Friday, February 29, 2008

Jersey Finger

Avulsion of the flexor digitorum profundus (FDP) tendon from its insertion on the base of the distal phalanx is known by the eponym "jersey finger". This injury of often a result from pulling on a jersey during an (American) football game. This injury was first described by VonZander in 1891, in a drummer.

Photograph of a flexor digitorum profundus tendon injury. Note that the injured finger is held in forced extension:



In the case of a FDP avulsion, MRI can be performed to see where the end of the torn, retracted tendon is.

Coronal images of the palm depict a flaccid FDP tendon in the palm, with surrounding edema:



Sagittal image of the ring finger reveals the
gap (red arrows) between the torn ends of the FDP and also depicts the intact flexor digitorum superficialis tendon (green arrows):



The first detailed classification of FDP avulsion was given by Leddy and Packer in 1977, and was elaborated upon by Buscemi and Page in 1987:

Type I- characterized by retraction of the tendon into the palm. There is often a painful nodule in the palm, where the retracted tendon lies. The vascular supply to tendon is disrupted, so it should be repaired as soon as possible, no later than 7-10 days after injury.

Type II- tendon retracts to the PIP joint. Further retraction is prevented by connections through the vincula longa; preserved vascularity through the vincula prevents necrosis and tendon contracture. Occasionally, a small bone fleck is avulsed, and this can be seen at the level of the PIP joint.

Type III- avulsion of a large bone fragment from the base of the distal phalanx. Tendon will not retract past the DIP joint, due to the A4 pulley. Must be treated with open reduction, because of possible associated avulsion of profundus tendon from the osseous fragment (Type IV lesion)

Type IV- type III lesions associated with a simultaneous avulsion of the FDP tendon from the fracture fragment.

Early diagnosis and treatment of these injuries is crucial. FDP avulsion is often incorrectly labeled a "sprain" or "jammed finger", treated with splinting, and the opportunity for timely treatment is lost. The cardinal sign of a FDP rupture is the complete loss of flexion at the DIP joint.

24 comments:

Anonymous said...

I damaged my fingerin this type of injury 8 weeks ago, my gp sent me for an xray, infact she never looked at my injury.No fracture,she never saw me once.I tried myself to splint my finger and excersise it. No obvious improvement after 6 weeks my pip joint flexed, not able to straighten, I contacted another gp and finally 8 weeks down the line, stiff painful finger with a swelling on the inner aspect of the pip joint, I want to know the best way to excersise. Dip joint is also very stiff and difficult to move. Should I splint &/or flex? exercise how?

Anonymous said...

if it's a torn tendon, like the one in the picture, then you should have it checked by an orthopedic. you might have to get a tendoscopy. but if it's just a torn ligament, t hen a splint would do, make sure the finger is kept straight.

charlie said...

i got surgery around july 1 because i got a jersey finger from playing football and its my ring finger when will i be playing football again

Ty said...

same thing happened to me you can tape it to the two closest fingers and chance it which is what I did, but the smart thing to do would be to sit out the season. P.S. while you may gain full mobility the reattachment point will always be a little weaker than it normally would be so for the rest of your football career it should be taped so it doesn't tear again because repeat surgery to the tendon is much less successful.

Karen said...

My son tore the tendon in his ring finger in a football game, and four weeks later, on October 10, he had surgery to repair it. I had no idea it was something serious, and plan on writing a letter to the coaches so that they are aware of this injury in case it happens to someone else.

My son was fortunate that the tendon had only shrunk as far as the bottom third of his finger and the surgeon was able to reattach it without spacers or grafts. It is very tight though. He's starting physical therapy today, and should be able to play football next year. Unfortunately he can't play any more this year.

Karen said...

My son tore the tendon in his ring finger in a football game, and four weeks later, on October 10, he had surgery to repair it. I had no idea it was something serious, and plan on writing a letter to the coaches so that they are aware of this injury in case it happens to someone else.

My son was fortunate that the tendon had only shrunk as far as the bottom third of his finger and the surgeon was able to reattach it without spacers or grafts. It is very tight though. He's starting physical therapy today, and should be able to play football next year. Unfortunately he can't play any more this year.

alex said...

Hey i just found out i have jersey finger, my surgery is gonna be a week from now, and i am wondering, can i still run+exercise(treadmill)? and would the best time be to run+exercise before i get the surgery or after i get the surgery?

Dylan H said...

i just had surgery yesterday for fdp repair. Does anyone know what the physical therapy consist of? and for how long?

Lachlan said...
This comment has been removed by the author.
Lachlan said...

i currently am recovering from jersey finger tendon reattachment. straight away you will start passively moving the finger and flexing the joints gently using your other hand. after two weeks you will start compression and ultrasound treatment to remove swelling from the finger and hopefully return proper motion. Its an extremely frustrating process but if done correctly and proper returned it should be a once off im hoping.Ive been told sport should be avoided for as long as possible ie football. However, this doesnt rule out all sport if proper care is taken im hoping

Anonymous said...

I injured my pinky finger 2 months ago and was told it was "bruised" by the ER doctor lol. I can flex the finger at all 3 joints, but it won't straighten out at the middle knuckle. Is this Jersey finger? And if so, should the doctor have done more than just x-ray my finger? He didnt even attempt to diagnose anything...just said if it'[s not broken then it's bruised. Probably cause he knew i had no insurance :(

Dylan H said...

That does not sound like jersey finger. With jersey finger you can not flex the most distal joint of your finger. Sounds like you may have an extensor injury or the swelling from your injury may be hindering the extension.

Lachlan.. I am on my 5th week of therapy and I have only seen minimal improvement. Have you regained full flexion?

Lachlan said...

Dylan H ... No i havent regained full flexion yet but im only in week 3. The surgeon and therapist have both said that flexion of the distal joint is one of the last things to return but it is almost never 100%. I was dissapointed to hear this but im just doing the exercises as im shown as much as i can and hopefully this helps me get near 100%

Allison said...

so, I'm told I have an avulsion fracture in my thumb, I cant find anything that describes what I saw on the xray. I have a piece of bone on the outside of my thumb (away from the palm) in the last joint. my finger is swollen, somewhat numb, and not liking the thought of bending. everything I see is the ring finger, or lower in the thumb. Anyone? I bowl and hunt, I need my right thumb!

Lachlan said...

an avulsion fracture im pretty sure is where a piece of the bone comes off with the tendon attachment. It is often said this is easier to fix than a tendon avulsion by itself as it is easier to heal bone to normal strenght again but tendon strength is harder to return to 100% like before tha injury. I would go and see a therapist and look at getting it fixed via surgery asap otherwise you movement of your thumb will affected in the long term id say. hope this helps and hope its fixable
cheers

Allison said...

Thanks Lachlan. I'm going in about an hour for a fresh round of xrays and to see the doc. Taking my big mean husband to make sure they get it fixed!!
I should know in a couple hours what they plan to do. I'll report back....

Allison said...

saw the doc, wasn't too impressed. she referred me to the fracture clinic, but says it will heal...got a chunk of bone in there, I think I'll wait for the ortho doctor to tell me it will heal.

Joeyi said...

My son injured the ring finger on his right hand and because we thought it was a jammed finger did not see a doctor for several weeks. We went to see an ortho and they took x-rays said there was no chip in the bone and it was not worth repairing. It is only the top digit that doesn't function but the finger continues to be sore with little flexibility after 4 more weeks. Most of the soreness is in the palm, I'm concerned of further injury but the doctor said the damage was done and you couldn't injure it further.

Lachlan said...

Joeyi that doctor im pretty sure has misdoagnosed this problem. My tendon when it came off recoiled into my palm and became sore. If i chose not too have it reattahced the pain just gets worse apparently and leads to carpal tunnel syndrome due to increased pressure being put on other ligaments and tendons of the hand. I would go and get another opinion because if the distal joint of the finger is not working that means most likely that there is no tendon attached and your son will most likely need an op to reattach it and will be fully healed within 12 weeks,I recover from mine about a month ago and its just gone 11 weeks yesterday since my op.

jules07 said...

I just suffered this injury on the weekend and am having the internal debate about whether to fix it or not. Our finals start next week and i'm weighing up whether i can hold off on the surgery for 3 weeks? It is such a pain for such a annoying little injury. However i don't really want to live the rest of my life with a gimpy finger. Tough decision!

Anonymous said...

I had this injury and had surgery to re-attach the tendon. The doctor had mentioned there is a small window of opportunity for surgical re-attachment (2 weeks), otherwise they cannot re-attach it. I would suggest having it done immediately. It has been 4 months since surgery, and I am not 100%, I cannot make a full fist (fingertip sticks out slightly) and the resting position is not straight, but I have enough motion and strength to live daily life. It is much better than when the tendon was not attached. The doctor had also mentioned if I had decided to not re-attach it, there are some simpler surgical procedures to reduce the pain in the palm.

Benjamin said...

how do you know if it's just a torn ligament, or if it is jersey finger?

Unknown said...

I injured my ring finger about 3 weeks ago. I have been in and out of the drs office since. xrays showed 2 fractures on the tip of my finger. I ended up getting an MRI and they said my tendon is torn as well. I initially had a bruise in my palm that went away 3 days later. i have no pain in the palm, i can bend my entire finger just not the tip. the swelling has reduced as well as the bruising. i live in a small town poor health care and they want to send me to Seattle for surgery on Monday. I am almost opting out of going due to the possiblity that its too late to repair.its not detached just torn...and complications involved, along with the EXPENSE alone..and no guarantee it will help. i can function just fine with it...this is what i have
1. full movement of finger other than tip
2. no pain
3. no pain in palm
4. no nodules anywhere
5. tendon is torn NOT detached
6. 2 fractures in finger right at bend of top bone

I am thinking surgery may not be worth it at this point..I am looking for some insight on this. I am going nuts in my head trying to decide whats right. My heart and gut are telling me surgery will be a waste and too risky. If its too late and they have to do a graft and what not then they are cutting into my forearm and the list goes on. Thanks to my drs 3 weeks will have passed. What do you think? If i dont get surgery will it get worse or just stay where its at? Is it possible to slowly try and let the tendor repair as it is just a tear? I do and have had a splint on it. thanks in advance for any insight. *sigh*

Unknown said...

Addition, MRI report says- tendon torn mildly. Retracted FDP tendon to the level of the proximal inter-phalangeal joint. Entensor tendon is intact, no damage.

Surgery necessary? I am thinking maybe some physical therapy may help?