Jersey Finger

Other Names

• FDP Avulsion Injury
• Rugby finger
• Sweater finger

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Background

Illustration of typical jersey finger mechanism of injury

Illustration of the flexor muscles. Note the FDP extends all the way to the distal phalanx

• This page refers to "Jersey Finger", an avulsion of Flexor Digitorum Profundus tendom from base of distal phalanx

History

• Needs to be updated

Epidemiology

• Needs to be updated

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Introduction

General

• Avulsion of the flexor digitorum profundus tendon off of the volar aspect of the distal phalanx
• Occurs due to forced hyperextension of the DIPJ while the finger is actively flexed
• Can be purely tendinous with/without bony avulsion

Etiology

• Considered a zone 1 flexor tendon injury
• Etiology is 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

Anatomy of the Flexor Digitorum Profundus

• Responsible for flexion of the metacarpophalangeal and interphalangeal joints of digits 2-5
• Inserts on the palmer aspects of the distal phalanges of digits 2-5

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Risk Factors

• Sports requiring grasping
  • Football
  • Rugby

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Differential Diagnosis

Differential Diagnosis Finger And Hand Pain

• Fractures
  • Phalanx Fractures of the Hand
  • Metacarpal Fractures
    • Boxers Fracture
    • Rolando Fracture
    • Bennett Fracture
• Dislocations
  • Metacarpophalangeal Joint Dislocation
  • Interphalangeal Joint Dislocation (Proximal and Distal)
  • Carpometacarpal Joint Dislocation
• Tendinopathies
  • Extensor Tendon Injuries of the Hand
  • Central Slip Extensor Tendon Injury
  • Flexor Tendon Injuries of the Hand
  • Boutonniere Deformity
  • Swan Neck Deformity
  • Jersey Finger
  • Mallet Finger
  • Trigger Finger
  • De Quervains Tenosynovitis
  • Volar Plate Avulsion Injury
  • Sagittal Band Injury
  • Mannerfelt Lesion (FPL Rupture)
• 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
  • Intrinsic Plus

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Clinical Features

Classic inability to make a fist with the ring finger suggesting jersey finger injury

Demonstration of the jersey finger test in the supinated position

History

• Athlete will typically be able to describe the injury
• They will report pain and swelling of the affected finger

Physical Exam: 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
• Inability to make a full fist

Special Tests

• Jersey Finger Test: isolate the DIPJ to evaluate if flexion is present

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Evaluation

Jersey finger of the 3rd and 4thh digit. Red arrows point to the avulsed fracture fragments at the volar side of the bases of the middle/long and ring finger distal phalanges

Longitudinal US images of the left little finger demonstrate avulsion of the bony insertion (P3) of the flexor digitorum profundus (FDP). The tendon fibers appear intact

Radiographs

• Standard Radiographs Hand
  • Standard evaluation, may be normal
  • Avulsion fractures can be seen as far back as the proximal interphalangeal joint

Ultrasound

• Evaluate integrity of tendon and degree of retraction

MRI

• Evaluate integrity of tendon and degree of retraction
• Can help with surgical planning

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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

Dorsal extension block splint

Acute Management

• Pain management
• Place in extension block splint
• Referral to hand surgeon

Nonoperative Management

• Indications
  • Generally considered surgical
  • If patient is unable/unwilling to comply with post-operative therapy
  • Potentially, chronic injuries (considered greater than 6 weeks)

Operative

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

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Rehab and Return to Play

Rehab

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

Return to Play

• Athletes can expect 8-12 weeks of loss of play following surgical treatment
• Return to play guidelines:
  • Functional active range of motion
  • Minimal to no pain
  • Grip strength greater than 80% relative to the uninjured side

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Prognosis and Complications

Prognosis

• Early surgical intervention tends to have better outcomes

Complications

• Quadrigia or DIP flexion contracture

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See Also

Internal

• 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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