Physiotherapy for Mallet Finger and Extensor Avulsion

What is mallet finger?

A mallet finger occurs when an object (such as a cricket ball, volleyball, or catching a mattress edge while tucking in sheets) strikes the tip of an extended finger, forcefully flexing the distal interphalangeal (DIP) joint and tearing the terminal extensor tendon, with or without a small avulsion bone fragment. The patient cannot actively straighten the fingertip, which rests in flexion. Without strict, continuous splinting, the tendon heals elongated, leading to a permanent extensor lag or secondary swan-neck deformity. Physiotherapy ensures proper immobilisation while keeping the proximal interphalangeal (PIP) joint free and moving.

How physiotherapy helps

• Custom DIP extension splint fitting advice
• PIP joint active range of motion maintenance
• Skin care and hygienic splint change education
• Gradual night splint weaning schedule
• Gentle active DIP extension exercise dosing

Common signs

• Drooping of the fingertip at the DIP joint that cannot be straightened voluntarily
• Pain, tenderness, and localized swelling directly over the back of the distal finger knuckle
• Ability to push the fingertip straight with your other hand passively without active holding
• Difficulty tucking shirts, putting hands in pockets, or performing fine finger tasks
• Occasional compensatory hyperextension developing at the middle PIP knuckle

Clinical rehabilitation framework

Evidence-informed clinical progression and starter exercise targets for mallet finger.

Frequently asked questions

Related conditions & care

Trigger FingerTrigger finger (stenosing tenosynovitis) occurs when inflammation, thickening, or nodule formation on the flexor tendon restricts its smooth glide through the first annular (A1) pulley at the base of the finger or thumb. In India, repetitive gripping, heavy domestic activities (such as wringing clothes, chopping, and sweeping), manual tool use, and underlying conditions like diabetes commonly precipitate the condition. As the nodule catches within the tightened pulley sheath, the digit snaps, clicks, or locks in a flexed posture. Conservative physiotherapy combines custom MCP joint splinting to prevent pulley irritation, tendon gliding exercises, gentle deep friction massage, and ergonomic utensil adaptations to restore smooth, painless finger excursion.

Colles FractureA Colles fracture is a complete fracture of the distal radius bone in the forearm with dorsal displacement of the wrist, typically sustained by falling onto an outstretched hand (FOOSH). It is particularly common among older adults with underlying osteopenia or osteoporosis in India, frequently occurring from slips on wet bathroom tiles or unpaved streets. Following 4 to 6 weeks in a plaster cast or surgical fixation with a volar locking plate, patients invariably experience severe wrist joint stiffness, restricted forearm turning (pronation and supination), finger puffiness, and diminished grip power. Post-immobilization physiotherapy focuses on gentle passive and active joint mobilisations, edema reduction, tenosynovial gliding, and graded resistance training to safely restore independence in carrying groceries, preparing meals, and personal care.

Carpal Tunnel SyndromeCarpal tunnel syndrome develops when the median nerve becomes compressed as it passes through the carpal tunnel on the palmar side of the wrist. Increased pressure within the tunnel, often linked to repetitive wrist bending, sustained gripping, fluid retention, or inflammatory changes, causes tingling, numbness, and burning pain in the thumb, index, middle, and radial half of the ring finger. For mild to moderate presentations, conservative physiotherapy focuses on relieving nerve compression, reducing flexor tendon friction, and preserving hand function.

Repetitive Strain Injury (RSI)Repetitive strain injury (RSI) refers to cumulative musculoskeletal pain and tissue strain affecting muscles, tendons, and nerves in the neck, shoulder, forearm, or wrist. It frequently arises from sustained posture, repetitive typing, smartphone use, manufacturing assembly, or manual instruments. Physiotherapy identifies the mechanical drivers of strain, relieves localised muscle and tendon tension, and corrects workstation ergonomics, movement patterns, and load pacing so symptoms do not keep recurring.

Clinical guides & articles for mallet finger

Evidence-informed articles, recovery timelines, and home care advice from our clinical library.