Mallet finger is a common hand injury that affects the tendon responsible for straightening the tip of the finger. It is classified as a flexion deformity injury because the injured person cannot actively straighten the fingertip, leaving it resting in a bent or flexed position. Mallet finger injuries are frequently seen in sport, particularly ball sports, but they can also occur during everyday activities at home or work.
From a physiotherapy perspective, early recognition and appropriate management are essential. Physiotherapy for mallet finger focuses on protecting the injured tendon or bone during healing, maintaining movement in surrounding joints, and restoring finger and hand function once immobilisation is complete. Without timely treatment, mallet finger injuries can lead to long-term stiffness, pain, and deformity that significantly affects hand use.
Key Facts
- Mallet finger is one of the most common tendon injuries of the hand, frequently affecting people involved in ball sports such as basketball and cricket in Australia.
- Most mallet finger injuries can be successfully managed with splinting and physiotherapy, avoiding the need for surgery when treated early.
Risk Factors
- Participation in ball sports such as basketball, netball, cricket, or football
- Poor hand protection or technique during sport
- Manual work involving tools or heavy objects
Symptoms
- Inability to actively straighten the fingertip
- Pain and tenderness around the fingertip joint
- Swelling and redness at the end of the finger
- A visible droop or bent position of the fingertip
Aggravating Factors
- Attempting to straighten the fingertip against resistance
- Accidental knocks or bumps to the injured finger
- Removing or loosening the finger splint during early healing
Causes
Mallet finger injuries occur when the extensor tendon at the tip of the finger is damaged. Tendons are strong connective tissues that attach muscles to bones and allow movement at joints. In the fingers, the extensor tendons run along the back of the hand and fingers and are responsible for straightening the finger joints.
A mallet finger injury happens when a sudden force bends the fingertip further than it should go. This can cause the extensor tendon to rupture or, in some cases, pull off a small piece of bone where the tendon attaches. This type of injury is called an avulsion fracture. In both situations, the extensor tendon can no longer straighten the fingertip, leading to the classic flexed appearance.
Physiotherapists commonly see mallet finger injuries following sporting incidents, but they can also occur from simple household accidents such as catching a finger in a door or striking the fingertip with a tool.
How Is It Diagnosed?
Mallet finger is usually diagnosed based on the history of injury and a physical examination. A physiotherapist or doctor will observe the resting position of the finger and assess active movement. The hallmark finding is the inability to actively straighten the fingertip, while passive movement is often still possible.
Physiotherapists will also assess the movement and strength of the other finger joints and the hand as a whole to identify any additional issues that may influence rehabilitation.
Investigations & Imaging
- X-ray
- Used to determine whether there is a bony avulsion fracture at the fingertip joint and to guide management decisions.
Grading / Classification
- Tendinous mallet finger
- The extensor tendon is ruptured without an associated fracture.
- Bony mallet finger
- The extensor tendon pulls off a fragment of bone from the end of the finger.
Physiotherapy Management
Physiotherapy plays a central role in the management and rehabilitation of mallet finger injuries. Physiotherapy for mallet finger focuses on protecting the healing tendon or bone, preventing secondary stiffness, and restoring finger strength and coordination once immobilisation is complete.
Exercise
Mallet finger physiotherapy exercises are introduced gradually once the splinting phase has finished and healing is confirmed. Early exercises aim to gently restore active extension and flexion of the fingertip without overstressing the healing tendon. As control improves, physiotherapists progress exercises to include grip strength, dexterity, and functional hand use relevant to work, sport, or daily tasks.
Activity Modification
Activity modification is essential during mallet finger rehab. Physiotherapists provide clear guidance on avoiding activities that place stress on the fingertip, particularly gripping or catching actions. During the splinting phase, patients are educated on how to safely perform daily tasks while keeping the finger protected.
Manual Therapy
Manual therapy techniques such as soft tissue massage and gentle joint mobilisation may be used by physiotherapists after splint removal. These techniques help address stiffness in the fingertip joint and surrounding fingers, supporting a gradual return to normal hand movement.
Bracing & Taping
Bracing is the cornerstone of early mallet finger treatment. Physiotherapists are skilled in fitting and adjusting extension splints that hold the fingertip straight while allowing movement in the rest of the finger. Strict adherence to splint wear, usually for around 8 weeks, is critical for successful healing.
Heat & Ice
Ice can be used in the early stages of a mallet finger injury to help reduce pain and swelling around the fingertip joint. Physiotherapists provide advice on safe ice application without removing the splint.
Education
Education is a critical component of physiotherapy for mallet finger. Physiotherapists emphasise the importance of continuous splint wear, skin care, and recognising signs that may require medical review. Clear education improves compliance and outcomes.
Other
Physiotherapists also address whole-hand function, ensuring that other fingers, the wrist, and grip strength are maintained throughout the rehabilitation process.
Other Treatments
Other treatments may include review by a hand specialist or occupational therapist for custom splinting. These treatments are often coordinated alongside physiotherapy to optimise outcomes.
Surgery
Surgery for mallet finger is generally reserved for cases where conservative management fails or when there is a large bony avulsion fracture causing joint instability. Surgical options may involve pinning the joint or repairing the tendon directly. Physiotherapy is essential after surgery to restore movement and strength.
Prognosis & Return to Activity
The prognosis for mallet finger injuries is generally very good when treated early with appropriate splinting and physiotherapy. Most people return to normal daily activities and sport, although minor stiffness or a small extension lag may persist in some cases.
Complications
- Permanent fingertip deformity if untreated
- Development of a swan neck deformity
- Joint stiffness and reduced hand function
Preventing Recurrence
- Use appropriate hand protection during ball sports to reduce fingertip injuries
- Maintain good catching and handling technique during sport
When to See a Physio
- If you cannot straighten your fingertip after an injury
- If pain or swelling at the fingertip does not settle within a few days