Jersey Finger (Flexor Digitorum Profundus Avulsion)
This patient has a jersey finger injury—an avulsion of the flexor digitorum profundus tendon from the distal phalanx—and requires immediate splinting in flexion followed by urgent hand surgery referral within 7-10 days for optimal outcomes. 1
Immediate Management
Splinting Protocol
- Immobilize the finger in 30 degrees of flexion at all joints (DIP, PIP, and MCP) to minimize tension on the retracted tendon and prevent further proximal migration 2
- Apply a dorsal splint that maintains this flexed position while allowing the patient to protect the injury 2
- The splint should be padded and comfortable but secure enough to prevent inadvertent extension 3
Critical Action: Urgent Surgical Referral
- Refer to a hand surgeon within 7-10 days as delayed repair beyond 2-3 weeks significantly compromises surgical outcomes and may necessitate tendon grafting or staged reconstruction 1
- MRI can be obtained by the hand surgeon to evaluate the level of tendon retraction (which determines surgical approach), quality of the tendon stump, and associated pulley injuries 1
- MRI demonstrates 92% sensitivity and 100% specificity for flexor tendon injuries in this setting 1
Why Surgery Cannot Be Delayed
The flexor digitorum profundus tendon retracts proximally after avulsion, and the degree of retraction determines both surgical complexity and prognosis 1. Early repair (within 7-10 days) allows:
- Direct reattachment to bone with suture anchors or pull-through techniques 1
- Preservation of the pulley system 1
- Better functional outcomes with restoration of DIP flexion 1
Delayed presentation beyond 2-3 weeks often requires tendon grafting, two-stage reconstruction, or may result in permanent loss of DIP flexion 1.
Common Pitfalls to Avoid
- Never immobilize in extension—this increases tension on the already-avulsed tendon and allows further proximal retraction 2
- Do not delay referral assuming conservative management is appropriate; unlike mallet finger (extensor injury), jersey finger requires surgical repair for functional restoration 1, 2
- Do not confuse with volar plate injury—volar plate injuries cause hyperextension instability but preserve active DIP flexion, whereas jersey finger presents with complete inability to flex the DIP joint 4, 5
- Avoid rigid immobilization of uninvolved joints—the PIP and MCP joints should be splinted in flexion as part of the protective position, but once surgical repair is complete, early controlled motion of uninvolved joints prevents stiffness 3, 6
Post-Surgical Considerations
After surgical repair, intensive hand therapy with controlled passive motion protocols is essential to prevent adhesions while protecting the repair 1. The hand surgeon will direct this rehabilitation, which typically begins 3-5 days post-operatively with specific protocols to balance tendon healing against the risk of debilitating stiffness 1, 6.