I am a 43 year-old woman who was cleaning carpeting two weeks ago when I jammed the tip of my middle finger. I am now unable to straighten the tip and it is painful and swollen. Is there anything I can do? EM - Billings

Dear EM,

You likely sustained a mallet (baseball) fingertip injury. Normally, the tendon that straightens the tip of the finger ends as a very thin, flat sheet inserting into the top of the bone just before the nail. Injuries that cause an acute hyperflexion of the joint can easily tear this tendon or even fracture the bone into which it inserts. This results in a noticeable "droop" in the finger along with painful swelling along the top of the joint. Although a mild loss of extension is often well tolerated, more severe extensor lags result in difficulty with hand dexterity and even gradual hyperextension of the middle joint resulting in decreasing finger flexion. In cases of bone fracture, joint malalignment and eventual arthrosis may occur.

Most mallet finger injuries respond well to a directed extension splinting program. A certified hand or occupational therapist can fabricate a custom extension splint to support the joint while the tendon injury heals.

In select cases, however, surgical repair or reconstruction is warranted. Regardless of treatment, results are generally better in cases treated earlier although reasonable results are often possible even after 3 months of neglect.

My advice is to seek a consultation with your primary care physician or orthopaedic surgeon. X-rays are often needed to look for more significant injuries to the bone and joint. A well-designed splinting program for 6-8 weeks often results in an acceptable return of function and appearance to the fingertip.