MALLET FINGER TREATMENT & PHYSIOTHERAPY MANAGEMENT

MALLET FINGER

1. Mallet finger - Dr.DHARANI MAVURU MPT ORTHO

2. After a sudden flexion injury, the distal phalanx droops and cannot be straightened actively. Three types of injury are recognised. Rupture of the most distal part of the extensor tendon. Avulsion of small flake of bone from the base of the terminal phalanx with the joint line affected. Avulsion of a large dorsal bone fragment, sometimes with subluxuation of the DIP joint

3. Mechanism of injury Sudden forced flexion of the distal phalanx

4. Clinical features Pain Swelling Loss of ROM at distal phalanx. Hyperextension of PIP joint due to unbalanced extensor mechanism.

5. Treatment Immobilization – distal joint in slight hyper extension with special mallet finger splint which covers only DIP JOINT and leaves proximal joint free.

6. Pop cast with- 60 flexion of PIP - hyperextension of DIP Immobilization period : 3-4 weeks Surgical method: extension block wiring - 2 K wires are passed percutaneously

7. Ruptured tendon is repaired by surgery sometimes. Avulsed bony fragment is fixed with k wire. Postoperatively, finger is immobilized in cast/splint for 3-4 weeks. Late cases- OR tendon repair If pain and deformity persist, arthrodesis can be done with 15degrees of flexion of DIP. Post-op immobilization- 8-10 weeks.

8. Physiotherapy management Aims: Regain ROM of the joint. Improve strength at DIP Joint. Improve voluntary extension of DIP

9. Immobilization /surgical repair Patient is encouraged to use hand with splint/POP Vigorous movements to all fingers. Reduce inflammation, pain, edema

10. mobilization PWB AROM Strengthening and re education to EDC by ES Lumbrical exercises. Full function- 3-4 weeks following mobilization.

11. complications Non union Persistant droop Swan neck deformity