Updated: 5/22/2021

Jersey Finger

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  • 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

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Questions (4)
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(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
1

Acute tendon repair

80%

(725/902)

2

DIP joint extension splinting for 6 weeks

8%

(74/902)

3

DIP and proximal interphalangeal joint extension splinting for 6 weeks

4%

(39/902)

4

Buddy taping to the middle finger for 2 weeks

3%

(30/902)

5

Early range-of-motion exercises and return to play as pain permits

3%

(31/902)

L 2 E

Select Answer to see Preferred Response

(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
1

excision of the palmar mass and 2-stage tendon grafting

69%

(2375/3448)

2

excision of the palmar mass and single stage tendon grafting

14%

(493/3448)

3

excision of the palmar mass and distal interphalangeal joint fusion

5%

(180/3448)

4

active silicone rod implantation

3%

(102/3448)

5

flexor digitorum profundis repair

8%

(280/3448)

L 2 D

Select Answer to see Preferred Response

(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:
1

Flexor digitorum superficialis avulsion

4%

(230/5358)

2

Central slip rupture

2%

(116/5358)

3

Sagittal band rupture

1%

(64/5358)

4

Distal extensor tendon rupture

2%

(89/5358)

5

Flexor digitorum profundus avulsion

90%

(4835/5358)

L 1 D

Select Answer to see Preferred Response

Evidence (2)
VIDEOS & PODCASTS (3)
EXPERT COMMENTS (14)
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