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It Barely Hurts. That’s Exactly Why It Gets Left.
Left untreated, a mallet finger usually heals with the fingertip PERMANENTLY drooping.
The tendon that straightens the tip has torn or pulled off a flake of bone. Without a splint holding the tip straight, the two ends heal with a gap of stretched scar in between, and the tip never fully lifts again.
In some fingers it goes further: the middle joint slowly bends backward while the tip droops, a shape called a swan neck.
Is it too late to splint? Up to about 3 months late, splinting is still usually worth trying. After that, the goal changes.
Where are you right now?
- Injured in the last few weeks, never splinted: get a splint on this week. You’re still in a good part of the window.
- One to three months, still drooping: splinting is still worth trying. Read “The window.”
- Months or years later: read “Living with it, or fixing it.”
- Splinted, but it still droops: see mallet finger still droops after splinting.
What happens if you leave it
- The droop sets. The tip rests bent and won’t lift on its own, though you can still push it straight with the other hand.
- It catches. On pockets, gloves, keyboards, hair.
- Swan neck, in some fingers. The pull that should straighten the tip goes to the middle joint instead, and over months that joint starts bending backward. A swan neck can start to snap or catch as you make a fist.
- A painful worn joint, sometimes, especially if a bone flake healed out of place.
Plenty of people live with a mild droop and full use of the hand. The trouble starts when it catches, hurts, or drifts into a swan neck.
The window
- OPEN: the first weeks. A splint holding the tip straight, worn 24/7 for 6 to 8 weeks without a single bend, heals most mallet fingers.
- CLOSING: about month 1 to month 3. Splinting is still usually worth attempting, same rules, same full-time weeks. The odds are lower and the final droop tends to be bigger. Late is still far better than never.
- SHUT for a simple splint fix: months to years. The goal changes from healing the tendon to living well with the finger.
The full splint rules are in mallet finger treatment.
(Mallet finger is the Fight Club of hand injuries. First rule: nobody talks about it, cos it doesn’t hurt.)
Living with it, or fixing it
Once the window has shut for splinting, these are the real choices:
- Leave it. If the droop doesn’t bother you or catch, this is a perfectly good option.
- A trial of splinting anyway, if a hand surgeon or therapist thinks there’s still something to gain.
- Tendon reconstruction. A hand surgeon can tighten or rebuild the tendon if the droop catches or a swan neck is developing.
- Fusing the last joint straight, for a painful, worn-out tip joint. You lose the bend at the tip, and lose the pain and the catching.
A mallet finger doesn’t punish you for being late. It punishes you for being never.
Is this normal?
Usually expected:
- Little or no pain after the first week, even though the tendon is torn.
- You can still bend the tip and grip normally.
- A small bump or redness over the back of the last joint.
Check with your doctor if the middle joint starts bending backward or snapping, or the tip joint becomes painful.
If it isn’t going to plan
It’s week 10. You meant to get it seen. It barely hurt, and the hand still worked, so it slid down the list.
Every week unsplinted, the gap in the tendon fills with stretched scar, and the muscle pulls its end a little further away. Past about 3 months, the tip droop is usually yours to keep.
So get a splint on now and start the 6 to 8 full-time weeks today. The odds are smaller than at week 1, but still well worth the effort. Have a hand therapist fit it so the tip sits truly straight and the middle joint keeps moving. See which mallet finger splint is best.
Get it checked today if
- There’s a cut over the back of the last joint.
- The fingertip is cold, pale or numb.
Get it checked this week if
- The fingertip droops and won’t lift on its own, and it’s never been splinted.
- The middle joint is starting to bend backward as the tip droops.
- The tip joint looks out of line or is painful.
Untreated, the droop usually stays. Splinted late, it often still improves. Never splinted is the only version with no chance.
Written by Nigel Chua, hand occupational therapist in practice since 2005. Thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. If your fingertip droops and has never been splinted, get a splint on this week.
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.