Have you ever considered how you can get injured if you try to catch a ball which is coming towards you and hits your fingertips? The answer lies in the delicate tendon which extends the finger, and which can be torn if stretched beyond its normal range of motion. The impact of an object is the most common injury mechanism, hence the injury is also referred to as a baseball finger, in international literature. Another term in international literature is “mallet finger” which is directly related to the Greek term “hammer finger” (“mallet” is the word for “hammer”).

Regardless of the term which someone can use, the result  is the same: After the injury, the terminal phalanx (ungulate) of a finger remains partially bent and can not be fully extended. There are cases where the tendon is detached along with a bone fragment from the phalanx. Patients with neglected disruptions may acquire stiffness and deformity. This deformity, like a “wave” on the finger, is called the “swan neck deformity”.
The disruption (namely the discontinuity) of the stretching tendon results, in addition to the collapse of the phalange, in the pain, swelling and hematoma which may lie underneath the nail. In some cases, a nail detachment also occurs. The middle and the index fingers are most susceptible to this specific injury.

The clinical picture and a detailed medical history will help the orthopaedist with the diagnosis, while simple x-rays will show if a fracture or a dislocation coexist. Particular attention and a proper diagnosis are required when it comes to children, as the injury can also affect the articular cartilage, resulting in the affecting of the joint development.
The treatment followed is mainly conservative: A special splint is placed on the finger and keeps the distal phalanx extended, until the tendon injury heals. Ice therapy and the elevation of the finger will help the subsiding of the swelling and pain. The patient wears the splint throughout the day for 4 weeks, while, for an extra 3-4 weeks, they can remove for a few hours (they can even only wear during the night), to initiate active mobilization of the finger.
However, in cases where fractures or a dislocation coexist, or when the patient does not respond to conservative therapy, then surgical treatment is required. The orthopaedist sutures the tendon and immobilizes the peripheral joint. If a bone fragment is detached, it is reattached onto its anatomical position as well. The lesion is repaired using thin wires or small screws. In cases of severe deformities, tendon grafts obtained by the patient themselves (autografts) or an arthrodesis of the distal interphalangeal joint may be required.

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