Elbow, Wrist & Hand

What It Is

The extensor tendons run along the back of the hand and fingers, and they straighten the fingers and thumb (American Academy of Orthopaedic Surgeons, n.d.). They can be injured at different points along the finger. This sheet mainly covers an injury at the fingertip, known as mallet finger.

If an object or ball strikes the tip of the finger or thumb and forces it to bend further than it should, the force can damage the thin tendon that straightens the end joint. Sometimes a small piece of bone is pulled away along with the tendon. Occasionally even a minor force, such as tucking in a bed sheet, can cause it. Afterwards, the fingertip droops and you cannot straighten it on your own (American Academy of Orthopaedic Surgeons, n.d.).

An injury to the extensor tendon over the middle joint of the finger (called a central slip injury) is different. It is common in basketball, and if it is not treated properly it can lead, over several weeks, to a bent-finger shape called a boutonnière deformity (Leggit and Meko, 2006). It is treated differently, so have any finger that you cannot straighten checked by a doctor.

Finger Extensor Tendon Injury Anatomy

All of the fingers have three bones in them, while the thumb only has two bones. At each joint, the bones are held together by ligaments. Tendons connect muscles to bone. The muscles that move the fingers and thumb are in the forearm and hand, and their tendons attach to the small bones of the fingers and thumb. The extensor tendons on the top of the hand straighten the fingers, and the flexor tendons on the palm side bend them (American Academy of Orthopaedic Surgeons, n.d.). The finger bones join the five metacarpal bones that make up the palm of the hand.

If the extensor tendon is torn or damaged, you will be unable to fully straighten your finger, and it could be painful for several weeks.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat a Finger Extensor Tendon Injury

1. Ice and Elevation

When the injury happens, apply ice (wrapped in a cloth, not directly on the skin) and keep your hand raised above the level of your heart (American Academy of Orthopaedic Surgeons, n.d.). Remove any rings from the finger (NHS, 2023). Most mallet finger injuries can be treated without surgery when they are treated promptly. Seek medical attention as soon as possible, ideally within a week of the injury (American Academy of Orthopaedic Surgeons, n.d.). If you notice excessive swelling or pain in the finger, get advice from your medical professional.

2. Splint

A doctor, nurse or hand therapist will fit a splint to hold your fingertip straight (NHS, 2023). The splint usually needs to be worn all the time, day and night, for 6 to 8 weeks (American Academy of Orthopaedic Surgeons, n.d.; NHS, 2023). Only take it off to clean the finger and the splint, and keep the fingertip straight the whole time it is off, for example by resting the finger flat on a table. If the fingertip droops at all, healing is disrupted and you will need to wear the splint for longer (American Academy of Orthopaedic Surgeons, n.d.; NHS, 2023). Keep the splint dry. You will still be able to bend the middle joint of the finger (NHS, 2023).

After this, most people gradually wear the splint less over the following 3 to 4 weeks, perhaps only at night (American Academy of Orthopaedic Surgeons, n.d.). Splinting usually gives acceptable function and appearance, but many people do not regain full straightening of the fingertip (American Academy of Orthopaedic Surgeons, n.d.). If the injury has not healed, you may need to wear the splint for another 8 weeks (NHS, 2023).

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Surgery: an operation may be considered if there is a large piece of broken bone or the joint is out of line, using pins to hold the pieces together while they heal (American Academy of Orthopaedic Surgeons, n.d.). Surgery is rarely needed (NHS, 2023).
Temporary pin: if wearing a splint is too difficult, a doctor may place a pin across the fingertip joint to hold it straight (American Academy of Orthopaedic Surgeons, n.d.).
Treatment for an old injury: for a mallet finger that is months or years old, options include a tendon graft or fusing the joint in a straight position (American Academy of Orthopaedic Surgeons, n.d.).

How I can help (see the My Approach tab)

Easing the forearm, shoulder and neck while you're in the splint
Gentle finger exercises once your team says it's safe
Hand strength and getting back to activity

Tips

Avoiding blunt injuries to the fingertip that force the tip downward helps to reduce the chance of this injury. So be extra careful when catching fast-moving balls.
While the injury heals, do not bend the fingertip, and avoid sports or exercise involving your hands (NHS, 2023).
Do not ignore a fingertip that will not straighten. Untreated mallet finger can lead to stiffness and lasting deformity (a swan neck deformity), but most people do well when it is treated properly and promptly (American Academy of Orthopaedic Surgeons, n.d.).
Your doctor or nurse may give you hand exercises to do around 6 to 8 weeks after the injury (NHS, 2023). Do not start exercising the fingertip joint until you are told it is safe. Once you're cleared, I can help you with these exercises. See the My Approach tab for how I work.
It can take several months for the finger to get back to normal, and tenderness, swelling and redness are common for the first few months (NHS, 2023).

Treatment

My Approach

With mallet finger, the splint does the main work: it holds the fingertip straight so the tendon can heal. Your doctor, nurse or hand therapist sets that plan, and I work within it. I won't bend or work on the injured fingertip until they say it's safe, and after surgery I need your surgeon's okay before we start.

Please bring any X-ray or scan reports and notes from your medical team to your first visit, especially if a small piece of bone was pulled away. They're an important part of planning safe treatment for you.

While You're in the Splint

Easing the forearm, shoulder and neck, which often tense up while you protect the hand
Keeping the wrist and other finger joints moving with the splint on, and gentle drainage work above the hand for swelling

Once You're Cleared to Move It

Gentle finger exercises as your team directs, increasing bending of the fingertip very gradually
If the fingertip starts to droop or struggles to straighten, we ease off and let your team know
Hands-on work for the hand and forearm, and scar work once the wound has fully healed if you had surgery
Grip strength, then a gradual return to sport and work

If the fingertip suddenly drops again or you lose movement, contact your doctor or hand therapist straight away.

What to Expect

Typical Course

Typical course: In the splint, visits are usually about weekly and focus on the rest of the arm. Once you're cleared, most people come once or twice a week, then weekly, then less often, with a reassessment at about 4 to 6 weeks. Expect the splint full-time for 6 to 8 weeks, then part-time for a few weeks, and several months for the finger to get back to normal, following your team's plan.

What I Focus On

Working Within Your Team's Plan

Protecting the Fingertip

Compensation Relief

Gentle Finger Movement

Hand Strength

Please read

When to See a Doctor First

When to get emergency help

If there is blood under the nail, or the nail is coming off, call 911 or go to the emergency room at your nearest hospital. This may be a sign of a cut in the nail bed, or of a broken bone with a wound that reaches down to the bone (an open fracture), which puts you at risk of infection (American Academy of Orthopaedic Surgeons, n.d.).

Sources

References

American Academy of Orthopaedic Surgeons (n.d.) Mallet finger. OrthoInfo. Available at: https://www.orthoinfo.org/en/diseases--conditions/mallet-finger-baseball-finger/ (Accessed: 7 October 2026).
NHS (2023) Mallet finger. Available at: https://www.nhs.uk/conditions/mallet-finger/ (Accessed: 7 October 2026).
Leggit, J.C. and Meko, C.J. (2006) 'Acute finger injuries: part I. Tendons and ligaments', American Family Physician, 73(5), pp. 810–816. Available at: https://www.aafp.org/pubs/afp/issues/2006/0301/p810.html (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooFinger Extensor Tendon Injury

What It Is

Finger Extensor Tendon Injury Anatomy

Self-Care & Treatment

How to Treat a Finger Extensor Tendon Injury

1. Ice and Elevation

2. Splint

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

While You're in the Splint

Once You're Cleared to Move It

Typical Course

When to See a Doctor First

When to get emergency help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooFinger Extensor Tendon Injury

What It Is

Finger Extensor Tendon Injury Anatomy

Self-Care & Treatment

How to Treat a Finger Extensor Tendon Injury

1. Ice and Elevation

2. Splint

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

While You're in the Splint

Once You're Cleared to Move It

Typical Course

When to See a Doctor First

When to get emergency help

References

Related Conditions

Finger Tendon Rupture

Flexor Tendon Injuries

Triceps Tendon Tear

Bowler's Thumb

Book a session