Mallet Finger and Surgical Treatment
Mallet finger is a common injury that results from damage to the extensor tendon at the fingertip, typically due to a forceful blow or trauma.
Surgical intervention is considered when the injury is accompanied by significant displacement of the joint. Surgery can repair the damaged tendon, re-align any associated fractures, and restore the finger’s functionality.
Immediate Post-Surgery Period
Pain Management:
It’s advised to keep the operated hand elevated above the heart level to minimise swelling. Over-the-counter pain relief medication can be used to manage discomfort during this phase.
Wound Care:
Keep the surgical area clean and dry to prevent infection. Instructions on how to care for the wound will be provided, including when and how to change dressings.
Splinting and Immobilisation:
A splint keeps the finger in a straight position, supporting the tendon repair. The duration of splinting varies, depending on the surgeon’s assessment of tendon healing.
Early Recovery Phase (2-6 Weeks)
Modification of Splint Use:
Depending on the surgeon’s assessment, the splint may be adjusted to allow for gentle movement. It should still be worn most of the time but may be removed for specific exercises and bathing.
Initiation of Physical Therapy:
A physical therapist may start working with the patient to develop a tailored exercise program focusing on exercises to improve flexibility and prevent joint stiffness.
Monitoring and Managing Swelling:
Patients are advised to monitor for signs of excessive swelling or infection and report these to their surgeon immediately.
Incremental Increase in Activities:
Patients may gradually increase their daily activities, always mindful of the healing finger. Activities that risk impact or strain on the finger should still be avoided.
Mid-Recovery Phase (6-12 Weeks)
Gradual Removal of the Splint:
As the tendon heals, the reliance on the splint decreases. The surgeon may advise longer periods without the splint, allowing the finger to adapt to normal activities.
Advanced Physical Therapy:
The physical therapy intensifies, with exercises to strengthen the finger and hand. These may include resistance training and activities that mimic daily tasks, ensuring the finger’s readiness to resume normal function.
Functional Exercises and Activity Resumption:
Functional exercises that use the affected finger in more complex movements such as gripping, pinching, and fine motor skills, are introduced. Patients can begin to resume more demanding daily activities as long as they do not experience significant pain or discomfort.
Continued Monitoring for Complications:
Regular follow-up visits are important to ensure that the recovery is on track. Any signs of complications, such as persistent pain, swelling, or decreased mobility, should be addressed promptly.
Late Recovery Phase (3-6 Months)
Complete Removal of the Splint:
The splint is no longer necessary, as the finger should have regained sufficient stability and strength. Patients are encouraged to use the finger normally in all daily activities, paying attention to any discomfort or limitations.
Continued Strengthening and Conditioning:
Physical therapy may still be ongoing, with exercises now focusing on building strength to match the unaffected fingers. This includes more rigorous strength training and conditioning exercises.
Return to Normal Activities:
Patients should be able to return to their regular hobbies, sports, and work-related tasks during this phase. However, these activities should only be introduced gradually and with modifications to prevent re-injury.
Evaluation of Recovery Progress:
Regular assessments with the surgeon are necessary to monitor recovery progress. These evaluations may include functional tests to compare the injured finger’s strength and mobility against the uninjured ones.
Final Stages of Recovery and Full Function Restoration (6-12 Months)
Consolidation of Strength and Flexibility:
The focus is on ensuring that the strength and flexibility of the injured finger match those of the uninjured fingers. Full participation in sports, musical instruments, and other hobbies that require fine motor skills and hand strength indicates successful recovery.
Endurance Building:
Activities are introduced to improve the endurance of the hand and finger, preparing the patient for prolonged tasks without discomfort or fatigue. This includes repetitive motion exercises that simulate real-life activities, ensuring the finger can withstand regular use.
Ongoing Self-Monitoring:
Patients are encouraged to monitor their recovery and adjust their activities as needed. Listen to the body’s signals, such as pain or fatigue, to avoid overexertion.
Long-term Care and Prevention:
Patients should make ergonomic adjustments to their work and leisure activities and continue with exercises that maintain hand strength and flexibility. Regular check-ups may be recommended to ensure the long-term health and functionality of the finger.
By the end of the twelve months, patients can expect to have regained near or full functionality of their fingers, allowing them to resume all their pre-injury activities without limitations.
Conclusion
The recovery journey from mallet finger surgery is meticulously structured, extending from immediate post-operative care to restoring function up to a year later. Adhering to the recovery protocol, maintaining open communication with a surgeon, and committing to prescribed rehabilitation exercises are important for a full recovery.
