Mallet finger injury

Ergonomics and Posture for Classical Guitarists, Aches and Pains, Injuries, etc...
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Bertran
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Re: Mallet finger injury

Post by Bertran » Sat Jun 22, 2013 5:40 pm

JLindstad,

I am not a doctor so I can't give you an expert explanation. But as much as I read I can tell you something. At my third post inside this topic you can find my words that there is a two kind of mallet finger injury. First one is when tendon tear off from bone and the second one is when tendon take a little piece of bone with itself.

If you have a first variant (my case), when tendon tear off the bone there resist a scars on the bone. New fiber of tendon try to catch over that scars (during first months) and that is a reason why is important to not let finger down on that phase of healing. So, I think that nothing bad was going on with bone if you treat your injury seriously.

If you have a second variant and tendon take a part of bone it is a little worse. I read once that in that case it is not good to stabilize your finger with splint at superextended position (it means that your first phalange is raised up). If you do that you leave a gap and bone is healing in that gap and fulfill the empty space but part of bone that is broken now lose its natural place. So, stabilization of your finger must be straight!

This is how I can help you but I hope that your doctor (or someone else on this forum) know much more than me.

Bertran

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Bertran
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Re: Mallet finger injury

Post by Bertran » Sat Jun 22, 2013 9:48 pm

After 2 weeks of therapy

At this post I want to offer to you some of my experience and knowledge about what you can expect after you take splint off and after 2 weeks of therapy. Also I will try to list some of useful exercises for finger(s).

Splint off

First let's go back to stage when I take splint off. At the early stage I was very concern about my 2-month splinting. Alluminium splint cover almost all of my finger (as you can see at the pictures) and when I take off my splint I have a serious problem with my PIP (second joint). It was very stiff and I didn't expect that because mallet finger was at DIP (first joint). My tendon is shorten itself and when I try to touch my palm I can't do that. Also, my finger is triggered (something jumped inside, probably tendon) and I feel a little pain at finger and at the palm (bellow the third joint).

I think that this is result of full finger stabilization and that is suspiciously. I suggest to all that you talk with your doctor about stabilization like that. Now (after I read something) and look at my experience I think that full stabilization is necessary about 2 or 3 weeks and after that you can make stabilization for only DIP joint. For that you can use stax splint or maybe Oval-8.

With alluminium splint your finger will be very stiff and your skin will be very sensitive. Of course that maybe be happen with other splints but little less. Also, your DIP joint (and maybe PIP joint) will be sensitive if you squeeze it with other hand and finger will be swollen at both case (I mean, whatever splint you use).

One big advice: when you take your splint off - try to play a guitar!! Of course, you can't do nothing. When my injury was happen I was at the middle of the Delcamp's D07. When I take my splint off I can't play nothing, even "Frere Jacques" :) It is very frustrating indeed. I only can lightly touch E-bass but I can't bend my DIP joint and play anything on the A-bass. Chords are mission impossible. Like I said - it is very frustrating but using guitar day-by-day you can follow your progress on very precise way ;)

Therapy and exercises

You must listen your doctor and do the therapy that he/she suggest to you. I use laser, I drink B-vitamin etc. Also, some of the suggestions are here:
  • - whatever exercise you practice don't push to hard. At the very beginning every exercise will be very painful. It is normal! General attitude is when you stretching/bending your finger you must feel the pain and little over that - then stop.
    - try to stretch your finger in all directions, not just bend your mallet finger. It is important that you give a power and flexibility to your tendon and your muscle at every way.
    - it is important to avoid warm water whenever you can. Do everything at cold water, specially after exercises (or use ice). Also, not at the begging (but after some day of therapy) you can put your finger under the cold water before exercises. The purpose is to stiff your finger and tendon and force it over the exercises!
There is a lot of exercises for your finger but I will also offer to you some of them that I have found very useful. Try to withstand every effort about 5 seconds. Repeat every exercise 10 times.

1. Put your hand with palm on the desk and try to lift up all of your fingers at once.
2. Put your hand with palm on the desk (or better to glass surface) and try to scrabble a surface and gather your finger (to make a fist :) ).
3. Touch with tip of the 1st finger tip of your thumb and slide with your 1st finger from the tip to the root of the thumb. Do it with all your fingers.
4. Be an eagle - make a strong claw!
5. Try to make a fist. This is most painful. Help yourself with free fingers.
6. It is incredibly how we lose a power in our finger during wearing a splint. The best way to check this is to use clothespin! When you put it in your finger you will know what to do with it. Great accessories!

After 2 weeks of therapy

Everything is individual. So, I can't (and nobody) can't promise to you what you can be able to do and what can't. But I will give to you some comparisons. After 2 weeks of therapy:
  • - My finger is still swollen and in the hospital they told me that it will be for a few months.
    - I can touch my palm with finger
    - I can gather a fingers to make a fist but my 2th finger is still out of full bending. I can bend it about 45 degree at the DIP.
    - Even I can't make a fist, now I can play at single 6,5,4 and 3th string. On second with big effort, on first I can't.
    - The skin at the tip of my 2th finger is very sensitive. If I just press the string with finger I feel a little pain. But if I try to slide with 2th finger over the string (example: Villa-Lobos Prelude No.1 - first measure) - it is very painful.
    - Only the chords that include 2th finger at E-bass and A-bass is maybe possible (depending of power).
So, as you can see, after 2 weeks of therapy I do some progress. It is so far away of playing CG but is far away of frustrating.

My big advice is: practice whenever you can, practice all of the day!

Bertran

Kevin Clark
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Re: Mallet finger injury

Post by Kevin Clark » Mon Jun 24, 2013 8:00 pm

It's does'nt really effect the bones unless the tendon pulls the some of the bone away when it snaps. It more to do with the tendon that snaps off of the bone. Hope this helps.

It's been three weeks now and this is driving me mad. I keep picking my guitar up and try to play something but I know I really can't play anything at all apart from sliding a bottle neck up and down! What a stupid injury!

Kevin Clark
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Re: Mallet finger injury

Post by Kevin Clark » Mon Jul 29, 2013 8:01 pm

It's been 8 weeks now and I got my guitar out last night for the first time. My finger's so stiff so I'm just just running up a chromatic scale to start with. I'm back!!!!
Regards Kev

JohnPierce

Re: Mallet finger injury

Post by JohnPierce » Mon Jul 29, 2013 9:23 pm

Johannes Lindstad wrote:What excatly happens to the bones inside the finger when you get a mallet finger? Can someone please explain?
Damage to the extensor tendon, with or without bone fracture. You can get very clear and complete explanations, with pictures and everything, by Googling for "mallet finger".

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Bertran
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Re: Mallet finger injury

Post by Bertran » Tue Sep 10, 2013 9:57 pm

After 3 months therapy

OK, let we see what is happen after 3 months of hard-working exercises. Of course, once again I must repeat that everything is individual and depending of age. I continue to read and find some new information – it seems to me that younger person have shorter recovery process. But anyway, I also think that my posts are useful for everybody, and that my advices and example of exercises can be acceptable for all.

Also, practicing to play guitar is very good because you can see where you are in your recovery process and how far are you from the level that you have been before injury. I decide to start from the beginning and use one (book) Guitar Method. Day by day, I do finger exercises and I play a guitar, from very simple to easy pieces. I think that it is also a good way to eliminate frustrations and recognize what is demanding doing stretches and (mallet) finger bending.

When I play guitar I always think about reason why is some chord or stretch is hard to me. So, maybe this sounds overmuch to someone but deserving that I start to inventing my own exercises. Also, don't link yourself to only one therapist. I have talk with others; they give me new advices and new exercises.

Some words about water and ice. In the beginning put ice on your finger and do exercises after it become a cold. Let finger be more stiff and it will be more demanding for your tendon. After exercises put ice again. Doing exercises with your hand in the water is great (specially if you have opportunity to put it into the sea (or salt-water)) but be careful: with hand in your water everything seems to be little easier (with no pain) so don't push to hard. This is the reason why it is good to do exercises without water at the beginning – you must know your limits! Override it into the water but don't to much.

Compared with my previous post I must say that I have made progress and eliminate some problems:
- My finger is still swollen but less than before
- I can make a full fist
- My skin is not sensitive; it is normal now
- After some months I can play on every string, I can do a lot of chords

Yes, it seems to be much better than before months or two but I am still not at the same level where I have been before injury. Why?

When I try to quick bend a finger it is still tighten and my tendon is still jump in my palm. I am still very concern about it. For most of the easier pieces (perhaps gradiing 2 or 3) this is not a problem. But when I try to bend my finger extremely I still can't do it. I you look at the picture it is easier to me to explain: with all my fingers I can touch the top of the palm with finger-tips but I still can't do that with my mallet finger (look at the picture and you will see the ''hole'').

At the first glance it seems to someone that there is no problem because we never put our fingers in this position while playing and we don't need to bend finger to maximum. After all, between palm and fingers (if you look at the picture) there is a neck of the guitar!

Unfortunately, this is not a true. We need to bend a finger to it's maximum. I have found piece where my 3th finger is on the F# at 1th string and after that is interval: my 2th (mallet finger) must replace 3th finger and at the same time 3th finger must jump to G at E-bass. If you can try to do that you can see that your 2th finger (imagine that it is injury finger) must be bend to maximum and that turn is quick movement – exactly what I explain that it is still my problem after 3 months.

So, I will continue to play and continue to do exercises. I do new progress, but my recovery process is not finish yet. Once, I read that tendon need about 1 year to recovery. My wish is to confirm that to you. I am half year far from that...

Bertran
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JohnPierce

Re: Mallet finger injury

Post by JohnPierce » Wed Sep 11, 2013 12:22 am

Bertran, thank you for continuing to update us on your progress. While I don't personally have - and hope to never have - such an injury, it is good to see what can be accomplished with careful, dedicated effort in handling something that could otherwise end one's guitar playing. You have my best wishes for your continued improvement.

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Bertran
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Re: Mallet finger injury

Post by Bertran » Wed Sep 11, 2013 9:42 pm

jwp,

Yep, when injury happen I was very sad and know that I must be very patient and devoted. Even now I don't know how much I can bring back.
But, at the same time I want to know as much I can but there are no enough mallet finger story at Internet, specially not from classical guitarist. This is my ''pilgrimage'' and I want to share it with others. I am sure that it will be very interesting to read this topic to everyone that had bad luck like me.
And hope that my posts will encourage them and find it useful.

Thank you for a best wishes, good luck to you! :merci:
Bertran

PeterLC

Re: Mallet finger injury

Post by PeterLC » Thu Nov 07, 2013 10:05 pm

Wow, hope you keep making progress!

I've had the same thing, on the RH - thank GOODNESS not on the LH. I'm now 14 months onwards, and can play HVL's 1st Etude at about 90% the speed I managed before. That used to be quite quick BTW, been playing it for 31 years so it should be. :) It was my middle finger; and although it hasn't come straight totally, AND I cannot fold it inwards as far as I used to (that's why I'm "happy" it wasn't the LH), it doesn't bother me anymore while playing. It took me 5 months before I started playing classical again, so my recovery was a bit slower. I could keep playing electric; pick-playing only (as I still do on the Les Paul), that was important to keep my spirit up. I held (and hold) the pick between index and thumb only, the bandaged middle-finger didn't get in the way.

My mallet-finger was caused by making up my bed, BTW. One of the most common causes... :?

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Bertran
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Re: Mallet finger injury

Post by Bertran » Fri Nov 08, 2013 11:16 pm

PeterLC,

Yes, I continue with progress but I still feel a little pain when I squeeze my DIP joint but less than before. Also, problems with full bending remains.

Thank you for your post, it is very interesting to me.
I always ask myself what is worse: to have mallet finger at the LH or RH. After reading your mail I conclude that is better to avoid this injury at all. :)

Bertran

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lagartija
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Re: Mallet finger injury

Post by lagartija » Sat Dec 21, 2013 12:55 pm

Bertran wrote:jwp,

Yep, when injury happen I was very sad and know that I must be very patient and devoted. Even now I don't know how much I can bring back.
But, at the same time I want to know as much I can but there are no enough mallet finger story at Internet, specially not from classical guitarist. This is my ''pilgrimage'' and I want to share it with others. I am sure that it will be very interesting to read this topic to everyone that had bad luck like me.
And hope that my posts will encourage them and find it useful.

Thank you for a best wishes, good luck to you! :merci:
Bertran
Bertran, many years ago I broke the radius of my left arm at the wrist. My age was 42. I had a cast on for 8 weeks (not unusual for a woman of my age because bone deposition is slower). When they took the cast off, I could not move my wrist. The doctor left the room to attend to an emergency and returned after five minutes. During the time he was gone, I carefully massaged my wrist then started to bend it slowly. When he saw that I could move it a few degrees, he said, "You'll be fine...you can do your own physical therapy." In my case, he was right. He gave me the exercises to do and like you, I did them religiously. I had a piece of graph paper and measured the progress every day. The doctor told me that I would probably get only 80% of the previous joint mobility, but he was wrong. I was motivated to bend my wrist because I practiced a Japanese martial art of sword drawing (Iaido) and I need to bend my wrist more to use proper technique. Over a period of 6 years, I not only regained all my former range but I increased it. If you keep at it and ask your body to respond, you may be surprised at the recuperative powers of the body. You have the ability to do it, I think, because you were able to move beyond the initial pain and discomfort and you have showed patience and not reinjured yourself. Sometimes, recovery is limited by what people expect. When I broke my back at T6, I was put back together surgically with hardware. After I was let out of my brace, I again fought my way back to a full recovery and can do everything that I could do before, and since I was very flexible, I worked hard to regain that. It took many months of careful but dedicated exercise to strengthen muscles that had atrophied while immobilized for 7 months and stretch tendons.
You will get there, Bertran. Don't despair. It does seem like it takes forever, but be patient and keep at it. :bravo:
You will play again and regain what you had before....mostly because you have the motivation to do so. Don't accept the limitation; keep reaching for the note and you will get there slowly but surely. Just as your hand probably stretched out when you first started to play, you will have to be patient with your body. But this time around, your brain knows what it wants your hand to do and that will make it faster.
:discussion:
When the sun shines, bask.
__/^^^^^o>
Classical Guitar forever!

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Bertran
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Re: Mallet finger injury

Post by Bertran » Sun Dec 22, 2013 10:17 pm

Lagartija,

Great post from you. And you better than me explain all of my thinking and approach. I understand everything that you said: we must trust and listen doctors but beyond our limitations there is an only our unexplored area of our body that only we investigate and believe at ours possibility.

Like I said before, I am close to full recovery but when injury was happen I don't know what to expect with broken finger. Also, I almost avoid problem that I describe (with last picture) with extreme bending of my (mallet) finger.

Now, after 8 months I am at the same position at the day before injury. Only thing that I must do before start to play is to stretch and warm up my finger.

Thank you for your support, I am very appreciative. :discussion:

Bertran

Nick57

Re: Mallet finger injury

Post by Nick57 » Sat Jan 18, 2014 7:04 pm

Great post!
I would add just a couple of points of emphasis to your quoted post.
- The doctor and therapist REALLY need to know what they are doing. I didn't break any bones but pretty much burst the fingertip most of the way across the last knuckle and down the left side almost to the fingertip. After getting patched up they sent me up to the Physical Therapy folks where I met my first doc. He wasn't the best choice. A couple of weeks later I met with one of the real doctors, my therapist making a point to get us together. Kudos to that young fellow! The second doctor had a vestige of mallet finger on the same finger *and* also played piano. It took a LOT longer to recover than it would have if he had been in from the first visit. We lost those first weeks of healing so were not at all sure if we could improve it. At that time the fingertip hung at a 35-deg angle.

- To the second bit of advise, 'Keep it straight...', in my case it wasn't until the second doctor was on the case that this little tidbit came up. For mine, it was 'keep it hyper-extended and DO NOT LIFT ANYTHING WITH THE LEFT ARM', that was the (second) Doc's orders. (He was rather 'firm' on that point, the onery cuss. Bless him for that!)
His point, when you pick up anything, that action includes the flexor muscles clear to your hands. Try it (ON AN UNDAMAGED arm!). Just pick up something draped over your forearm. Hold it. Feel the 'pulling tension' in the palm side of your hand? Look at your hand. See all the big muscles on the palm side of your hand, fingers, the power up your forearm? Compare those to the muscles on the back side of you hand and wrist. You have a LOT of power built into closing a fist and pretty much just enough strength and connectivity on the backside to open that fist.
Bad news there for healing ligaments.
Keep it straight or extended, per instructions, full-time and ALL the time. No lifting.
No. That is the answer to, "But, but, how about ..."

Ten years or so 'after', that finger is a little different. The middle knuckle is a little stiff from the ~12 weeks of hyper extension that was required of the first knuckle. I still have just a little droop of 5-deg or so on the first knuckle. After the healing of the bursting bit that finger is pretty sensitive to touch and temp from just behind the fingertip pad back to the knuckle but mostly so on the pinkie side of the finger. It isn't 'as originally equipped' by any means but it works.

So, should any of you suffer similar misfortunes, don't mess about with it. Get GOOD professional help on your side promplty... and do YOUR part to get it better.

Nick

Thanks for the post and grats on the recovery Bertran.
- It is very useful if you can find a hand specialist who can see and treat a hundred of injury like this. Sorry to all doctors - I don't want to be a clever than they are - but I hear that even orthopeadist, physiatrist, general surgery doctors know a lot,... but they can not treat you with all of the care like hand specialist will.

- To prove previous statement there is one good new advice. Finger must be stabilize in straight or even extra-extended position (tendon injury only). My new doctor say if I can find stax splint that I can replace his improvised splint on my own. But at the very beginning it is very important that you don't let phalange to fall down, not even for a one second of time! This is because a new fibers of tendon is at the phase of creation and they are try to catch the bone. If you allow your phalange to drop down you can destroy a new fibers and you are going back to the beginning of the recovery process. My doctor don't tell me that, just to change a splint. But I am sure that hand specialist will not forget to give me a warning like this.

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Bertran
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Re: Mallet finger injury

Post by Bertran » Thu Jan 30, 2014 9:14 pm

Nick57,

Thank you for your story. Thank you for your support and good wish, too.

Regards, Bertran

Pede
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Re: Mallet finger injury

Post by Pede » Tue Apr 08, 2014 5:33 pm

Thanks for this topic. Unfortunately I have a "mallet finger" now, my left hand pinky.
I had a bikeaccident for 4 weeks ago.
Lets hope it will recover completely. I decided to continue practising right hand the coming weeks.
Is it still an issue for your playing today Bertran? I hope not.
Gert Petersen 2000, Spr-BRW, Felipe Conde FP17 Negro, Santos Hernandez 1932 S-BRW, Asturias 10 string s-IRW, Ramirez 1a Especial 2014, Bernabe M5 S, Bert Kwakkel Merula 1982, Baroque guitar by Martin de Witte

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