A Mallet Injury Case Study with Recommendations for Practice

Abstract

A case report of a 46-year-old female physiotherapist who sustained a right middle finger tendinous mallet injury, while adjusting a pillow under a patient in the intensive care unit (ITU) is described below. Initial treatment consisted of immobilisation of the distal interphalangeal (DIP) joint in slight hyperextension 24 hours a day for eight weeks. Ten days after reduction in splint-wearing time, a 15° extension lag developed at the DIP joint, which was actively correctable with hyperextension of the proximal interphalangeal (PIP) joint. Blocked strengthening of the terminal extensor tendon combined with prevention of hyperextension at the PIP joint resulted in a good outcome. Considerations for practice including prolonged splint protection and graded exercise programmes for tendinous mallet injuries and suggestions for splinting combined mallet and swan neck deformities are discussed.