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Anatomy
Anatomy
Illustration by Dr. Lisa Bryski
Jersey fingers are an avulsion of the flexor digitorum profundus (FDP) tendon off of the volar aspect of the distal phalanx.1
CLASSIC PRESENTATION
CLASSIC PRESENTATION
The distal interphalangeal (DIP) joint is suddenly and forcefully hyperextended while the finger is actively flexed. A common mechanism is when a patient grasps the jersey of an opponent who is pulling away.1
1
DIAGNOSIS
DIAGNOSIS
The diagnosis is based on
history
physical exam
x-ray to rule out bony injuries
The physical exam will reveal the resting posture of the hand is disrupted and the injured finger extended.
Clinical Tip: Pathognomonic finding of jersey finger is the inability to actively flex the DIP joint.
Ultrasound can also be used to evaluate the digital flexor system and has been reported to be more accurate than physical examination (95 vs. 79 percent) particularly when performed within seven days of injury.3
2
A linear transducer is used to confirm the presence of an irregular hyperechoic bone fragment (black arrows) attached to the retracted FDP tendon, in both axial and transverse views. However, the avulsed fragment may not always have a hyperechoic bone fragment.
The avulsed bone fragment is located close to the third annular (A3) pulley of the flexor tendons (white arrowheads) and 2 distal strings of FDS tendon (black arrowsheads). The empty distal tendon sheath (curved white arrow) and irregular appearance of the base of the distal phalanx confirms the diagnosis of jersey finger.2
A dynamic examination performed with gentle movements of the distal phalanx can help determine the diagnosis by showing no movement inside the tendon sheath.2
MANAGEMENT
MANAGEMENT
All types of Jersey finger injuries require surgical repair and therefore, prompt referral to a hand surgeon is necessary.
REFERENCES
REFERENCES
Bachoura, A., Ferikes, A. J., & Lubahn, J. D. (2017). A review of mallet finger and jersey finger injuries in the athlete. Hand and Wrist Sports Medicine, 1–9.
Gautard, G., Gautard, R., Celi J., Jacquemond, G., & Bianchi S. (2009) Sonography of Jersey Finger, 389-392.
Gilleard, O., Silver, D., Ahmad, Z., & Devaraj, V. S. (2010). The accuracy of ultrasound in evaluating closed flexor tendon ruptures, 71–74.
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