When can I play tennis after sustaining a mallet finger injury?

Discussion in 'Health & Fitness' started by markcoop, Oct 11, 2012.

  1. markcoop

    markcoop New User

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    I hurt my middle finger on my dominant hand playing basketball a couple of days ago. I will have my finger in a splint for 6-8 weeks. Anyone have this injury and try to play tennis with it? If so, how soon after the injury? Obviously I can't fully grip the racket, but I think I can grip it enough to hit balls. I usually drill once a week and play in a league once a week at a 4.0 level.

    Thanks for any input
     
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  2. LeeD

    LeeD Bionic Poster

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    As soon as it don't hurt when you hit a volley, overhead, or serve.
    Modern tennis is loosely held grips, and losing one finger means little.
    Don't tape your middle finger to your index finger.
     
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  3. Vlad_C

    Vlad_C Semi-Pro

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    After 10 weeks at least.
     
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  4. LeeD

    LeeD Bionic Poster

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    OK, maybe the question should be, ...."HOW TOUGH ARE YOU?" or how dumb?
    I raced motocross while in a cast, 6 pins, wire, and plate in the tib/fib. RACED, not just practice.
    I raced motocross 3 weeks after breaking a collarbone, twice.
    I windsurfed in high winds 3 weeks after breaking a collarbone.
    I practiced for 2 weeks at the end of summer with the varsity high football team, with a broken fibula, displaced and overlapped by 1". Got it pinned first game of the season (surgery, 3 screws, 21 stitch opening), and played the final 2 games of the fall season in late Nov.
    Am I stupid? Of course! Am I tough? You decide.
     
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  5. Chas Tennis

    Chas Tennis Hall of Fame

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    There are a few threads on mallet finger in Health & Fitness.
     
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  6. markcoop

    markcoop New User

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    Thanks for the responses. My biggest concern is hurting my finger further, or delaying the healing process. I would wear a splint that prevents the finger from bending, but I'm concerned about the vibration traveling to the finger.
    I think the pain will be ok.

    I did read through some of the other threads. I didn't find specifically what I'm looking for (will I cause further damage if I'm wearing the splint).
     
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  7. LeeD

    LeeD Bionic Poster

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    Accidents can happen.
    You can hit for an hour without your middle finger just fine, and then ONE stroke, you forget and use your middle finger, and instant reinjury.
    But you know that. Any body part that is not 100% is your weak point.
    Just what is tennis worth to you?
    Nobody can guarantee your tennis future. It might be fine, it might not. You can only control the NOW part of life.
    As in life, goes tennis.
     
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  8. markcoop

    markcoop New User

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    I understand and appreciate your attitude. I've seen it in other threads as well. Of course tennis means alot to me or I wouldn't be posting this thread. I understand an accident can happen and I'm willing to live with that. I'm trying to understand if an accident doesn't happen, will I further hurt my finger just by normal play.
     
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  9. Chas Tennis

    Chas Tennis Hall of Fame

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    You need to ask your Dr those important questions, not people on the internet.

    There is plenty of information searching. Here is a more detailed description by some Dr. I would not accept anything from this article but use it to extend your research of your injury.

    http://www.togct.com/downloads/bernstein/Mallet-Finger.pdf

    http://www.bssh.ac.uk/patients/commonhandconditions/malletfingerinjury

    A friend of mine has it. I do not think that his injury will completely heal. He was injured catching a platform tennis ball. If it were my injury I would do everything your Dr says and more to give my tendon every chance to reconnect or otherwise heal.

    How did it happen, did the BB hit the end of your finger?
     
    Last edited: Oct 11, 2012
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  10. LeeD

    LeeD Bionic Poster

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    Most of my doctors knew I was going to resume my sports while still in the recovery process.
    Before my time, the accepted course of action for any injury was rest rest rest, no stress and rest some more.
    During the late '60's, a new idea was put forth by some "medical experts"... maybe use the body to promote whatever the body needs to heal and recover is better than sleeping an laying around ???
    With any usage, there is always in increased chance of a re injury, while the injured part is still healing. That is countered by the effects of exercise to accelerate the body's natural healing process.
    Every doctor told me not to exercise (do my sport) as their first course of counsel, to cover their butts. EVERY doctor smiled and said, "good luck, don't crash, and let's see" when I told them I was going back to racing in a cast, or while the collarbone was one week set.
    I made the decision to take the chance. They reaped the benefits of the dumb test dummy.
    After 5 days removed from my 13 month left leg cast, I went surfing in the heaviest WestCoast waves, OceanBeachSF at 6' and hollow. I had made a fiberglass "cast" to tape around my shrunken leg, to support and protect it in case the surfboard hit it wrong. I used crutches to get to the water's edge.
     
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  11. charliefedererer

    charliefedererer Legend

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    Don't screw up your finger for life.



    After an acute injury, the process of inflammation begins.

    Cells at the site of injury release chemicals (cytokines) that cause protein strands to be laid down to heal the torn tendon.

    Those protein strands are thin and flimsy like a spiders web.

    [​IMG]

    Like a spiders web, those strands are easy to break with any movement.



    Over time though (six weeks) those strands are bound together, just like the many strands in a rope or cable are bound together to form one strong rope or cable.

    [​IMG]

    [​IMG]





    The problem is that with early movement, the ends of the tendon pull apart again, tearing the fragile protein strands.

    The body has to start over again.



    If too many restarts happen, each end of the tendon seals over in scar tissue.

    Only surgery to cut away the excess scar tissue and fixation of the two ends surgically would then result in healing.

    But with such extensive inflammation and surgery around such a small joint as exists at the end of the finger, you increase the chance that the joint "freezes" from getting involved in the inflammation - with excessive internal scar tissue freezing the joint movement.



    So don't blow your chance at healing by playing tennis. You have to grasp the racquet too firmly to avoid motion.




    I gave up playing tennis for 6 weeks when I incurred a mallet finger when I attempted to catch a smashed tennis ball, rather than let it fly into an adjacent court.
    That was years ago and I am pleased to have a normal functioning finger.
     
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  12. makinao

    makinao Rookie

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    Did you get it x-ray'd? I had the same problem in my non-dominant hand may years ago, and an x-ray revealed one joint was broken into 3 parts. It required surgery, a retaining pin and splint for 3 weeks, then another 3 weeks of physio-therapy. Got back most of its range of motion. While it was my non-dominant hand, I have a 2-handed backhand. I had to re-learn a 1-handed backhand before it was completely healed. So now I have both in my arsenal.
     
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  13. Chas Tennis

    Chas Tennis Hall of Fame

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    I'm trying to understanding this injury and so far have the following picture: The tendon that goes to the end of the finger on the top attaches at more than one location on the bones of the finger (I have to check this). ?. The last attachment on a finger is small and if an impact or other stress occurs in an unfortunate way the tendon rips off at the last attachment. There is difficulty in healing if the tendon is completely off the bone and somehow must find & reattach to the bone. If some of the tendon is still attached I guess healing is much more likely. ?

    [​IMG]

    There's often a lot of uncertainty with injuries even after MRI's and other imaging. Since you had this injury, do you know the nature of your tendon damage, complete or partial detachment? If you don't know, can you speculate on what might have happened especially since you healed so well?
     
    Last edited: Oct 12, 2012
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  14. markcoop

    markcoop New User

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    I didn't go to a doctor. After some quick searches, it seems so obvious what I have. I guess I don't know if there is a fracture or a tear (an x-ray would show the fracture), but the treatment is the same (splint). I guess I'm guessing a bit here that there's not a big (or multiple) fracture that would require surgery. It didn't seem that bad when it happened. No pain. Just caught the tip of my finger on the basketball. It was a bit freaky that I couldn't lift the tip of the finger. I felt the top of the joint and didn't feel anything crazy. So, no doctor to ask.

    charliefedererer - That was a great explanation. The best I've seen and consistent with everything I've read.

    So assuming I want to do something stupid (like play tennis while it's healing), I guess the longer I wait the better. I mean playing after 3 weeks would most likely be much better than playing right now because those strands are stronger. Remember, I'm not going to bend my finger for 6 weeks. Just want it to heal to the point where it could withstand some vibration.
     
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  15. charliefedererer

    charliefedererer Legend

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    Most with this injury have a complete tear of the tendon from a very sudden force applied to the finger tip:

    [​IMG]


    Besides the more common complete tear of the tendon, if the force is applied more slowly, it is more likely that the tendon pulls off a piece of the bone it is attatched to, as in the second pic below (fracture of distal phalanx):

    [​IMG]


    Both types of injuries usually respond to a splint.


    Occasionally, a more complex injury occurs where the bone and tendon retract. My understanding is that complex injuries are more likely with unusually high forces like in an auto accident, or a crush injury involving machinery.
    The examining hand surgeon would then more likely find on physical exam a larger bony fragment palpable under the skin, or the bump of a retracted bone and tendon further down the finger.
    These unusual circumstances might prompt an MRI to further investigate what is going on, but I don't think an MRI is obtained with mallet fingers that occur with a common ball injury, and that don't have a larger fragment of bone or curled up tendon under the skin.
    More complex injuries may have to be surgically repaired, to pull the retracted tendon/bone into alignment and fix it there with sutures or a pin.



    ["Mechanism of injury" is a term taught to all who are involved in trauma care.
    The greater the force involved, the greater the resultant injury.
    Also understanding the way the injury incurred often allows one to predict the type of injury, or at least be more alert to order further imaging to better delineate the extent of the injury.]
     
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  16. OHBH

    OHBH Semi-Pro

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    Practice lefty, it will do wonders for your game when you return to playing with your dominant side
     
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  17. Chas Tennis

    Chas Tennis Hall of Fame

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    If the tendon is completely detached it may or may not reattach - permanently. To maximize your chances of healing you need to see a well-qualified Dr.
     
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  18. LeeD

    LeeD Bionic Poster

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    So, is the joint still red, swollen, sensitive, and seems to itch as well as sting?
     
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  19. markcoop

    markcoop New User

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    The joint is a little swollen, sensitive, a little discolored, not itchy or sting.

    Chas Tennis - I do understand the suggestion to see a doctor. There's a part of me that agrees. Since I really don't believe there is any major fracture in there (based on touch, lack of pain, low swelling, not a huge impact), a small fracture or tear will both be treated with a splint. I immobilized the finger the first night (Tuesday). If I do go to a doctor, most likely on Monday, they will certainly bend the finger and I'd be a week behind the heeling practice.
     
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  20. LeeD

    LeeD Bionic Poster

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    I think most of the guys who played under the basket in high school got that, me included. Red, swollen, can't move it, stinging pain, a little itchy bother.
    I always was careful to go up with my other hand, not the shooting hand, to rebound. Also, when attempting a shot block, same thing, save your shooting hand. Took half the season to heal, usually after the Bball season was over.
    I still have 5 crooked fingers from breaks and sprains, no biggie. Badge of stupid, that's all.
     
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  21. Vlad_C

    Vlad_C Semi-Pro

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    Hey LeeD,
    Don't take this the wrong way, I think you're a cool guy, but reading about all your past injuries, makes me imagine that you look something like this:

    [​IMG]

    :shock::shock::shock:
     
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  22. Chas Tennis

    Chas Tennis Hall of Fame

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    I don't know but I believe that if the tendon is detached it very often does not reattach.

    The Dr is likely to know better how to splint the finger to increase the chances that it will heal (reattach if detached) or apply other treatment, who knows? He can better answer the healing time questions and activities that are OK.
     
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  23. LeeD

    LeeD Bionic Poster

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    Vlad, if you saw that vid posted of me serving, you put up a pretty good representation. At the time of my vid, my ankle wasn't working at all, my left knee would swell up about 1/2" after playing, and I couldn't lift my left hand to my mouth to brush my teeth or to shave without support from my right hand at the elbow.
    I'd already broken my collarbones four times.
    I'd separated my left shoulder twice, right shoulder 3 times.
    I'd dislocated my left shoulder once.
    4 of my fingers are permenaently bent in weird abnormal directions from breaks, 2 have pins.
    I've broken more than 12 ribs.
    Got 2 leg surgery breaks, and one greenstick.
    Pretty cool, eh? Who says you can't live a full life without money?
     
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  24. markcoop

    markcoop New User

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    I really do understand and appreciate your comments. In fact, most of the time I would do exactly what you say. I have had two dislocated fingers and did go to the doctor and followed up with physical therapy.

    I was planning to go to the doctor till I started to do some research. It was so clear what the injury is and what the treatment is. Every site said the same thing: Immobilize the finger in a straight position with a splint (maybe even slightly hyper-extend it). There are splints specifically for this injury (stax). If I wasn't convinced that this is the only course of action (surgery if more serious), then I wouldn't do it myself.

    BTW - It is my understanding that with proper splinting, there is a high probability of the tendon re-attaching. The key is to allow the body to heal itself by holding the finger straight.

    Thanks
     
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  25. LeeD

    LeeD Bionic Poster

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    It's a FINGER!
    You don't need to give the FINGER all the time.
     
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  26. markcoop

    markcoop New User

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    Thought I'd give people an update. I splinted the finger for 6 weeks. There was no way I could properly grip the racket with any splint on. I did go to the gym alot. Did cardio and lifted some weights. Some weight exercises I couldn't do, but there were plenty I could do. At times I felt stress in my finger doing exercises, but I hoped that it was ok as long as the finger was kept straight.

    At 6 weeks I took the splint off and I was able to hold my finger straight out. I read alot about how to loosen up the finger. Did a little bit every day for a week. I was hoping to get on the court at week 7, but there was no way it was going to happen. The next week I was close to making a fist. I was still nervous because the finger wouldn't straighten by itself. When I helped, it would stay though. At week 8, this past Monday, I played for the first time. No pain. But still hard to really grip the racket. It's only the tip of my finger, but it sure mad a difference. Baseline shots seemed ok. Net shots were harder. Serving was the hardest.

    So, I'm getting there but it seems like it still may take a bit longer.
     
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  27. LeeD

    LeeD Bionic Poster

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    Glad you're almost back.
    ATROPHY. When you splint anything for 6 weeks, it will take twice as long to recover, and fully heal in quad that time. That is normal.
    I was in a hip cast for 5 months, then a short leg cast for 7 months after that. I rode my BSA500MX on the beach at least 15 days with the short cast on :):)
    Day I got out of my short cast, after a walker for 2 months, my calf was smaller than my forearms, weaker too. That left thigh was close to the size of my bicepts.
    5 days out, I went surfing at OceanBeachSanFrancisco on a 6' hollow day. My surfing buds couldn't catch any waves (they'd been surfing maybe 4 years), I got two, didn't stand on on the first and rode the second to shore. Surfer maybe 25 out of the next 30 days, crutching to the shore, then grabbing my board from my bud's who carried it down to the shore.
    You gotta do what you gotta do. Took longer than 4 years to be able to run on the soft sand beach.
     
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  28. charliefedererer

    charliefedererer Legend

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    Thanks for the update.

    You were smart to stay in shape at the gym.

    I've had this type of hand gripper for years. It has individual press down springs for each of your fingers. They come in a range of strengths. I got mine from Amaz*n.com. Do you have one?

    [​IMG]

    I have full "strength" in my left 4th finger that I incurred the mallet finger deformity years ago. Despite plenty of exercise, I did lose a bit of ability to fully curl my finger at the distal joint after 6 weeks in the splint - but I never notice this interferes with anything. [I am right handed.]
     
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  29. markcoop

    markcoop New User

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    charliefedererer - I don't own such a hand gripper, but I have used such a hand gripper in the past when I dislocated my finger and did PT. Maybe I'll pick one up. I'm actually more concerned about outward pressure (see below).

    Since my last post I've played tennis two more times. Tennis is much better. I can now grip the racket well. I played a match yesterday and serving was ok at the beginning but eventually started to bother me a bit. I do see progress with the grip, so I'm happy about that.

    As far as the exercises, I am doing the following:
    - Bending and extending the finger with the aid of my other hand.
    - Making a fist by myself. Gets better every time I do it.
    - Lift small objects with my recovering finger and thumb.

    I still wear the splint at night and some of the day (maybe a few hours during the day).

    At this point, my only concern is that I can't straighten the finger without the aid of my other hand. In other words, after bending and extending a few times, I can make a fist by myself (at least most of the way). But I then can't extend the finger by itself. After I help extend the finger, I can hold it straight. I am able to move it up a bit, but not all the way. I'm hoping this is because the joint is still a bit swollen and stiff and I don't have the strength to do it yet. Just not sure if this is normal. I tried doing an exercise where I put a rubberband around my fingers and try to extend outward. Can't really do that with the recovering finger yet. I will keep at it. If I don't see improvement in this area I will finally go to a doctor.
     
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  30. makinao

    makinao Rookie

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    Pardon me for berating you, but after 2 months you still can't extend your finger on its own, and its still swollen? My mallet finger injury was probably worse than yours, and after two months I was off the splint, had over 80% range of motion on its own, and could grip a tennis racquet securely. The difference is that I took my injury to a surgeon and PT from the get go, and you've just been guessing all along.

    Besides the fact that your recovery is taking longer than you expected, this injury will haunt you when you get older. For your sake, see a doctor now. And don't forget to tell him/her everything that has transpired.
     
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  31. markcoop

    markcoop New User

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    No problem berating me. I probably deserve it. Not really sure why I've been so stubborn about going to a doctor for this injury. As long as I'm seeing progress, I believe things are healing. Many sources I've seen don't recommend removing the splint for 2 months. I have purposefully been weening off the splint slowly. As long as I'm using the splint at all, there's going to be stiffness. The swelling is minimal at this point, but still there.

    Did you have surgery? I would imagine that would change the whole equation for healing.

    If I were to go to a doctor, what would they do? I can only imagine 3 courses of action:
    1) I'm doing everything ok. It's healing fine. Keep it up.
    2) I took the splint off to soon or was to aggressive exercising it and need to re-splint.
    3) Operate.

    I still don't believe I need (3). I do know a few doctors and nurses who have just took a quick look at it. No one has given me any huge concern like you have a piece of bone sticking out.

    Action (2) is possible. The negative of not re-splinting at this point is I will lose a bit of range of motion. First sign of not seeing progress and I'll go to the doctor and this will most likely be what I will do.

    I'm pretty sure I'm still in (1) above. These injuries take time to heal. I've read many accounts of months after the splint is off. I'm playing tennis again and have noticed grip improvement every time. It does make sense to me that pushing up on the tip of the finger will come back last. As long as there's stiffness, I can't imagine it any other way.
     
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  32. makinao

    makinao Rookie

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    You could add 4) You've already botched up the initial management of your injury. So while it will heal and the swelling will go away, it will not return to optimal. So the best a doctor could do at this point is damage control.
     
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  33. markcoop

    markcoop New User

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    Interesting option. I guess the question I have is what does botched up mean. There are two courses of action to treat a mallet finger: splint or surgery. Surgery is only used when absolutely necessary. The large majority of the cases splint. I never had a ton of swelling and to the touch felt no bone protruding. If there was any mistake, there is the slight chance that I actually needed surgery (which I can always still do). But I can't understand how you could conclude I may have botched things up by using a stack splint (purchased on Amazon) designed specifically for this injury and used in the great majority of cases.

    I think there different kind of people in this world. On one end of the spectrum you have people who like to do as much as possible themselves. One the other end, you have people who rely on others as much as they can. Apparently I'm more of a do-it-yourself person. Of course one should go to an expert, a doctor in this case, when their expertise is needed. That does not make doctors beyond reproach. Many doctors don't always do what's in the best interest of their patients. A great example, although not related, is how doctors tend to ignore nutrition as a path to better health. In my case, I have no doubt that the time spent going to a doctor, the x-rays, the follow-up visits, the PT and of course, the bills, would have yielded a good result. But after doing my research, something I always like to do before seeing a doctor, I concluded it was not necessary. Did I make a mistake? I think there's a very small possibility that I have, but I do understand the small risk I took.
     
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  34. Chas Tennis

    Chas Tennis Hall of Fame

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    There's uncertainty about injuries regarding the nature of the injury. Drs have the most educated idea of the required timeliness of treatment.

    You seem to believe that you can get surgery to reattach a tendon at any time. Please don't have confidence in your conclusion and see a Dr.

    For myself, I don't believe in hoping for reattachment for a detached tendon regardless of what I can find on the internet and have decided that I would see a Dr right away. I have also heard one bad story of waiting for a very short time on one particular tendon detachment and losing the option for surgery. ?? There is also the simple logic - if a tendon separates and pulls back from the attachment site on the bone, how does it find its way back to reattach?
     
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  35. dbb

    dbb New User

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    Markcoop, your journey down the path of Hippocrates is truly dizzying.

    Tell me, when you're working on that formidable backhand of yours -- even though you know all the fundamental components of the stroke and how it should be properly executed -- do you trust yourself completely to provide the necessary guidance to ensure it reaches peak performance? Or, perchance, do you seek the support of a professional tennis instructor to help?
     
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  36. markcoop

    markcoop New User

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    So, after 13 weeks I decided to go to a doctor about my finger. It was healing ok, but I was a bit concerned about the results. A normal success for this kind of injury means you are left with a permanent 10 degree (or less) droop in my finger. I didn't do any measurements, but I was concerned about it.

    So I go into the doctor's office and he immediately makes a bunch of claims about how my finger is not healed. He orders an x-ray. The x-ray shows no fracture and a decently healing finger. He retracts his initial comments and claims I'm one of the few self treating patients he's seen with this injury that actually did a good job with it (I know, he's just saying that to make me feel good). Finger is healing with a 10-15 degree droop though. He thinks I can do better if I re-splint for another 6 weeks with a custom splint (hopefully get it closer to a 5 degree droop).

    So, I'm out for tennis for another couple of months.

    If I had gone to a doctor right away:
    1) They would have made me a custom splint right away. Splint is more comfortable and may even do a slightly better job because of the fit.
    2) I probably would've been done with this whole episode a bit quicker (probably by a few weeks because I clearly needed more time then I gave it).

    Hopefully this experience will help someone else in the future.
     
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  37. Chas Tennis

    Chas Tennis Hall of Fame

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    Thanks a lot for the follow up.

    I would be very relieved that my finger had mostly healed even if not optimally - yet.

    If I got that injury I would be very uncertain as to whether the small tendon still had any degree of attachment. And also after a diagnosis, uncertain what could be done medically to increase the chance for the best outcome. As soon as I learned about Mallet Finger I decided that I certainly would see a Dr right away. I'm sure that you have had a considerable amount of concern about your finger during many of those weeks.

    Good luck with the next phase.
     
    Last edited: Jan 9, 2013
    #37

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