Tendons in the fingers allow us to bend and straighten our digits, contributing to dexterity. Most of the muscles that provide this force are located back in the forearm to minimise bulk in the hand and fingers, thus the tendons are often quite long.
The fingers are, however, quite susceptible to injury, especially when playing competitive ball sports. Two common sporting finger injuries are mallet finger and jersey finger.
The term mallet finger refers to the appearance of the finger after rupture of the extensor tendon (tendon that straightens the finger) at the end of your finger. This can occur either as a pure rupture of the tendon or the tendon can avulse (pull away) a fragment of bone with it.
Jersey finger is an injury whereby the flexor tendon (tendon that bends the finger) ruptures at its insertion onto the end of the finger resulting in an inability to bend the most distal joint of the finger. This commonly occurs in the setting of tackling sports where the fingers are curled tightly around an opponent’s jersey before it is violently ripped out of one’s grip. The most frequently affected finger is the ring finger as this finger is relatively longer than the neighbouring digits when the fingers are curled over – check it out when you make your own fist!
Treatment for Mallet and Jersey Finger Injuries
Most mallet injuries can be very successfully managed without surgery. This decision will depend on a number of factors but one of the most important is how long it has been between the time of your injury and the time of assessment – a delay in diagnosis can significantly affect your outcome.
Non-operative management generally consists of splinting the distal finger joint in full extension for a period of time. Usually this will be strict 24/7 splinting for the first 6 weeks, followed by a further 6 weeks of night-time splinting before the splints can be discarded altogether.
If surgery is performed this may involve reattachment of the avulsed tendon back to the bone or fixation of the bony fragment that has been pulled away with the tendon. Either way, following surgery you will need to protect this repair and will be referred to see a hand therapist for provision of a custom-made finger splint and a detailed rehabilitation program.
It can take up to three or four months to feel like you have completely recovered from this kind of injury
Surgery is almost always required for this type of injury as the flexor tendon has more tendency to retract further back into the finger once it has ruptured.
Surgery to repair the flexor tendon back to its bony insertion can use small sutures anchors, simple stitches or sometimes stitches that come out of the skin and are tied over a plastic button that sits over your fingernail (these days the use of an external button is quite rare).
Following surgery, working closely with a hand therapist is of critical importance to get the best result possible. This injury can take four to six months to feel like you have completely recovered.