I don’t usually write about personal issues, but since I do like to document the unusual things that happen to me (and since Facebook isn’t really good for that sort of thing in the long term), I thought I would make an exception and write a post documenting the stupidest, most ridiculous injury I’ve had in my thirty-odd years. Those of you who came only for the nature stories and photos may want to skip this post; however, I hope it will help others who find themselves suffering from the same stupid injury.
I wish I could claim that this injury was received while birdwatching – perhaps the result of an over-eager chickadee snatching a sunflower seed from my hand – in order to tie it in with the subject of this blog. The closest it comes to being bird-related is that I was getting ready to go to an OFNC Birds Committee meeting after dinner one evening when it occurred. At. 6:20 pm on February 24th, I was putting on my boots and tucking my pants inside when my finger jammed and I felt a large “pop” – rather like when you crack your knuckles, but magnified. It didn’t hurt, but when I pulled my hand out of boot I noticed that the tip of the middle finger on my left hand was bent down at a 45-degree angle. When I tried to straighten it, the finger was completely unresponsive. I could push it back up into a straight position with my other hand, but when I let go it immediately drooped again.
It didn’t seem to be an emergency, so I drove over to a walk-in clinic hoping it was just dislocated and that it could be popped back into place. The doctor took one look at it and told me to go to the hospital ER to get it X-rayed. By this time I was beginning to feel a small ache deep in the joint.
I arrived at about 7:30. I’d never been to the ER before, and was impressed by how quickly I was triaged, signed in, and sent to the X-ray waiting area. That’s when the wait began. About an hour and a half later a friendly X-ray technician brought me in, and told me he’d had the exact thing happen to him on his pinky finger. He said that the injury had resulted in the tendon becoming separated from the bone and that he needed surgery to fix it. I said, “So it’s not going to be as simple to fix as if it were just dislocated.” He said yes.
I wasn’t surprised when the ER doctor showed me the X-ray about an hour later and told me that I had indeed torn the extensor tendon (the one that runs along the top of the finger and allows the finger to extend straight out) from the bone, an injury known as “mallet finger”. Mallet finger is a relatively common injury, particularly in sports when a basketball or baseball forcefully strikes the end of an extended finger. Other names for this injury include “Baseball Finger” and “Drop Finger”. I’ve since learned that people can even get this injury simply by tucking in the sheets while making the bed! Sometimes a piece of bone may tear off with the tendon, but fortunately the X-rays showed that this wasn’t the case. I just needed to have a splint put on and then I could go home.
It took another hour for someone to put the splint on. By that time it was 11:00 and I was feeling my exhaustion more than the ache in my finger. I was told that a hand surgeon would call me in about a week to set up a follow-up appointment, at which time he would examine me to see whether the tendon had healed on its own, or whether surgery would be required to reattach it. I thought this meant my appointment would be in about a week, but after doing some internet research the following day I learned that the splint needed to be worn continuously for 6-8 weeks! Under no circumstances could I take it off and let the finger droop, as the healing tendon may tear again if that happens.
I was given what is known as a Stack (or Stax) splint. I wasn’t given any care instructions, and didn’t ask since I thought I would only be wearing it for a week. As it is plastic, with an opening for the fingertip and tiny holes on both sides, I thought it would be okay to let it get wet while in the shower, washing my hands, etc. It turns out that letting it get wet is NOT a good idea, as then it gets damp and sticky inside, particularly where the skin presses against the inside of the splint. Also, by the third day, it was beginning to smell like feet that had been encased in sneakers for too long. I wasn’t sure how to clean the splint and wasn’t about to risk taking it off, so I eventually came up with my own method of cleaning it: I cut up a J-cloth into tiny strips, dipped the strips in some rubbing alcohol, then fed the strips between the splint and my finger with the help of a nail file or letter opener, trying to bring the alcohol into as much contact with my finger and the splint as much as possible. I did this every two or three days, and while it didn’t entirely help with the stickiness, it helped the smell! I dealt with the stickiness by cutting up a stiff paper towel into a thin strip and inserting it between the finger and splint as well, leaving it there day and night and changing it daily. After learning that lesson I obtained some disposable gloves to wear while in the shower and washing dishes.
I was sick of wearing the splint by the second day, so having to leave it on for an entire 8 weeks seemed unbearable. I felt miserable the entire first week since even the most ordinary tasks had become a challenge for me, and everything took longer than usual. Although I tried to be careful, I ended up hitting my finger against the occasional door frame more than once while reaching for the knob because my finger tends to stick straight out. I also pulled the splint off less than 24 hours of wearing it. I was using that hand to slide a folder into a filing cabinet, and when I pulled my hand out the splint was no longer on it. I am fortunate I did this on Day 1 of the splint rather than Day 21, for if splint comes off and the finger droops, the clock turns back all the way back to Day 1 again.
Other minor inconveniences included difficulty pulling things out of a pocket or a purse with the splinted hand, cutting food, and picking up items from the floor. One day on the bus I dropped a glove on the floor, and as I was sitting beside the window with a seat in front of me and someone beside me, I couldn’t pick it up with my injured hand and had to wait for my seatmate to get up so I could reach across with my good hand.
Since it happened in February, I also had to contend with finding proper winter gloves that fit over the splint. My regular gloves are too tight, so I bought a pair of ski mitts which were really thick and really warm (the best I could do as it was so late in the season). Unfortunately I am not a “mitt” person and then had difficulty carrying things and opening doors while wearing it. Then I found my fiancé’s open-fingered gloves, which were a godsend. As they were too large for me, I only used the left-hand glove for my injured hand, which allowed me to pull it on and off without worrying about the splint coming off with it. The exposed fingertips meant I could actually open doors and hold things, such as my keys, and use my iPhone.
Typing is the worst part of wearing the splint, as it’s my “D” key finger that has the splint. My typing has gotten better over the past 7 weeks, as my index finger has compensated for my useless middle finger, but any time I have a several letters from the “D” and “F” columns all together – i.e. “freedom”, “delete” – my fingers tangle up together and I have to stop and type with only one finger.
Today marks the 51st straight day of wearing the splint…or 7 weeks and 2 days. The joint still gets that deep, painful ache every now and then, but for the past 10 days or so I also have felt a light, maddening discomfort in that finger similar to when one sits in the same position for a very long time, such as on a long car or plane ride. This is accompanied by the urge to stretch and flex my fingers. Hopefully this means it has healed and is ready to bend and flex properly. I see the hand surgeon for my follow-up appointment in six days, so at that time the splint will come off to see whether my finger can extend straight out on its own…or whether it will droop again. If it still droops, I might have to wear the splint for another 3 or 4 weeks.
From everything I’ve read on-line, even if it has healed, I will still need to wear the splint for a couple more weeks at night and during any activities that may put the finger at risk. If fully healed, I can expect the finger to be stiff, and will likely need to do exercises to regain strength and range of motion. In many cases, the finger may have a slight, permanent droop, called an “extensor lag”, though apparently this does not usually affect the function of the finger.
Though I am now used to the splint and to having limited function in my left hand, I am both eagerly and nervously awaiting next week’s appointment and seeing the results of the 8 weeks’ treatment. I will report back later to let you all know the outcome!
Update Five Years Later….
January 20, 2019
Wow, I can’t believe this post has become my most popular post ever…even more so than my controversial posts about owl baiting! So many people have commented here with their own stories of this ridiculously devastating injury, showing that there is a real lack of good, centralized information or concrete solutions on this subject. I suspect that’s because it seems insignificant to non-sufferers when it is anything but – losing the mobility of a single finger affects the function of the whole hand, which in turn affects basic functions such as getting dressed, taking a shower, and opening doors. Those of us who depend on our hands for earning a living – such as typists, musicians, and sports players – may not be able to fulfill our job requirements the two months our fingers are in a splint, plus the additional four months it takes to regain the mobility lost in the split second it took to rupture the tendon. I thank you all for coming here and sharing your difficulties, your solutions to common problems, and supporting each other as we learn to cope with life in a splint!
I am posting this update here as the updates I made in the comments are now lost in the sea of 300+ other comments. Also, people have been asking about the exercises I did as the link no longer works. So here is a quick timeline about what happened after the splint came off:
April – May 2014
I was so excited to see the hand surgeon and get my splint off, but once it did I was crushed when I saw my finger. It was a bit swollen and lumpy, the skin was peeling, my fingertip drooped a bit, and it was very sensitive. The doctor bent it forcefully a couple of times and said it was healed. He also told me that this is a six-month injury, meaning it would take six months to return to normal, and wearing the splint takes only two of the months. He advised me to baby it for two weeks and only wear the splint at night. When I asked if the finger needed protection he just said something like, “It’s got to get used to the world again sometime”. I felt so depressed about the state of my finger then that I couldn’t write about the experience for a couple of months.
I did nothing with the finger for two weeks (though I still wore the splint at night). It seemed pretty much useless anyway, sticking straight out all the time. There was a lump on top of the DIP and my fingertip constantly felt tingly and super-sensitive where it had touched the splint, like it was falling asleep. It hurt whenever I accidentally bent it or bashed it, such as forgetting about it when reaching for a door handle.
I only kept the splint on for at night for two weeks – I would have kept using it at night if I had felt it needed it, but by then it didn’t hurt as much when I accidentally bashed it or bent it.
After two weeks I started the exercises found here. I’m not sure if I needed to give it time for the swelling to go down first, but once I started the exercises it looked a lot better.
The exercises should be done 2-3 times per day, for 5 minutes. The most important exercises are called blocking exercises. The fingers of the other hand are used to block the other finger joint, and the last joint is then bent for a count of 10, and then straightened for a count of 10. The bending exercises regain flexion lost from being in a splint, and the straightening exercises are to strengthen the tendon that was injured.
May and June 2014
I started the exercises around May 7th with maybe a 10° lag, but it improved significantly after about three or four weeks of exercises. It felt weird bending the finger the first couple of days, producing a sort of discomfort that wasn’t quite pain, but enough to make me question whether I was doing it right. I just kept doing the exercises until that feeling went away.
I didn’t go to physio as I was able to regain some flexibility on my own doing the blocking exercises described here. I also had to regain mobility in the other joint, the PIP closest to the hand, as the surgical tape had prevented that joint from moving fully and I didn’t realize I needed to spend some effort trying to bend it (TIP: make sure you can bend your PIP while the DIP is splinted, and do it frequently!). To regain some flexibility I would bend the joint as far as I could, and hold it there for a full 60-120 seconds. At first I used my other hand to bend it; then I would repeat the exercise by actively try to bend it and hold it on its own. I did this with each joint separately, blocking the middle joint with my other hand to bend the fingertip.
It took about 5 weeks after starting the exercises before I could bend my finger to about 80°. The tendon was still stiff at that point, but I just kept doing the blocking exercises a couple of times a day (on the bus going to work, going home, while watching TV etc.) until it improved. It felt really strange and uncomfortable at first, but it started feeling much better as the weeks progressed.
By June the tendon had healed, but was still a bit stiff; I could type with it and almost make a fist, though there was a gap big enough to slide a highlighter through since my fingertip didn’t come anywhere close to touching the base of the finger. I couldn’t quite form a 90° angle with the last joint; it was maybe about 80°. I still had a 5° droop at the tip and a slight bulge on top of the DIP joint – this 5° extensor lag seems to be common to everyone who gets this injury, no matter if they don’t ever let the fingertip droop while wearing the splint. The super-sensitive feeling at the finger-tip was just about gone.
Almost six months since the injury, the finger was still not 100%. The lag seemed reduced, but I still couldn’t make a complete fist, and it still hurt at times. Still, this did not affect the function of it; I had the complete use of that finger. The joint closest to my hand was the one that hurt.
My finger had no lag now, though I still couldn’t curl that finger into a complete fist. The gap gradually diminished, though. The residual pain on top of both knuckles was almost gone – however the tendon felt sore when I pushed down on it.
My finger looked completely normal 11 months after the injury, and worked just fine. However, it still hurt along the top between both joints when I tried to make a complete fist; and I still couldn’t get the end of the finger to touch the base when I tried to make a fist – there was still a small gap. This did not limit the function of the finger in any way, or prevent me from doing everyday things. While the finger was not quite 100%, it was not enough for me to be concerned or need to see a doctor.
By May my hand finally felt 100%. By the end of the year it was like it never happened. I think I was one of the lucky ones, although when my doctor said it was a “six-month injury” he should have said a “twelve-month injury”, since it did take that long to get back to normal, and I would have managed my expectations accordingly. Then again, most of my problems later were due to my PIP joint becoming stiff, and not taking care to flex it while my DIP joint was in the splint.