Should I splint a jersey finger?

Management of Jersey Finger

Yes, a jersey finger should be splinted immediately to prevent further tendon retraction and optimize surgical outcomes. Proper splinting is a critical first aid intervention for this injury, which is an avulsion of the flexor digitorum profundus (FDP) tendon from its insertion at the distal phalanx.

What is Jersey Finger?

Jersey finger is an avulsion injury of the flexor digitorum profundus tendon from its insertion at the base of the distal phalanx. It typically occurs when:

• The finger is forcefully extended while actively flexed
• Commonly seen in contact sports (rugby, football, basketball)
• Most frequently affects the ring finger

Initial Management Algorithm

1. Immediate Splinting:

   • Splint the affected finger in the position found 1
   • Maintain the distal interphalangeal (DIP) joint in slight flexion
   • Include the proximal interphalangeal (PIP) joint in the splint
   • Do not attempt to straighten a deformed finger 1

2. Wound Management (if open injury):

   • Cover any open wounds with clean dressing to prevent contamination 1
   • Control bleeding if present

3. Vascular Assessment:

   • If the finger appears blue, purple, or pale, activate emergency services immediately 1
   • This indicates compromised blood flow requiring urgent intervention

Splinting Technique

• Use a rigid splint that immobilizes both the DIP and PIP joints
• Pad the splint adequately to prevent pressure injuries
• Secure splint with tape or wrap, ensuring it's snug but not constrictive
• Leave fingertip exposed for circulatory checks

Rationale for Splinting

Splinting is crucial because:

• Prevents further retraction of the avulsed tendon
• Reduces pain and prevents additional injury 1
• Facilitates safe transport to medical facility 1
• Improves surgical outcomes by maintaining tendon position

Additional Important Measures

1. Maintain Motion of Uninvolved Joints:

   • Instruct the patient to move uninvolved finger joints regularly through complete range of motion 2
   • Early motion of uninvolved joints prevents stiffness, which is one of the most functionally disabling complications 2
   • Finger stiffness is extremely difficult to treat after healing 2

2. Ice Application:

   • Apply cold to reduce pain, swelling, and disability 1
   • Use ice-water mixture in a plastic bag with a thin towel barrier between ice and skin
   • Limit cold application to 20 minutes (or 10 minutes if uncomfortable) 1

Timing Considerations

Time to treatment significantly impacts outcomes:

• Early presentation and treatment (within 10 days) is associated with good functional outcomes 3
• Delayed presentation may require more complex surgical procedures, including tendon lengthening 3
• Most jersey finger injuries require surgical repair with 8-12 weeks recovery before return to contact sports 4

Diagnostic Considerations

• Standard 3-view radiographs (PA, lateral, and oblique) should be obtained 2
• Ultrasound has proven valuable in diagnosis and pre-operative planning 3
• MRI may be used to evaluate the level of tendon retraction and quality of the tendon stump 1

Common Pitfalls to Avoid

1. Misdiagnosis: Jersey finger is often mistaken for a simple sprain
2. Inadequate immobilization: Failure to properly splint can lead to further tendon retraction
3. Delayed referral: This injury requires prompt surgical evaluation
4. Neglecting motion of uninvolved joints: Leading to preventable stiffness
5. Attempting to reduce/straighten the finger: This may cause further damage 1

Remember that jersey finger is a surgical condition requiring prompt referral to a hand specialist after initial splinting and first aid measures.