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

[Vlad_C]

Originally Posted by LeeD

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.

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:

[Chas Tennis]

Originally Posted by markcoop

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.

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.

[LeeD]

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?

[markcoop]

Originally Posted by Chas Tennis

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.

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

[LeeD]

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

[markcoop]

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.

[LeeD]

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.

[charliefedererer]

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?



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.]

[markcoop]

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.

[makinao]

Originally Posted by markcoop

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.

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.

[markcoop]

Originally Posted by makinao

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.

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.

[makinao]

Originally Posted by markcoop

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.

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.

[markcoop]

Originally Posted by makinao

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.

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.

[Chas Tennis]

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?

[dbb]

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?

[markcoop]

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.

[Chas Tennis]

Originally Posted by markcoop

........................................
Hopefully this experience will help someone else in the future.

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.