What is the treatment for jersey finger (flexor tendon rupture)?

Jersey Finger Treatment

Jersey finger (flexor digitorum profundus tendon rupture) requires urgent surgical repair within 7-10 days of injury to achieve optimal functional outcomes, as delayed treatment beyond 3 weeks significantly compromises results and may necessitate salvage procedures rather than primary repair. 1, 2, 3

Immediate Diagnostic Approach

Clinical Presentation:

• Loss of active flexion at the distal interphalangeal (DIP) joint is the hallmark finding 2
• Injury typically occurs when the flexed finger is forcibly extended (grabbing opponent's jersey in rugby/football) 1, 4
• The ring finger is most commonly affected 1, 4

Imaging:

• Standard radiographs should be obtained first to identify bony avulsion fragments and classify the injury 1, 2
• Ultrasound is valuable for diagnosis and preoperative planning, helping locate the retracted tendon and assess tissue quality 1, 3
• MRI can detect tendon injuries but is not routinely necessary if ultrasound and clinical exam are diagnostic 5

Classification-Based Treatment Algorithm

Leddy-Packer Classification determines surgical urgency:

Type I (tendon retracts to palm):

• Most urgent - requires surgery within 7-10 days 1, 2
• Blood supply disrupted, highest risk of tendon necrosis
• Direct reinsertion to bone using suture anchors or intraosseous sutures 1

Type II (tendon retracts to PIP joint level):

• Surgery recommended within 2-3 weeks 2, 3
• Blood supply partially maintained via vinculum
• Direct reinsertion typically successful 1, 2

Type III (bony avulsion fragment):

• Requires osteosynthesis with K-wires or screw fixation 2
• Can be repaired up to 3-4 weeks with good results 2

Type IV (tendon avulsion with volar plate fracture):

• Rare variant requiring combined tendon repair and fracture fixation 6
• Surgical approach must address both injuries 6

Surgical Technique Considerations

Primary Repair (< 3 weeks from injury):

• Direct reinsertion to distal phalanx using suture anchors or pull-through button technique provides reliable fixation 1, 2
• Intraosseous sutures are effective for pure tendon avulsions 1
• Volar plate augmentation may improve repair strength, though early clinical data is limited 3
• Wide-awake surgery allows intraoperative assessment of tendon repair integrity 3

Delayed Presentation (> 3 weeks):

• Myostatic contracture develops, preventing direct repair 1, 2
• Options include:
  • Tendon lengthening procedures for contracture 1
  • Tendon resection (arthrodesis of DIP joint) - satisfactory results in 60% 2
  • Palmaris longus tendon graft - generally unsatisfactory outcomes 2
  • DIP joint capsulodesis as salvage 2

Critical Management Pitfalls

Timing is everything: Patients presenting within 3 weeks achieve satisfactory results with primary repair in nearly all cases, while those presenting late require salvage procedures with inferior outcomes 1, 2, 3

Secondary rupture risk: Even with successful early repair, secondary rupture occurs in approximately 10-20% of cases, emphasizing the need for adequate postoperative protection 2

Patient compliance is essential: Non-compliance with postoperative splinting protocols significantly increases failure rates 1

Postoperative Management and Return to Play

• Immobilization for 6-8 weeks with gradual mobilization 1, 3
• Most athletes cannot return to contact sports for 8-12 weeks minimum 3
• Functional outcome at 6-12 months is generally satisfactory when surgery is performed early with adequate patient adherence 1, 6
• All reinsertions performed within 3 weeks of injury yielded satisfactory results in one series, though secondary rupture occurred in 18% 2

The key distinction from mallet finger: Unlike mallet finger which can heal non-operatively over 8-12 weeks even with delayed treatment, jersey finger requires surgical intervention and cannot be managed conservatively 3