What type of splint should be used for a partial tendon tear of the third (middle) finger?

Splinting for Partial Tendon Tear of the Middle Finger

For a partial tendon tear of the middle finger, use a dorsal blocking splint that immobilizes the affected joint while allowing motion of adjacent joints, or buddy taping to the adjacent finger for stable injuries—the specific splint type depends on which tendon is injured and at what joint level.

Determining the Injury Type

The first critical step is identifying which tendon is partially torn and at which joint:

• Extensor tendon injury at the DIP joint (mallet finger): Requires strict DIP joint immobilization in extension or slight hyperextension for 8 weeks uninterrupted 1
• Flexor tendon injury: Typically requires surgical referral as partial tears often progress 2
• Volar plate injury at the PIP joint: Requires dorsal blocking splint 3

Obtain radiographs immediately to rule out avulsion fractures, which change management entirely—bony mallet injuries with fragments ≥1/3 of articular surface or any volar subluxation require surgical referral 1, 4

Splinting Approach by Injury Location

For DIP Joint Injuries (Mallet Finger Pattern)

• Use a rigid DIP extension splint (stack splint or custom-molded) that immobilizes only the DIP joint in full extension or 5-10 degrees of hyperextension 1, 2
• The PIP and MCP joints must remain free to move—begin active PIP and MCP motion exercises immediately to prevent stiffness 1
• Duration: 8 weeks of continuous wear without removal—even brief removal restarts the healing timeline 1
• Critical pitfall: Removing the splint even once during the 8-week period compromises healing and requires restarting the immobilization period 1

For PIP Joint Injuries (Volar Plate)

• Use a dorsal blocking splint in neutral position (0 degrees) rather than the traditional 30 degrees of flexion 3
• This approach prevents both hyperextension injury and flexion contractures 3
• Splinting at neutral position results in fewer flexion deformities and faster return to function compared to 30-degree flexion positioning 3
• Duration: Typically 3-4 weeks with progressive weaning 3

For Stable Fractures or Sprains

• Buddy taping to the adjacent finger is appropriate for stable injuries without significant displacement 2, 5
• This allows protected motion while preventing excessive stress 2
• Duration: 3-4 weeks for most stable injuries 2

What to Avoid

Do not use resting hand splints that immobilize multiple joints unnecessarily—these increase muscle deconditioning, promote compensatory movement patterns, and can worsen symptoms through increased attention to the injury 6

Avoid removable splints for injuries requiring strict immobilization (like mallet finger), as patient compliance issues lead to treatment failure 1

Do not apply heat—use ice therapy for 10-20 minutes with a thin towel barrier for initial pain and swelling control 1

Immediate Referral Indications

Activate emergency services if the finger appears blue, purple, or pale, indicating vascular compromise 4

Refer urgently for:

• Open injuries 4
• Avulsion fractures ≥1/3 articular surface 1
• Any volar subluxation on lateral radiograph 1
• Flexor tendon injuries (usually require surgery) 2
• Inability to maintain reduction 4

Pain Management During Immobilization

• Topical NSAIDs preferred over oral for safety 1
• Ice therapy provides effective short-term relief during acute phase 1
• Re-evaluate immediately if unremitting pain develops during immobilization, as this may indicate complications 1