Mallet finger (extensor tendon avulsion at the DIP joint)

What it is

A thin tendon runs down the back of the finger and attaches to the last bone to lift the fingertip straight. In a mallet injury that attachment tears, either the tendon pulling off the bone or a fleck of bone pulling off with it. The tip then hangs down and you cannot lift it under your own power, although someone else can lift it for you.

How volleyball causes it

The ball hits the very tip of a straight finger end-on and forces the last joint to bend while the tendon is actively holding it straight. In volleyball that is most often a block where one fingertip is slightly ahead of the others and meets the ball first, or a one-handed dig or reach where the ball catches the end of a finger. It also happens tucking a fingertip into the floor on a dive or a failed pancake, and catching a finger on the net or an opponent's jersey while withdrawing the hands from the block. The dangerous feature is how little it hurts. Players tape it, keep playing the tournament, and the tendon heals long or not at all, leaving a permanent droop.

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What it feels like

• The last joint of the finger droops and will not lift when you try, though you can push it straight with the other hand
• Swelling and a dull ache over the back of the fingertip rather than sharp pain
• A bruise or blood under the nail
• The tip catches on pockets and gloves and will not sit flat on a table
• Often you can still grip, hit and pass, which is why it gets ignored

Stop and get it seen if

• You cannot actively lift the fingertip at all. That is the injury itself and it needs assessing within days, not weeks, because how it is splinted early determines the final result.
• Blood collecting under the nail, or the nail lifting out of its fold. That combination points to a fracture through the joint and a nailbed injury, and it changes the treatment.
• The middle knuckle starts hyperextending as the tip droops, giving the finger a wavy swan neck shape. That means the whole extensor mechanism has shifted and is a more complex problem.
• An open cut over the back of the last joint, which can mean the tendon or the joint itself is exposed and carries an infection risk.
• Skin under the splint that becomes white, soggy, ulcerated or painful. Splint-related skin breakdown needs a clinician to refit it, not a longer stretch of tolerating it.

What recovery usually looks like

Stages, not a schedule. Everyone moves through these at their own pace, and the ranges are wide because real recoveries are.

1. 1. Held straight, continuously

   the treating clinician sets the duration, and it is measured in weeks rather than days

   The fingertip is held in full extension by a splint a clinician has fitted and reviews, so the torn attachment can knit at the right length.

   • A clinician has fitted the splint and decides when it comes off. That call is theirs, not the app’s and not yours.
   • The joint bending during this period is the thing the splint exists to prevent, which is why the clinician sets the rules for changing it.
   • Pain is often minimal throughout. That is normal and is not a sign the injury is minor.
   • The middle knuckle is left free and keeps moving normally.

2. 2. Coming out of the splint

   2 to 6 weeks after splinting ends

   Reintroduce bending at the last joint gradually while checking the tip is still holding straight

   • The tip stays straight, or close to straight, when the splint is removed for a check
   • Bending returns slowly and the joint feels stiff and thickened
   • A small residual droop of a few degrees may appear and is a common outcome

Ready to play again when

• The fingertip lifts actively to level, or within a small and stable lag, without a splint
• Cleared by the clinician who fitted or supervised the splint
• A hard-driven ball can be taken on the hand without the tip dropping again afterwards
• Full fist and normal grip strength for everyday tasks
• No pain or swelling over the back of the last joint the morning after a session

Keeping it from coming back

This is ordinary training, so unlike the rest of this page it does tell you what to do.

• Rubber band finger extension. Band around the fingertips, spread and lift the fingers against it. Stronger finger extensors help the fingers stay straight and aligned at the instant of impact.
• Practise block hand shape with all fingertips in one plane. Wall presses and partner ball presses with fingers spread and stiff, so no single fingertip is left leading into the ball.
• Train the pancake and the sprawl to land on the flat back of the hand, not on fingertips. Rehearse it on a mat until the flat-hand contact is the default.
• Finger extensor isometric holds against a table edge, lifting each fingertip individually and holding, to build control of the last joint specifically.
• Keep nails short. A long nail on a finger that takes a ball end-on is what turns a tendon injury into a nailbed injury as well.