Jersey finger

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Jersey finger, also known as rugby finger, is a finger-related tendon injury that is common in sport and can result in permanent loss of flexion of the end of the finger if not surgically repaired. The injury is common when one player grabs another's jersey with the tips of one or more fingers while that player is pulling or running away. [1] It is the most common closed flexor tendon injury and occurs in the ring finger in 75% of cases. [2]

Contents

Signs and symptoms

Cause

A Jersey finger is a traumatic rupture of the flexor digitorum profundus (FDP) tendon at its point of attachment to the distal phalanx. [4] This injury often occurs in American football when a player grabs another player's jersey with the tips of one or more fingers while that player is pulling or running away. [5] The force of this action hyperextends the tip of the finger at the DIP joint while the proximal portion of the finger is flexed. This action can partially or completely rupture the FDP tendon at or near its attachment point on the distal phalanx. Sometimes, the force is great enough to pull off or avulse a piece of phalangeal bone to which the tendon can remain attached. [6] Although it is a common football injury, this injury can occur during other sports or activities as well.

After the injury occurs, the torn FDP tendon may retract slightly, remaining in the finger near the PIP joint, or can retract more fully into the palm of the hand. A person who suffers a jersey finger injury in which the FDP tendon is completely ruptured cannot flex the affected digit at the DIP joint without assistance.

Anatomy

Fingers1.jpg

All four non-thumb digits (index finger, middle finger, ring finger and little finger) contain three bones called the phalanges that are aligned in a linear row like box cars in a train. These bones are designated the proximal phalanx (closest to the palm), the middle phalanx, and the distal phalanx (farthest from the palm). The joints between these bones are referred to as the proximal interphalangeal joint (PIP, between the proximal and middle phalanx) and the distal interphalangeal joint (DIP, between the middle and distal phalanx). muscles that begin in the forearm send long tendons to the fingers and these tendons attach at different points on these bones. Flexing and extending these digits occurs when these muscles contract and their tendons pull on their bony attachments. The deepest of the flexor muscles in the anterior forearm is called the flexor digitorum profundus muscle (FDP); it gives off four tendons that travel through the carpal tunnel into the hand and attach to the distal phalanx in each of the four non-thumb digits.

Treatment

The classically used Leddy and Packer Classification [7] classifies Jersey finger tendon injuries based on the degree of tendon injury, retraction, and presence of a concomitant fracture.

ClassDescriptionTreatment
IVincula ruptured with tendon retraction to palmPrimary tendon repair within 10 days
IIVincula intact with tendon retraction to proximal interphalangeal jointPrimary tendon repair within 10 days (but may be delayed)
IIIFracture fragment retains tendon at distal interphalangeal jointRepair of fracture fragment (6 weeks)
IVFracture fragment has tendon avulsed off and retractedRepair of fracture fragment and tendon repair (12 weeks)

Whether surgical fixation provides benefit over non-operative management remains unclear. [8] Sometimes, internal fixation of the tendon (with sutures) and or fractures is chosen. [9] Post surgical complications can include rupture (1%), [10] infection, pin failure and nail and joint deformity. Surgery is often accompanied by a rehabilitation protocol to strengthen the injured muscle and help the patient regain as much range of motion (ROM) as possible at the affected joint. The finger may never return normal extension or range of motion (ROM).

Repair is commonly done under local anesthesia and a Bruner approach is utilized. Local anesthetic is injected prior to draping and again prior to incision for augmentation of the first injection. An incision is made along the finger and the subcutaneous tissue is dissected to the depth of the flexor sheath. The ruptured tendon is identified, and a tag stitch is placed, next the tendon is pulled through the pulleys using a shoehorn technique. The flexor tendon is then reattached to the distal phalanx using the pants-over-vest technique using a suture anchor repair and over-the-top and pull-out repair. Adequate repair is assessed by asking the patient to make a fist and then wound closure is done. [11]

Related Research Articles

Foot Anatomical structure found in vertebrates

The foot is an anatomical structure found in many vertebrates. It is the terminal portion of a limb which bears weight and allows locomotion. In many animals with feet, the foot is a separate organ at the terminal part of the leg made up of one or more segments or bones, generally including claws or nails.

<span class="mw-page-title-main">Lumbricals of the hand</span>

The lumbricals are intrinsic muscles of the hand that flex the metacarpophalangeal joints, and extend the interphalangeal joints.

The flexor digitorum profundus is a muscle in the forearm of humans that flexes the fingers. It is considered an extrinsic hand muscle because it acts on the hand while its muscle belly is located in the forearm.

<span class="mw-page-title-main">Flexor digitorum superficialis muscle</span>

Flexor digitorum superficialis is an extrinsic flexor muscle of the fingers at the proximal interphalangeal joints.

<span class="mw-page-title-main">Ulnar nerve</span> Nerve which runs near the ulna bone

In human anatomy, the ulnar nerve is a nerve that runs near the ulna bone. The ulnar collateral ligament of elbow joint is in relation with the ulnar nerve. The nerve is the largest in the human body unprotected by muscle or bone, so injury is common. This nerve is directly connected to the little finger, and the adjacent half of the ring finger, innervating the palmar aspect of these fingers, including both front and back of the tips, perhaps as far back as the fingernail beds.

<span class="mw-page-title-main">Upper limb</span> Consists of the arm, forearm, and hand

The upper limbs or upper extremities are the forelimbs of an upright-postured tetrapod vertebrate, extending from the scapulae and clavicles down to and including the digits, including all the musculatures and ligaments involved with the shoulder, elbow, wrist and knuckle joints. In humans, each upper limb is divided into the arm, forearm and hand, and is primarily used for climbing, lifting and manipulating objects.

Extensor digitorum muscle

The extensor digitorum muscle is a muscle of the posterior forearm present in humans and other animals. It extends the medial four digits of the hand. Extensor digitorum is innervated by the posterior interosseous nerve, which is a branch of the radial nerve.

The flexor pollicis longus is a muscle in the forearm and hand that flexes the thumb. It lies in the same plane as the flexor digitorum profundus. This muscle is unique to humans, being either rudimentary or absent in other primates. A meta-analysis indicated accessory flexor pollicis longus is present in around 48% of the population.

<span class="mw-page-title-main">Mallet finger</span> Type of fracture

A mallet finger, also known as hammer finger or PLF finger or Hannan finger, is an extensor tendon injury at the farthest away finger joint. This results in the inability to extend the finger tip without pushing it. There is generally pain and bruising at the back side of the farthest away finger joint.

Dorsal interossei of the hand

In human anatomy, the dorsal interossei (DI) are four muscles in the back of the hand that act to abduct (spread) the index, middle, and ring fingers away from hand's midline and assist in flexion at the metacarpophalangeal joints and extension at the interphalangeal joints of the index, middle and ring fingers.

Abductor digiti minimi muscle of hand

In human anatomy, the abductor digiti minimi is a skeletal muscle situated on the ulnar border of the palm of the hand. It forms the ulnar border of the palm and its spindle-like shape defines the hypothenar eminence of the palm together with the skin, connective tissue, and fat surrounding it. Its main function is to pull the little finger away from the other fingers.

Interphalangeal joints of the hand

The interphalangeal joints of the hand are the hinge joints between the phalanges of the fingers that provide flexion towards the palm of the hand.

Vincula tendina

Within each osseo-aponeurotic canal, the tendons of the flexor digitorum superficialis and flexor digitorum profundus are connected to each other, and to the phalanges, by slender, tendinous bands, called vincula tendina.

Interphalangeal joints of the foot

The interphalangeal joints of the foot are between the phalanx bones of the toes in the feet.

<span class="mw-page-title-main">Jammed finger</span> Medical condition

Jammed finger is a colloquialism referring to a variety of injuries to the joints of the fingers, resulting from axial loading beyond that which the ligaments can withstand. Common parts of the finger susceptible to this type of injury are ligaments, joints, and bones. The severity of the damage to the finger increases with the magnitude of the force exerted by the external object on the fingertip. Toes may become jammed as well, with similar results.

<span class="mw-page-title-main">Palmar plate</span>

In the human hand, palmar or volar plates are found in the metacarpophalangeal (MCP) and interphalangeal (IP) joints, where they reinforce the joint capsules, enhance joint stability, and limit hyperextension. The plates of the MCP and IP joints are structurally and functionally similar, except that in the MCP joints they are interconnected by a deep transverse ligament. In the MCP joints, they also indirectly provide stability to the longitudinal palmar arches of the hand. The volar plate of the thumb MCP joint has a transverse longitudinal rectangular shape, shorter than those in the fingers.

<span class="mw-page-title-main">Ulnar claw</span>

An ulnar claw, also known as claw hand or 'spinster's claw', is a deformity or an abnormal attitude of the hand that develops due to ulnar nerve damage causing paralysis of the lumbricals. A claw hand presents with a hyperextension at the metacarpophalangeal joints and flexion at the proximal and distal interphalangeal joints of the 4th and 5th fingers. The patients with this condition can make a full fist but when they extend their fingers, the hand posture is referred to as claw hand. The ring- and little finger can usually not fully extend at the proximal interphalangeal joint (PIP).

The hand of benediction, also known as benediction sign or preacher's hand, occurs as a result of prolonged compression or injury of the median nerve at the forearm or elbow.

Median nerve palsy Medical condition

Injuries to the arm, forearm or wrist area can lead to various nerve disorders. One such disorder is median nerve palsy. The median nerve controls the majority of the muscles in the forearm. It controls abduction of the thumb, flexion of hand at wrist, flexion of digital phalanx of the fingers, is the sensory nerve for the first three fingers, etc. Because of this major role of the median nerve, it is also called the eye of the hand. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers. Tendon transfers have been very successful in restoring motor function and improving functional outcomes in patients with median nerve palsy.

Extrinsic extensor muscles of the hand

The extrinsic extensor muscles of the hand are located in the back of the forearm and have long tendons connecting them to bones in the hand, where they exert their action. Extrinsic denotes their location outside the hand. Extensor denotes their action which is to extend, or open flat, joints in the hand. They include the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor digitorum (ED), extensor digiti minimi (EDM), extensor carpi ulnaris (ECU), abductor pollicis longus (APL), extensor pollicis brevis (EPB), extensor pollicis longus (EPL), and extensor indicis (EI).

References

  1. ↑ Abrego, Mariano O.; Shamrock, Alan G. (2020), "Jersey Finger", StatPearls, StatPearls Publishing, PMID   31424875 , retrieved 2020-05-04
  2. ↑ "Jersey Finger - Hand - Orthobullets". www.orthobullets.com. Retrieved 2020-05-04.
  3. ↑ Tuttle, Harrison G., MD, et al. Tendon Avulsion Injuries of the Distal Phalanx. Clinical Orthopaedics and Related Research. April 2006. No. 445. Pp. 157-168.
  4. ↑ CHT, Lori Algar OTD, OTR/L. "Jersey Finger: Treatment For a Common Contact Sport Injury". www.3pointproducts.com. Retrieved 2020-05-04.
  5. ↑ Wang, Quincy C., MD, and Johnson, Brett A., MD. Fingertip Injuries. American Family Physician. May 15, 2001. Vol. 63, Number 10. Pp. 1961-1966.
  6. ↑ Shabat, Shay; Sagiv, Paul; Stern, Avi; Nyska, Meir (2002). "Avulsion fracture of the flexor digitorum profundus tendon ('Jersey finger') type III". Archives of Orthopaedic and Trauma Surgery. 122 (3): 182–183. doi:10.1007/s00402-001-0352-9. ISSN   0936-8051.
  7. ↑ Henry, SL; Katz, MA; Green, DP (2009). "Type IV FDP avulsion: lessons learned clinically and through review of the literature". Hand (N Y). 4 (4): 357–61. doi:10.1007/s11552-009-9199-2. PMC   2787222 . PMID   19399559.
  8. ↑ Brady, Chevonne; Lee, Alice; Gardiner, Matthew; Baker, Richard; Giddins, Grey; Wade, Ryckie G. (1 February 2022). "The outcomes of zone 1 flexor digitorum profundus tendon injury: A systematic review and meta-analysis". Journal of Plastic, Reconstructive & Aesthetic Surgery. 75 (2): 893–939. doi:10.1016/j.bjps.2021.11.026.
  9. ↑ Kovacic, Jeffrey; Bergfeld, John (2005). "Return to Play Issues in Upper Extremity Injuries". Clinical Journal of Sport Medicine . 15 (6): 448–452. doi:10.1097/01.jsm.0000188208.00727.0b. ISSN   1050-642X.
  10. ↑ Brady, Chevonne; Lee, Alice; Gardiner, Matthew; Baker, Richard; Giddins, Grey; Wade, Ryckie G. (February 2022). "The outcomes of zone 1 flexor digitorum profundus tendon injury: A systematic review and meta-analysis". Journal of Plastic, Reconstructive & Aesthetic Surgery. 75 (2): 893–939. doi:10.1016/j.bjps.2021.11.026.
  11. ↑ , Ilyas A, Drummey R. Jersey Finger Repair. J Med Ins. 2020;2020(297) doi:https://jomi.com/article/297
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