While the injured DIP joint is splinted, physiotherapy focuses on:

• Patient Education:
  • Thorough explanation of the injury, the purpose of splinting, and the critical importance of strict adherence to the splinting protocol.
  • Instructions on how to clean the finger and splint without allowing the DIP joint to bend.
  • Warning signs to look out for (e.g., skin irritation, worsening pain, signs of infection).
• Maintaining Mobility of Uninvolved Joints:
  • The splint allows the middle (PIP) and knuckle (MCP) joints to move. Physiotherapists will guide exercises for these joints to prevent stiffness in the rest of the hand. This includes:
    • Full finger flexion (making a fist): Bending the middle and knuckle joints fully.
    • Finger extension: Straightening the middle and knuckle joints.
    • Thumb movements: Ensuring full range of motion in the thumb.
  • These exercises are performed with the mallet splint securely in place on the injured finger.
• Managing Swelling and Pain:
  • Elevation: Keeping the hand elevated (above heart level) can help reduce swelling.
  • Cryotherapy (Ice): Applying ice packs (wrapped in a cloth) to the affected area can help with pain and swelling, used cautiously to avoid skin damage, especially around the splint.
  • Gentle Soft Tissue Mobilization: Around the unaffected parts of the hand and forearm to improve circulation and reduce generalized stiffness.

Physiotherapy After Splint Removal (Rehabilitation Phase):

Once the splint is removed (typically after 6-8 weeks), the DIP joint will likely be stiff and may have some residual “droop.” The goal of physiotherapy now is to gradually restore full range of motion, strength, and function to the finger. This phase is crucial and requires careful progression to avoid re-injury.

• Gentle Passive Range of Motion (PROM):
  • Initially, the therapist (or the patient under guidance) will gently bend the DIP joint to begin restoring flexion. This is done with extreme caution to avoid overstretching the healing tendon.
  • Isolated DIP-joint flexion/extension: Specific exercises to move only the end joint, often using the other hand to assist.
• Active Range of Motion (AROM) and Tendon Gliding:
  • As tolerance allows, active exercises are introduced to encourage the extensor tendon to glide and the DIP joint to actively straighten.
  • Finger Extension Exercises: Gentle attempts to actively straighten the DIP joint, focusing on engaging the extensor tendon.
  • Tendon Glides: Exercises that involve specific finger positions to promote the smooth gliding of tendons within their sheaths (e.g., hook fist, full fist).
• Strengthening Exercises:
  • Once sufficient range of motion is achieved and the tendon has demonstrated good healing, strengthening exercises are gradually introduced.
  • Resisted Finger Extension: Using therapy putty or resistance bands to strengthen the extensor muscles.
  • Grip Strengthening: Squeezing a soft ball or therapeutic putty to improve overall hand strength.
  • Fine Motor Dexterity: Exercises like picking up small objects (coins, pins) to improve coordination and precision.
• Functional Activities:
  • Gradually integrating the injured finger into daily activities, ensuring proper mechanics and avoiding positions that put excessive stress on the healing tendon.
• Scar Management (if surgical or laceration):
  • If surgery was performed or there was a laceration, scar massage and desensitization techniques may be used to prevent scar adhesion and improve skin mobility.
• Night Splinting:
  • Often, the mallet splint is continued for nighttime wear for several additional weeks (e.g., 2-4 weeks) after daytime splint removal to provide continued support during sleep.