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Jersey Finger

Jersey Finger is a tendon injury of the finger in which the flexor tendon detaches from the fingertip, preventing the affected finger from bending at the end joint. The name comes from a common sports scenario where the injury occurs—when an athlete grabs an opponent’s jersey and the finger gets forcefully extended while trying to flex. This condition is most often seen in athletes playing contact sports such as football, rugby, or wrestling, but it can also occur in other high-impact activities.

It is a serious injury because untreated jersey finger can lead to permanent loss of finger flexion, weakness of grip, and long-term disability in hand function.

Anatomy Involved

To understand jersey finger, it is important to know the anatomy of the finger flexor tendons:

  • The flexor digitorum profundus (FDP) tendon is the tendon that allows the fingertip (distal phalanx) to bend.
  • This tendon runs along the finger and attaches at the base of the distal phalanx.
  • When the FDP tendon is forcibly pulled away from the bone, it results in jersey finger.

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Causes and Mechanism of Injury

The classic mechanism involves:

  • A person grips an object (like an opponent’s jersey).
  • The opponent pulls away suddenly.
  • The finger is forcefully extended while the FDP tendon is actively contracting to flex the fingertip.
  • This sudden force leads to tendon rupture or avulsion from the bone.

Classification of Jersey Finger

Jersey finger injuries are classified according to Leddy and Packer’s classification, which helps guide treatment:

1. Type I:

  • Tendon retracts into the palm.
  • Blood supply is disrupted.
  • Requires urgent surgery.

2. Type II:

  • Tendon retracts to the level of the proximal interphalangeal (PIP) joint.
  • Blood supply partially preserved.

3. Type III:

  • A small bone fragment is avulsed along with the tendon.
  • Tendon retracts only to the distal interphalangeal (DIP) joint.

4. Type IV:

  • Large bony fragment avulsion with both tendon and bone separation.

5. Type V (extension of classification):

  • Comminuted fracture with tendon involvement.

Clinical Features

  • Inability to bend the fingertip: The hallmark feature.
  • Pain and swelling: Usually at the base of the distal phalanx.
  • Tenderness: Felt on the palmar side of the finger.
  • Bruising or hematoma: May be present around the injured site.
  • Finger held in extension: While other fingers flex normally, the affected fingertip stays straight when making a fist.

Diagnosis

1. Physical Examination:

  • The patient is asked to make a fist; the injured finger remains extended at the DIP joint.
  • Testing each finger individually shows the absence of active DIP flexion.

2. X-rays:

  • Identify bony avulsions or fractures.

3. Ultrasound or MRI:

  • Used to visualize tendon retraction and soft tissue involvement.

Treatment and Management

1. Non-Surgical Treatment:

  • Rarely recommended.
  • May be considered only in elderly patients with low functional demands or when surgery is contraindicated.
  • Usually results in loss of flexion strength.

2. Surgical Treatment:

  • Timing: Best results when performed within 7–10 days of injury.
  • Direct tendon repair using sutures.
  • Tendon reattachment with bone anchors or pull-out wires.
  • Bone fragment fixation with screws or pins if a fracture is present.

3. Rehabilitation:

  • Post-surgery, the finger is immobilized in a splint for 4–6 weeks.
  • Hand therapy begins early with controlled passive and active motion to prevent stiffness.
  • Gradual strengthening exercises follow to restore grip function.

Complications

  • Permanent loss of DIP joint flexion.
  • Reduced grip strength.
  • Stiffness or limited motion due to scarring.
  • Chronic pain and deformity.
  • Tendon re-rupture or failed repair after surgery.

Prognosis

  • Early surgical repair: Good to excellent outcomes, with many patients regaining full finger flexion and strength.
  • Delayed treatment: Poor prognosis due to tendon retraction, scarring, and loss of blood supply.
  • Athletes: Can often return to sport after 3–4 months, depending on the severity and success of rehabilitation.

Conclusion

Jersey finger is a tendon injury where the flexor tendon detaches from the fingertip, preventing active bending of the distal joint. It commonly occurs in contact sports when a player grips an opponent’s jersey, hence the name. Prompt diagnosis and surgical treatment are critical to restoring normal finger function. With timely intervention and proper rehabilitation, most individuals can regain good hand strength and flexibility, preventing long-term disability. Delay in treatment, however, can result in permanent deformity and functional loss.

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