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Jersey Finger

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Other Names

  • FDP Avulsion Injury
  • Rugby finger
  • Sweater finger

Background


Pathophysiology

  • Typically, forced extension of actively flexed finger
  • In sports, may represent a finger caught in a jersey
  • 4th digit most commonly affected[1]
  • Torn tendon can retract as far as palm

Risk Factors

  • Sports requiring grasping (?)

Differential Diagnosis


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

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

Classification

Leddy and Packer Classification

  • Type I [2]
    • 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

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

Return to Play

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

Complications

  • Quadrigia or DIP flexion contracture

See Also


References


  1. Manske PR, Lesker PA. Avulsion of the ring finger flexor digitorum profundus tendon: an experimental study. Hand. 1979;10 (1): 52-5. Pubmed citation
  2. Leddy, Joseph P., and John W. Packer. "Avulsion of the profundus tendon insertion in athletes." The Journal of hand surgery 2.1 (1977): 66-69.
Created by:
John Kiel on 18 June 2019 23:16:35
Authors:
Last edited:
28 October 2020 13:58:06
Categories:
Tendinopathies | Trauma | Finger | Hand | Upper Extremity | Acute