Jersey Finger

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4.4 of 73 Ratings
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Expert CommentsTopic Podcast

Mark Vitale MD

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 Summary
o 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.
o 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.
o Treatment is usually direct tendon repair or open reduction and internal fixation depending on
the presence and size of a bony avulsion.
 Epidemiology
o 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
o Pathophysiology
 FDP muscle belly in maximal contraction during forceful DIP extension
 Anatomy
o Muscles
 Flexor Digitorum Profundus (ulnar n. and AIN n.)
o Flexor zones
 zone I extends from insertion of FDS distally
 Classification
o

 Leddy and Packer classification

 (based on level of tendon retraction and presence of fracture)
Type Description Treatment
FDP tendon retracted to palm. Leads to Prompt surgical treatment within 7 to 10
Type I disruption of the vascular supply days
Attempt to repair within several weeks for
Type II FDP retracts to level of PIP joint optimal outcome
Large avulsion fracture limits retraction to Attempt to repair within several weeks for
Type III the level of the DIP joint optimal outcome
Osseous fragment and simultaneous
avulsion of the tendon from the fracture
fragment ("Double avulsion” with If tendon separated from fracture fragment,
subsequent retraction of the tendon usually first fix fracture via ORIF then reattach
Type IV into palm) tendon as for Type I/II injuries
Ruptured tendon with bone avulsion with
bony comminution of the remaining distal
phalanx (Va, extraarticular; Vb, intra-
Type V articular)
 Presentation
o 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
o Radiograhs
 may see avulsion fragment
 Treatment
o 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
o Quadrigia
 advancement of > 1 cm carries risk of a DIP flexion contracture or quadrigia