Jersey Finger

Other Names

• FDP Avulsion Injury
• Rugby finger
• Sweater finger

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Background

• Zone 1 flexor tendon injury
• Avulsion of Flexor Digitorum Profundus tendom from base of distal phalanx

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Pathophysiology

• Typically, forced extension of actively flexed finger
• In sports, may represent a finger caught in a jersey
• 4th digit most commonly affected
• Torn tendon can retract as far as palm

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Risk Factors

• Sports requiring grasping (?)

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Differential Diagnosis

• Fractures
  • Phalanx Fractures (Hand)
  • Metacarpal Fractures
    • Boxer's Fracture
    • Rolando Fracture
    • Bennett Fracture
• Dislocations
  • Metacarpophalangeal Joint Dislocation
  • Proximal Interphalangeal Joint Dislocation
  • Distal Interphalangeal Joint Dislocation
  • Carpometacarpal Joint Dislocation
• Tendinopathies
  • Extensor Tendon Injuries (Hand)
  • Central Slip Extensor Tendon Injury
  • Flexor Tendon Injuries (Hand)
  • Boutonniere Deformity
  • Swan Neck Deformity
  • Jersey Finger
  • Mallet Finger
  • Trigger Finger
  • De Quervains Tenosynovitis
  • Volar Plate Avulsion Injury
  • Sagittal Band Injury
• Ligament Injuries
  • Gamekeepers Thumb (UCL)
  • Radial Collateral Ligament of the Thumb Injury (RCL)
• Neuropathies
  • Wartenbergs Syndrome
  • Carpal Tunnel Syndrome
  • Guyon Canal Syndrome
• Arthropathies
  • Carpometacarpal Arthritis
  • Finger Arthritis
  • Rheumatoid Arthritis
• Nail Bed Injuries
  • Nail Bed Lacerations
  • Nail Bed Avulsions
  • Subungual Hematoma
  • Paronychia
  • Felon
• Pediatric Considerations
  • Proximal Phalanx Avulsion Fracture (Thumb)
  • Middle and Distal Phalanx Avulsion Fracture
• Other
  • Dupuytrens Contracture

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Clinical Features

• General: Physical Examination Hand
• Finger typically swollen distally, with bruising over distal phalanx and DIPJ
• Resting position might be relative extension compared to other fingers
• Patient will be tender in similar distribution
• Cardinal finding is inability to flex DIPJ while flexion at PIPJ and MCP maintained

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Evaluation

• Standard Radiographs Hand
  • Standard evaluation, may be normal
  • Avulsion fracture is triangular avulsion fragment at flexor aspect of distal phalanx and DIPJ
• US
  • Evaluate integrity of tendon and degree of retraction
• MRI
  • Evaluate integrity of tendon and degree of retraction

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Classification

Leddy and Packer Classification

• Type I
  • FDP tendon retracted to palm and subsequent disruption of the vascular supply
  • Surgery: 7 to 10 days
• Type II
  • FDP retracts to level of PIPJ
  • Surgery: within several weeks
• Type III
  • Large avulsion fracture limits retraction to the level of the DIP joint
  • Surgery: within several weeks
• 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)
  • Surgery: ORIF fracture fragment
• Type V
  • Ruptured tendon with bone avulsion with bony comminution of the remaining distal phalanx

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Management

Acute

• Pain management
• Place in splint
• If partial tear, conservative management may be considered

Operative

• Typically a surgical problem due to high morbidity of loss in finger flexion
  • Direct tendon repair
  • Tendon reinsertion with dorsal button
  • ORIF fracture fragment
  • Staged tendon grafting
  • DIP Arthrodesis

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Return to Play

• Dictated by surgeon and ability to perform sport-specific tasks

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Complications

• Quadrigia or DIP flexion contracture

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See Also

• Hand and Wrist Anatomy (Main)
• Finger Pain (Main)
• Hand Pain (Main)

External

• Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/

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