summary Jersey Finger is a traumatic flexor tendon injury caused by an avulsion injury of the FDP from the insertion at the base of the distal phalanx. Diagnosis is made clinically with a finger that lies in slight extension at the DIP relative to other fingers in the resting position. Radiographs may show a bony avulsion if present. Treatment is usually direct tendon repair or open reduction and internal fixation depending on the presence and size of a bony avulsion. Epidemiology Anatomic location ring finger involved in 75% of cases during grip ring fingertip is 5 mm more prominent than other digits in ~90% of patients therefore ring finger exposed to greater average force than other fingers during pull-away Etiology Pathophysiology FDP muscle belly in maximal contraction during forceful DIP extension Anatomy Muscles Flexor Digitorum Profundus (ulnar n. and AIN n.) Flexor zones zone I extends from insertion of FDS distally Classification Leddy and Packer classification (based on level of tendon retraction and presence of fracture) Type Description Treatment Type I FDP tendon retracted to palm. Leads to disruption of the vascular supply Prompt surgical treatment within 7 to 10 days Type II FDP retracts to level of PIP joint Attempt to repair within several weeks for optimal outcome Type III Large avulsion fracture limits retraction to the level of the DIP joint Attempt to repair within several weeks for optimal outcome Type IV Osseous fragment and simultaneous avulsion of the tendon from the fracture fragment ("Double avulsion” with subsequent retraction of the tendon usually into palm) If tendon separated from fracture fragment, first fix fracture via ORIF then reattach tendon as for Type I/II injuries Type V Ruptured tendon with bone avulsion with bony comminution of the remaining distal phalanx (Va, extraarticular; Vb, intra-articular) Presentation Physical exam pain and tenderness over volar distal finger finger lies in slight extension relative to other fingers in resting position no active flexion of DIP may be able to palpate flexor tendon retracted proximally along flexor sheath Imaging Radiograhs may see avulsion fragment Treatment Operative direct tendon repair or tendon reinsertion with dorsal button indications acute injury (< 3 weeks) technique advancement of > 1 cm carries risk of a DIP flexion contracture or quadrigia postoperative rehab should include either early patient assisted passive ROM (Duran) or dynamic splint-assisted passive ROM (Kleinert) ORIF fracture fragment indications types III and IV (for type IV then repair as for Type I/II injuries) techniques with K-wire, mini frag screw or pull out wire examine for symmetric cascade once fixation completed two stage flexor tendon grafting indications chronic injury (> 3 months) in patient with full PROM of the DIP joint DIP arthrodesis indicated as salvage procedure in chronic injury (> 3 months) with chronic stiffness Complications Quadrigia advancement of > 1 cm carries risk of a DIP flexion contracture or quadrigia
QUESTIONS 1 of 4 1 2 3 4 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07SM.93) An 18-year-old rugby player has had pain in his ring finger after missing a tackle 1 week ago. Examination reveals tenderness in the distal palm, and he is unable to actively flex the distal interphalangeal (DIP) joint. Radiographs are normal. What is the most appropriate management? QID: 8755 Type & Select Correct Answer 1 Acute tendon repair 82% (886/1084) 2 DIP joint extension splinting for 6 weeks 8% (83/1084) 3 DIP and proximal interphalangeal joint extension splinting for 6 weeks 4% (41/1084) 4 Buddy taping to the middle finger for 2 weeks 3% (35/1084) 5 Early range-of-motion exercises and return to play as pain permits 3% (36/1084) L 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ06.52) A 22-year-old rugby player presents with a mass at the base of his ring finger 5 months after sustaining an injury while making a tackle. Physical examination demonstrates a lack of active distal interphalangeal joint flexion, but full passive range of motion of all joints of the ring finger. Radiographs are normal. What is the most appropriate treatment to regain normal finger function? QID: 163 Type & Select Correct Answer 1 excision of the palmar mass and 2-stage tendon grafting 69% (2488/3625) 2 excision of the palmar mass and single stage tendon grafting 15% (526/3625) 3 excision of the palmar mass and distal interphalangeal joint fusion 5% (189/3625) 4 active silicone rod implantation 3% (108/3625) 5 flexor digitorum profundis repair 8% (294/3625) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ05.246) A 16-year-old football player sustains an injury to his ring finger after making a tackle. A clinical photograph is shown in Figure A. What is the most likely diagnosis? QID: 1132 FIGURES: A Type & Select Correct Answer 1 Flexor digitorum superficialis avulsion 4% (235/5571) 2 Central slip rupture 2% (121/5571) 3 Sagittal band rupture 1% (66/5571) 4 Distal extensor tendon rupture 2% (90/5571) 5 Flexor digitorum profundus avulsion 90% (5034/5571) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic
All Videos (2) Podcasts (1) Login to View Community Videos Login to View Community Videos Cleveland Combined Hand Fellowship Lecture Series 2020-2021 Jersey Finger: Case of the Week - Joanne Wang, MD Joanne H. Wang Hand - Jersey Finger C 8/5/2021 166 views 2.0 (1) Login to View Community Videos Login to View Community Videos Diagnositc Ultrasound of the Hand - Introduction - Dr. Scott Pollock General - Jersey Finger C 2/9/2013 610 views 3.7 (3) Hand⎪Jersey Finger Hand - Jersey Finger Listen Now 10:5 min 8/17/2020 327 plays 5.0 (1)