

Which brings me to my next point…

2. You need an x-ray if you have a mallet finger

If this happens to you, it’s extremely important to get an x-ray. Mallet fingers come in three varieties:

Soft tissue mallet (no surgery)
Bony mallet (no surgery)
Bony mallet with joint subluxation (surgery!)

The only way to differentiate among these types is with an x-ray.

A soft tissue mallet is the classic pattern, 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 may benefit from surgery. In this case, such a big piece of bone breaks off that not only does the tendon not function, but the entire joint is no longer stable. Not good.

And if you never get an x-ray…you have no other way of knowing.

3. Surgery is almost never needed to treat a mallet finger. But the non-operative treatment is no joke.

So. In the majority of cases, the news is good. You don’t need surgery!

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.

Splinting the finger puts the ruptured tendon (or bone fragment) back in contact with its place of origin. But 8 weeks have to pass to develop enough scar tissue to be able to use the finger normally again.

If you disrupt that healing process even once, the whole thing rips back apart. Envision pulling off a scab and the wound just 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.

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. Which is not affected by this injury.

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.

5. A “perfect outcome” isn’t the goal of mallet finger treatment

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…unfortunately, a perfect outcome 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.

Wrapping it up

I hope this helps. As always, my role is to educate you so that you can choose the path best suited for you. There is rarely a single ‘right’ answer that fits every patient’s situation.

And of course, if you are in Denver, Colorado and find yourself with a mallet finger, I’d be happy to help you out.

Why Is My Finger Drooping? A Patient’s 5-Step Guide to Mallet Fingers