General Guideline Principles for Mallet Finger
for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Mallet Finger.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Mallet Finger of Hand, Wrist and Forearm Injuries

Mallet finger is a common occupational injury, but it can occur with little visible trauma. The extensor mechanism of a digit at the distal upper extremity joint is ruptured, with or without fracture of the distal phalangeal segment.

Mallet finger is easily diagnosed when there is an inability to extend the distal interphalangeal joint, which usually occurs as a result of trauma or distal interphalangeal joint arthrosis.

Diagnostic Studies of Mallet Finger

• Diagnostic Studies of Mallet Finger X-Rays

Diagnostic Studies of Mallet Finger X-Rays are recommended In most cases of mallet finger, a fracture must be found.

• Ultrasound

Ultrasound of Mallet Finger is not recommended to identify mallet finger

Medications of Mallet Finger

Ibuprofen, naproxen, or other older generation NSAIDs are recommended as first-line medications for the majority of patients. Although most evidence suggests that acetaminophen (or the analogue paracetamol) is marginally less effective than NSAIDs.

It may be a reasonable alternative for patients who are not candidates for NSAIDs. There is evidence that NSAIDs are as effective as opioids (including tramadol) for pain relief while being less impairing.

1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic Mallet finger

   Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic Mallet finger are recommended for the treatment of mallet finger, whether acute, subacute, or chronic

   Indications – NSAIDs are recommended for the treatment of acute, subacute, and chronic mallet finger. Over-the-counter (OTC) medications may be adequate and should be tried first.

   Frequency/Duration: For many patients, using it as needed may be appropriate.

   Indications for Discontinuation: Symptom relief, ineffectiveness, or the emergence of adverse effects necessitates discontinuation.

    

2. NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

   NSAIDs for Patients at High Risk of Gastrointestinal Bleeding are recommended Misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors should be used concurrently in patients at high risk of gastrointestinal bleeding.

   Indications: Cytoprotective medications should be considered for patients with a high-risk factor profile who also have indications for NSAIDs, especially if long-term treatment is planned. Patients at risk include those who have a history of gastrointestinal bleeding, the elderly, diabetics, and cigarette smokers.

   Frequency/Dose/Duration: Misoprostol, sucralfate, and H2 blockers are all recommended. Dose and frequency are determined by the manufacturer. There aren’t thought to be any significant differences. in terms of effectiveness in preventing gastrointestinal bleeding

   Indications for Discontinuation: Intolerance, adverse effects, or discontinuation of an NSAID.

    

3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects
   • NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

     NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended Acetaminophen or aspirin as first-line therapy appears to be the least risky in terms of cardiovascular side effects.

      

   • NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

     recommended If necessary, non-selective NSAIDs are preferred over COX-2 specific drugs. To reduce the possibility of the NSAID counteracting the beneficial effects of aspirin in patients receiving low-dose aspirin for primary or secondary cardiovascular disease prevention, the NSAID should be taken at least 30 minutes after or 8 hours before the daily aspirin.

      

4. Acetaminophen for Treatment of Mallet Finger Pain

   Acetaminophen for Treatment of Mallet Finger Pain are recommended for the treatment of mallet finger pain, especially in patients who are contraindicated to NSAIDs

   Indications: All patients suffering from mallet finger pain, whether acute, subacute, chronic, or post-operative

   Dose/Frequency: According to the manufacturer’s recommendations; may be used as needed. When taken in excess of four grammes per day, there is evidence of hepatic toxicity.

   Indications for Discontinuation: Pain relief, adverse effects, or intolerance

    

5. Opioids of Mallet Finger

   Opioids for Treatment of Acute, Subacute, or Chronic Mallet Finger Pain are not recommended to alleviate acute, subacute, or chronic mallet finger pain

   Opioids for Treatment of Acute, Subacute, or Chronic Mallet Finger Pain are recommended for short-term (no more than seven days) use as an adjunctive therapy to more effective treatments for postoperative pain management.

   Indications: For post-operative pain management, a brief prescription of opioids as an adjunct to more effective treatments (especially NSAIDs and acetaminophen) is frequently required, particularly at night.

   Frequency/Duration: Prescribed as needed during the day, then only at night until completely weaned off.

   Rationale for Recommendation: Because NSAIDs do not provide adequate pain relief for some patients, judicious use of opioids, particularly at night, may be beneficial. Opioids are recommended for short-term, selective use in postoperative patients, with the primary use being at night to achieve postoperative sleep.

Rehabilitation of Mallet Finger

1. Therapy: Active

   Therapeutic Exercise

   Therapeutic Exercise is not recommended Most patients with mallet finger do not need to participate in an exercise programme.

   Therapeutic Exercise is recommendedIn a subset of patients with residual deficits, particularly those who have undergone surgery,

   Frequency/Dose/Duration –Total visits may be as few as two to three for patients with mild functional deficits or as many as 12 to 15 for patients with more severe deficits who have documented ongoing objective functional improvement.

   More than 12 to 15 visits may be indicated if there is documentation of functional improvement toward specific objective functional goals (e.g., increased grip strength, key pinch strength, range of motion, advancing ability to perform work activities) when there are ongoing functional deficits. A home exercise programme should be developed and performed in conjunction with therapy as part of the rehabilitation plan.

    

2. Therapy: Passive

   Splints – Extension Splinting With the Joint in a Neutral Position

   Splints – Extension Splinting With the Joint in a Neutral Position is recommended to treat acute or subacute mallet finger

   Indications – Mallet finger, acute or subacute.

   Frequency/Duration – Splinting for six to eight weeks, with the possibility of nocturnal use for another two to four weeks.

   Splints must keep the finger in continuous, full extension for at least six weeks. Some protocols last eight weeks, while others require an additional two to four weeks of nocturnal use.

   Some require nocturnal use for an additional two to four weeks.

   Instructions for Splint Wear

   Instructions for Splint Wear is recommended that patients be given detailed instructions on how to wear their splints Evidence in Support of Splint Wear Surgery

Surgery of Mallet Finger

Surgery is recommended when the DIP joint is subluxed in a subset of individuals with displaced fractures.

What our office can do if you have workers compensation Mallet Finger

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.