Raleigh Hand Center
3701 Wake Forest Rd
Raleigh, NC 27609
What is a jersey finger?
A “jersey finger” is a term for a specific type of flexor tendon injury. The flexor tendons of the hand are crucial elements of hand function. These tendons work together to bend, or flex, our fingers allowing our hands to perform an infinite possible number of tasks. Each finger contains 2 long finger flexors, the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS). These tendons originate in the forearm, travel through the carpal tunnel in the wrist, and insert on the bones of the fingers (phalanges). A “jersey finger” occurs when the FDP tendon is torn from its attachment on the bone at the end of the finger (distal phalanx). This is usually is caused by a sudden force on the tip of the finger, classically when trying to grab the football jersey of a moving opponent. The other tendon in the finger, the FDS, remains intact in a jersey finger.
There is a close relationship between form and function in the hand, and a delicate balance exists between the bones and soft tissue structures. A small disruption of this fine balance can affect the overall function of the hand. This cannot be more apparent than with flexor tendon injuries.
Flexor tendon injuries have challenged even the most skilled orthopaedists and hand surgeons for decades. Repair techniques have advanced over the years and outcomes have improved. However, even in the best reports, some patients have problems with stiffness, scar tissue, and decreased hand function.
How is the injury diagnosed?
Sometimes the diagnosis is not clear to the patient at first. Patients may think that the finger is “jammed,” and when the bruising and swelling improve, they notice that they cannot bend the end of the finger. The diagnosis is confirmed on the basis of history and physical exam in the office. A related fracture can be identified with an x-ray. CT scan, ultrasound, and MRI are not usually required. Early diagnosis and treatment is very important.
What are the treatment options?
When a flexor tendon is completely disrupted, the muscle belly in the forearm pulls the tendon end away from the bone. In normal conditions, the tendons in the arm are under a small amount of tension, like a stretched rubberband. If torn, the tendon end retracts, as would a cut rubberband. This gap prevents the tendon from healing back down to the bone. Surgery is the only way to repair the rupture. Therefore, non-operative treatment will not restore full tendon function.
There are some people who wish to avoid the risks of surgery and the long rehabilitation afterwards and choose non-operative treatment. Since the FDS tendon is intact, the finger can still bend at the first two joints, but not at the end joint (DIP joint). Some people have been able to modify their activities and live relatively normal lives with an unrepaired jersey finger. Nevertheless, most people choose surgery for this condition if the diagnosis is made soon after the injury.
What is involved with surgery?
The surgery is usually performed on an outpatient basis using either regional anesthesia or general anesthesia. During surgery, the FDP tendon is identified and repaired back to the distal phalanx. This is called a “primary repair.” This is performed with suture which anchors the tendon down to the bone. The incision is made on the palm side of the finger and in the palm of the hand in order to retrieve the retracted tendon. Occasionally there is a fracture at the tendon attachment, and this is repaired at the same time with pins or screws.
If there has been a delay of more than a few of weeks, it may not be possible to bring the retracted tendon back to the bone and perform a primary repair. In this case a tendon graft can be used to substitute, called "flexor tendon reconstruction". A commonly used tendon graft donor is the palmaris longus tendon from the forearm since there is no significant loss of function after its removal. Unfortunately, flexor tendon reconstruction in this setting has a much higher risk of scaring, stiffness, and decreased range of motion, and it is not always recommended.
Is therapy required?
Yes. Occupational therapy guided by a therapist trained in hand care is critical in the recovery from a repaired flexor tendon rupture. The therapist will guide the patient through the rehab protocol and promote an increase in range of motion and reduction in swelling, scar tissue, and pain. While the tendon repair is healing it is possible to rupture, or break, the repair. On the other hand, if a patient does not work on adequate range of motion during recovery, the hand and fingers will invariably be stiff. Therefore, patients require guidance by therapists to perform optimal rehabilitation.
What can I expect after surgery?
Rest and elevation of the hand to the level of the heart is very import for the first few days after surgery to reduce swelling. Shoulder and elbow range of motion are important to help prevent stiffness in these joints.
After the surgery, your wrist and fingers will be immobilized in a plaster splint to protect the repair. The splint will be removed in our clinic after a few days and a removable splint will be made for you. It is important to protect the repair as it heals and avoid attempting to make a tight fist or straighten the finger and wrist. This can put too much stress on the repair. At first, the therapist will focus on reducing pain, swelling, and increasing range of motion. Later, as the tendon repair heals, strengthening will be emphasized. Therapy often continues for 3 months or longer.
Most patients can return to more normal function at about 4 months post-operatively, but maximum improvement can take 6-12 months. Recovery time varies among patients, depending on the severity of the injury, possible complications, and pain tolerance of the patient. Sometimes people do not regain full range of motion or strength after the injury. My goal is to help each patient obtain the most function possible.
What are the complications from surgery?
Possible complications include bleeding, infection, swelling, stiffness, rupture of the repair, and damage to the surrounding nerves and blood vessels. If scar tissue (adhesions) and stiffness become a problem, an additional surgery called a “tenolysis” can be helpful to gain more motion. This procedure is designed to remove scar tissue around the flexor tendons. Other complications are also possible but are uncommon.
This material is intended for general reference only and does not replace an evaluation by a physician.
Copyright 2014 Erickson Hand Surgery
Raleigh Hand Center
3701 Wake Forest Rd
Raleigh, NC 27609