Making the Most of Mallet Finger Splinting,
Clinical Pearl No. 3 – December 2008

HandLab Clinical Pearls

December 2008                               No. 3

 MAKING THE MOST OF MALLET FINGER SPLINTING

 

Although many of us think of a mallet finger as a simple injury, we frequently see patients whose final result is less than desirable. One small maneuver may help the patient avoid an extension lag at the DIP joint. As we know, stress applied to healing tissue elongates it. Since most mallet finger injuries are treated closed with splinting, our desire is to eliminate stress to the healing tendon ends over the DIP joint.

Patients naturally hold their finger in extension to assist with splint application and removal. During this active finger extension, tension is transmitted through the dorsal apparatus to the terminal tendon insertion (via the lateral bands).Mallet-replacement

 Protective posture for patient to assume when mallet finger splint is applied or removed.

If there is disruption of the tendon due to a mallet injury, tension potentially causes a “gap” to form between the healing tendon ends.

My preference is to teach the patient to place the tip of the finger on the palm of the hand/thenar eminence (flexing only the PIP joint) with the superficialis muscle (see photo). In this position tension cannot be transferred across the healing tendon. While maintaining this position the patient removes the splint, cleans the finger, and re-applies the splint. The little finger may appear too short for this maneuver. Allowing the ring finger to flex along with the little finger will make it easier for the little finger DIP joint to be supported by the palm.Mallet-2

In this position, self removal and application of mallet finger splint is easy and protects the healing tendon from stress.

Download Clinical Pearl No. 3, Making the Most of Mallet Finger Splinting, December 2008

 

ADDITIONAL SUGGESTED READING

Clinical Pearl No. 33 – How Can Each Therapy Visit be as Focused and Productive as Possible?

Clinical Pearl No. 27 – Complex Made Simple: Pasta Transfer

Clinical Pearl No. 22 – Lumbrical Muscle Tightness & Testing

Clinical Pearl No. 21 – Nuances of Interosseous Muscle Tightness Testing

Clinical Pearl No. 20 – Quantifying Interosseous Muscle Tightness

Clinical Pearl No. 19 – Interosseous Muscle Tightness Testing

Clinical Pearl No. 3 – Making the Most of Mallet Finger Splinting

Book Chapter – Therapist’s Management of the Stiff Hand, Rehabilitation of the Hand and Upper Extremity – 2011

Book Chapter – Principals of Splinting and Splint Prescription, Surgery of the Hand and Upper Extremity – 1996

Journal Article – Exercise Splint for Effective Single-Finger Active Hook Exercises by Ahearn, D and Colditz, JC, Journal of Hand Therapy – 2005

Journal Article – Lumbrical Tightness: Testing and Stretching [Abstract only], Journal of Hand Surgery 2002

Journal Article – Efficient Mechanics of PIP Mobilisation Splinting, British Journal of Hand Therapy – 2000

Journal Article – Modification of the Digital Serial Plaster Casting Technique by Colditz, JC and Schneider AM, Journal of Hand Therapy – 1995

What Do You See? No. 4 – The Lumbrical-Plus Finger

What Do You See? No. 2 – Finger Scissoring

Video Clip – Drawing the Dorsal Apparatus

© HandLab; 2014 all rights reserved


Disclaimer: HandLab Clinical Pearls are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact.