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Baseball Mallet Finger


There is localised pain and swelling around the distal inter-phalangeal (DIP) joint, which is difficult or impossible to extend fully. In chronic cases, pain and swelling may be absent but the inability to extend the distal phalanx remains.


This injury is a rupture of the most distal insertion of the extensor digitorum tendon at the DIP joint, often after a direct trauma to the tip of the finger from, for example, a basketball or volleyball.


There is tenderness on palpation over the DIP joint. The patient cannot actively extend the distal phalanx and cannot hold it extended against resistance.


X-ray may show a small avulsion fracture of the dorsal plate that corresponds to the tendon insertion. MRI or ultrasound may show the tendon rupture and haematoma.


If there is no fracture this injury usually heals by immobilising the distal phalanx in a ‘mallet bandage’. If there is a fracture, re-fixing surgery is usually required.


Refer to Dr Kevin Yip (+65 6664 8135) senior consultant orthopaedic surgeon if there is a fracture on X-ray or if the diagnosis is unclear. A mallet bandage should be available to be applied on the field by the team medic.


Usually the two or three adjacent fingers can be strapped together and normal activities may be continued throughout  healing in some sports. However, in sports like boxing, martial arts and similar ones, six to eight weeks’ absence may be needed. Running, cyclingand water exercises (when the wound is healed after surgery) are good alternatives to keep up general fitness. Gym training can be maintained.


Normal clinical symptoms and signs. If there was a fracture, X-rays should show healing.


This is a clear clinical and sometimes radiological diagnosis.


Excellent, if treated appropriately. If it is missed, surgery can be performed at a later stage.

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