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It's not an easy splint to make on yourself ... it really helps to have 2 free hands! But yes, you are right, it really helps to take a little extra time, and to pay attention to the small details. Can make a huge difference to the patient's comfort. I hope your thumb makes a brilliant recovery 😊

I would definitely lean towards splinting rather than surgery in the circumstances you describe. Surgical outcomes are just too unpredictable, unless there is joint subluxation or incongruity. Give it a good 6 weeks of immobilisation/protection in a splint, and here's to a brilliant outcome for you! Cheers

@@iandowley8059 thanks for your quick answer. 🙏 Another thing i was wondering is how they could say „the tendon is supposed to be okay“ - because you cant see that on xray. Is it because i could stretch the fingertip a bit even though it was hanging? Thank you for your expertise.

@@KAdamy-qj5md When the force/tension is placed through the tendon and bone at the moment of injury, in most cases only one of the two will rupture (the 'weakest link in the chain', so to speak) and the other will be intact. This is not always the case, especially in high impact injuries (eg motor vehicle accidents), but it is probably a fair assumption in most mallet finger injuries

@@iandowley8059 thank you so much 🙏

@@iandowley8059 i have a custom made Splint with 10-15 degree of hyperextension in DIP due to the bony fragment the occupational Therapist said. Do you think hyperextension in this case is fine?

A good outcome from splinting gets less and less likely the longer you delay. A year after the injury, there is probably less than 50% chance of the tendon actually healing - but this estimate is based on very limited experience. Most patients I have had who have been in that situation have elected not to even try - they are usually getting quite used to living with the bent fingertip, and don't want to go through the hassle of 8 weeks of splinting with no guarantee of a good outcome. However, I have definitely had an occasional success story - even one patient who was 3 years post mallet injury, wore his splint full time (very diligent) for 8 weeks then part time for 2 more weeks, and made a full recovery. So, in summary, more likely to be unsuccessful, but no reason not to give it a go! All the best 😊

To the best of my knowledge, the research on using PRP injections for TFCC injuries is very limited and with inconclusive results. In other words, there is no reason for anyone to say "you should do it" (because on average it makes no difference), but also no reason for me to say "you should not do it" - because on average it makes no difference, but there is a chance that you will respond well to it and get some benefit. I hope this is true for you, and that you recover very well!

Hi there - thanks for getting in touch. From your description, it sounds as though there was no recent re-injury episode - you injured your wrist 2.5 years ago, but recently it just started hurting again without a new injury episode of note. This is really good news. Your wrist was able to settle down and become pain free after your initial, more severe injury; so it is very likely to be able to settle down again now after a minor flare-up. Treat your wrist with a little extra care to help any inflammation to settle down - back off on your workouts by 10-20%, be more diligent with using the wrist bands or supports that helped you 2 years ago. If needed, be more cautious with certain movements (eg supination - palm-up twisting - can be aggravating for many TFCC injuries). But don't stop exercising! Keep your wrist and hand strong, and as the pain eases again, build back up to your normal loading in a steady, gradual way. It might take a few weeks, but the likely outcome is very good. All the best!

Hi - thanks for reaching out. There are a couple of possibilities here: 1. Could be a TFCC injury but for some reason the MRI isn't showing it. This isn't very likely, but certainly possible - no scan is 100% accurate or reliable. Or, 2. Could be some other cause of ulnar sided wrist pain which is mimicking a TFCC injury. This seems more likely to me, as there are many possible causes of pain in that area, including some that won't show up on any scan (like irritation of the ulnar nerve; or I've even had patients with wrist pain that has been from nerve root irritation in their neck!). It can be a very long and frustrating process trying to get a clear diagnosis and then to make sure you are on the right treatment pathway... and even when you get everything right, the human body can still be very slow and gradual in the way it improves and recovers. Don't give up, though - you can do this! I really hope you get the very best of advice and support throughout your recovery process.

Hello, and thanks for getting in touch. Unfortunately, I'm not sure how to advise you. There are so many different types of fractures, all with different treatment pathways. I really hope you are getting the right medical advice for your specific injury, and that your thumb recovers very quickly

@@iandowley8059 thank you sir

So sorry to hear of your wrist injury. Avascular necrosis of the scaphoid is a very difficult thing to treat, and unfortunately there are no guaranteed pathways to a good outcome. IF you have access to a good hand surgeon, they are likely to recommend a vascularised bone graft - this is a relatively new surgical option which involves grafting in a piece of healthy bone with its own blood vessel to improve the chances of healing. The other surgical options are more directed towards 'salvage' - helping to reduce the pain of an arthritic or unstable wrist, usually through some form of partial or complete wrist fusion. These would not usually be considered so early - more likely to be necessary many years after the initial injury. I hope you can get the right advice and the right care for your complex injury. All the best!

Thanks! Glad you found it helpful 😊

Hi, it really depends on where you are, and how the health care system works in your country. Ideally, you can find a hand therapist somewhere close to you who can custom-make a thermoplastic splint for you. If not, you may need to come up with a makeshift alternative. I have seen patients do this using bits of reticulation pipe, pop-sticks from icecreams, small strips of aluminium, or many other things. The principle of treatment is the same - keep the end joint straight FULL TIME for 6-8 weeks. Good luck!!

Hi there! Slightly tricky question to answer, as it depends what you mean by the 'sheath'. If you have a typical Dupuytren's operation (called a fasciectomy), the diseased and thickened connective tissue is cut out, hopefully restoring the ability of your thumb to lift out straight again. There are definitely risks though - in the short term, risk of scar tissue forming aggressively and pulling the thumb back down, or in the longer term a Dupuytren's contracture can recur in the same location 😢. It can be a very tricky problem for some people. I really hope you and your thumb get a brilliant outcome 👍

@iandowley8059 oh okay ..I understand... it's trigger thumb for me... the sheath that holds the pulleys together In the thumb/ finger

​@50shadesofgibbs49 Gotcha - a trigger thumb release is successful- and stays that way - in a very high percentage of cases. Not 100% though. In 25+ years of hand therapy I can recall 2 patients who had the released pulley basically grow back again due to the aggressive formation of scar tissue. Very unlikely 😊

Really sorry to hear about your injury 😢. Unfortunately, your doc has it right. A scaphoid fracture that has been untreated for 5 months has a VERY low chance of healing without surgery. If it was my wrist, I would be lining up for the operation ASAP. I trust you get the very best of care both during and after the surgery. Here's to a fantastic recovery!

@@iandowley8059 thank you for your reply! Means a lot. Curious to know if there have been cases that it doesn't heal ?

@@rohanzoink4769 Sadly yes, there is never a guarantee of good healing, no matter which treatment pathway you choose. It is a matter of trying to maximise your odds of a good outcome. In this case it is a pretty simple choice - a very good chance of good healing with surgery (but not guaranteed), or a very good chance of no healing without surgery. The other main variable which has a big negative impact on bone healing is smoking - if you are a smoker, quitting even temporarily until a few weeks after your surgery will significantly reduce the risk of the bone not healing. 😊

Hmm, interesting question. The most likely scenario is that at the time of the initial tendon injury, there was also an injury to one or both of the collateral ligaments at the end joint. If so, this is very likely to improve steadily as the ligaments continue to heal, as long as you can avoid re-injury. A similar feeling of instability could occur just from having some swelling present inside the joint - again, something which should subside and improve gradually. Permanent instability seems very unlikely. I would certainly advise a little extra caution with that finger over the next 2-4 weeks. Maybe keep using the splint part time, or at least be extra cautious in risky environments. All the best with your recovery!

@@iandowley8059 thank you so much! I wouldn’t be surprised if the cal lateral ligaments were injured- my joint got dislocated during the accident. It popped right back when I extended my fingers but it was very painful and swelled excessively the following couple days. Well I sure appreciate your prompt reply! The information is very helpful.

You are welcome!

So glad you found it helpful 😊. I hope you make a wonderful recovery from your injury

In many cases, definitely possible. Every case is different, so I can't say for sure about your particular situation, but in my experience 80-90% of TFCC injuries make an excellent recovery without needing surgery. I hope your wrist goes very well!

​@@iandowley8059 @karstendees8076 I am 23 year old bodybuilder ,before 7 months i got this injury ,my doctor suggested me to wear brace,but i don't properly weared it,i used that hand for so many works,but after 2 months,i visited the doctor he told me it's cured,and the pain continued for another 4 months and now I visited the doctor he told me to take a MRI ,and after that he scolded me for not wearing the brace properly for 45 days,and I have a click sound while twisting the wrist in left side its my left wrist ,and there was an inflammation and the forearm bone won't attached with my wrist,there is an inflammation there,and doc suggested me for surgery,but I asked for alternative so he told me to wear the brace and immobilize the hand for several days,now I am wearing the brace properly with proper rest,is it possible to cure this with the Braces itself?please tell me if I give a proper rest will this work ?

​@@iandowley8059r u there?

Sorry to hear about your long term struggles with wrist pain ☹. I really can't comment on how to proceed in the UK health system, sorry. Here in Australia there are basically 2 options - 1. get your GP to refer you to a public hand clinic, sit on a waiting list for 6-12 months, and then see an orthopaedic surgeon who might send you for an MRI, or refer you for hand therapy, or maybe offer surgery; or 2. if you have private health insurance, you can go and see a private hand therapist (like me) who can assess your wrist, try some splinting or exercise treatments if they seem appropriate, send you for an MRI if needed, or arrange for you to see a surgeon if needed. How it works in the UK ... ??? not sure! All the best trying to find your way through the maze 😊👍

They can be SERIOUSLY annoying problems! Sorry to hear you are having so much trouble, Joseph. Here's to an excellent (eventual) recovery for you.

Hi David, I mostly use 2.0mm microperforated Orfit Colors - it is marginally too thick for a small finger, so if you have access to a range of plastics you might want to use something which comes in a 1.6mm thickness for smaller hands. Having said that, the extra thickness is rarely a problem, and I like the versatility of the 2mm plastic - I can use it for all my finger and wrist splints, and with a bit of reinforcing can even make it work for an elbow splint. Cuts down on the number of different plastics I need to keep in stock ☺ Cheers - happy splinting!

Freaked me out a bit at the time, too! 😂🙃😳

70-80 degrees C. ~170 Fahrenheit according to one of their other videos

Hello - thanks for getting in touch. Sounds like you are doing all the right things for the early stage of a TFCC sprain, using RICE and immobilisation. With a little care, it is likely to settle down very well in the coming weeks, just like any other sprain or soft tissue injury. Each week that goes by, you should need less immobilisation and you can return to doing upper limb exercises in the gym gradually. Taping/strapping your wrist can really help reduce the risk of flare-ups at the gym. Either use this technique for simple circumferential compression: ua-cam.com/video/ufkemzfp53Y/v-deo.htmlsi=om3ZQyOaEF_t5Zpf or try this one if you are getting pain mostly with the palm-up rolling of the forearm: ua-cam.com/video/HHOP-kzdipM/v-deo.htmlsi=HPfrqBwPtWOInD6S All the best for your recovery!

@@iandowley8059 Many thanks for your active help. Currently, my symptoms are better, the dull pain has almost disappeared, but I still cannot perform exercises that put heavy pressure on my wrists like push-ups. Maybe I should still take a few weeks off like you said. Hopefully my condition is not serious enough to require surgery.

​@@h_ngm4032That sounds really encouraging! Here's hoping for ongoing steady improvement, and eventually a full return to your usual gym workouts. Best wishes

So sorry to hear about your injury. Unfortunately, after 7 years there is very little chance of improvement without surgery. And surgery would certainly be considered risky, as it may make your finger worse rather than better. A persistent mallet finger can be very annoying, but I hope it is something you can learn to live with and work around, so that you can do whatever you want with your life! All the best

@@iandowley8059 "And surgery would definitely be considered risky..." you have said. I went to the doctor a few weeks ago and he said the same thing. He said I should get used to it. Can you give me more details? Why is the surgery risky? -Loss of function that may occur in the finger -Bad image -Pains that will not go away like the ones above?

Hi Ben, Absolutely worth treating it in a splint. The odds of a successful outcome are a bit less after 2 months without treatment, but I have sometimes had success even 6 months after the injury. Here's to a brilliant result for you! All the best

Hello! Thanks for watching the video - I hope it was helpful for you. These injuries can vary greatly, from very mild to very severe. It is hard to know what risk you have without seeing your thumb 🙃. If possible, I would definitely recommend you see a good doctor or physiotherapist who can examine your thumb, maybe refer for an X-ray, and then provide you with some appropriate treatment. That might be some protection in a splint or brace; it may mean seeing a surgeon if the injury is more severe. Here's hoping you have a very minor injury which recovers rapidly!

@@iandowley8059 and i can do my dalily activities with that finger when moving finger into front side( ✊but the thump is inside all finger) i fell pain at that time only

I can do my daliy activities with that finger when moving finger into front side (✊but the thumpnis inside all finger )i fell pain at that time only please replay 🥲

​@@iandowley8059And can i use rhe cotton cloth as a bandage heare👀

I graduated years back and injured it they told me it was nothing and taped it up, till this day it hurts and swell it hard or if I try to catch a football thrown hard

Hi Raymond; here in Australia the thermoplastic sheets can be purchased from medical supply companies - but this might be quite different if you are in some other part of the world. The plastic I use most often is made by Orfit, so another option would be to see if Orfit have a distributor anywhere near you? I buy it in 60cm x 45cm sheets, which is a bit of overkill for a single mallet finger splint! Maybe someone could send you a sample piece? 10cm x 6cm would be enough for almost any finger. I use Orfit Colors 2.0mm microperforated. All the best getting a splint made for your finger!

👍😊

Hi there - glad you enjoyed the video! There are lots of thermoplastic options on the market, usually available through medical supply companies. The one I use in the video is an Orfit product, called Orfit Colors 2.0mm microperforated. Making a splint on your own hand is certainly possible - I have done it myself - but I would not recommend it for a novice. It takes a while to get used to working with the plastic, and having 2 hands free is a great help! Hopefully you can find someone to help you out. All the best 😊

Hi Renato, In theory it might be possible for a mallet finger injury to heal years after the initial injury, but the odds of a good outcome become smaller and smaller over time. I have had good results using splints 6-9 months after the injury, but would be hesitant to recommend it if years have passed. Most people with long-term mallet deformities get quite used to it, and it is probably not worth losing 8 weeks of finger function for a very tiny chance of success. I am not going to comment on your toe injury, sorry - not my area of expertise! Thanks for getting in touch 😊

Hello! Glad you found the vid helpful 🙂. Your finger has had a rather unusual pathway of on/off splinting, but even though it has been a bit disrupted, 12 weeks of total splinting should be enough for the tendon to be really well healed. A 10 degree lag at this stage is just an indication that the tendon has healed in a slightly longer position than it was in before the injury. Further splinting allow this healed/scarred tendon to tighten up a little shorter, but I would look at the risk/benefit analysis and suggest that you are taking more risk (of stiffness and disuse) for a slight chance of gaining a few degrees, which will have zero functional benefit. As long as the lag stays at 10-15 deg, it is usually a non-issue in the longer term. I would encourage you to stop splinting, get the finger back into functional activities again, and only splint/protect it during high risk sporting activities. Hope this helps! Here's to a fantastic result for you and your finger...

Thanks Doc those are really helpful points! In your experience, does the hyperextended splint have a better prognosis for eventual lag than the standard splints? I'm a guitar player and although my right ring is fortunately one of my least important fingers, I still really hope to regain the ability to play with it. Glad there are people out there who put in the work to help people with nagging injuries like these, thanks!@@iandowley8059

Very likely, as long as you are very diligent at keeping the splint on full time so the end joint never has a chance to bend. There is some increase in risk from delayed splinting, but this should be minimal after 18 days. I have successfully treated patients several months after the initial injury. I hope your finger makes a complete recovery!

Hi there - sorry to hear of your injury. While it is preferable to see a doctor or physio and get an X-ray, you can most often get these to heal just by protecting them adequately. This means keeping the end knuckle of the finger in a fully extended (straight) position FULL TIME for 8 weeks. Never allow it to bend for this whole time. This is easiest to achieve with a splint that has been fitted to your finger, but I have had patients who have made their own splints just with a piece of plastic or wood plus some tape. All the best getting it sorted out

@@iandowley8059 I did a little research online and i think i have the tendon mallet because mine isn't painful

Update ?

You are very welcome!

Hi there, Rem - while you could make a thumb spica from any thickness of plastic, I quite like a 2mm thickness (eg Orfit Colors 2mm microperforated, or equivalent) as it is thick enough to give decent support while not being completely rigid, which helps with comfort. 1.6mm would be fine for many hands, but may not be supportive enough on a large or muscular hand. In terms of dimensions, I can make a thumb spica for an average sized hand from a square of thermoplastic 18x18cm, meaning I would expect to get 6 thumb spicas from a 45x60cm sheet with a few bits left over to make finger splints out of. Happy splinting! - Ian

Hi Rudy, thanks for sharing your story. It is definitely a bit unusual for it to develop in the thumbs, but then it is also unusual to have it start in your 20s, so I guess you are just a bit special! Glad to hear it has been so slow to progress - hopefully it stays that way. Constant thumb pain would be really weird as a symptom of Dupuytren's disease, so if you can track down a decent hand therapist near you it might be worth seeing if there is something else causing it. All the best, Rudy 😊

Sounds like you've done a really good job of settling your TFCC sprain down. The process of building it back up again can be really hard to find your way through, because the wrist moves in so many different planes of motion and subtle twists or angle changes can completely change the irritability of the tissues. Please persevere! I'm sure you will get there

So I should start building up its strength now. Thank you so much. I appreciate your help. Either way I will pay a visit to the doctor just in case. You helped me very much though calming my mind.

Hi there, thanks for getting in touch. Your son sounds quite remarkable, and anyone with that level of commitment and determination should never be written off! He has clearly taken a lot of impact through his wrists during some very formative years, but this is not all bad - yes, it sounds like there is some tearing of the TFCCs, but there will also be lots of adaptive changes making his wrists much tougher than the average. I haven't seen his scans, so I can't say for sure that he won't need surgery, but in most cases when TFCC tears become painful, the tear isn't the problem - the pain is the problem. With correct load management, the pain can often be brought under control - hopefully eliminated - and the tear remains as a 'scar'. I have had heaps of patients over the years who have made full recoveries to high levels of sporting activity after very painful TFCC injuries. This process may involve a significant de-loading of the wrists for a period, sometimes splinting is needed and sometimes cortisone really helps too (but not just as a temporary fix so he can keep training!). Once the wrist pain has settled, he can re-load in a careful and graduated manner. I hope you can find a good physio to help guide you! Here's to a brilliant recovery, and a full return to boxing for your son 😊

Thank you so much for replying, it's greatly appreciated and offers some hope for my son and I can't wait to show him your message as I know it will lift his spirits. I've subscribed to your channel and hope it grows. You have a fantastic channel and so informative and again I greatly appreciate your reply. I hope you and your family have a fantastic Christmas my friend and wish you nothing but the best for 2024.

Hi Sinthu, glad you found it helpful! When I made the video I was hoping it would be useful for people all round the world. May I ask where you are?

Glad to hear it! Hope you recover really well