Jersey finger, also known as rugby finger, is a

finger A finger is a limb of the body and a type of digit, an organ of manipulation and sensation found in the hands of most of the Tetrapods, so also with humans and other primates. Most land vertebrates have five fingers ( Pentadactyly). Chambers ...

-related tendon injury that is common in sport and can result in permanent loss of flexion of the end of the finger if not surgically repaired. The injury is common when one player grabs another's

jersey Jersey ( , ; nrf, Jèrri, label=Jèrriais ), officially the Bailiwick of Jersey (french: Bailliage de Jersey, links=no; Jèrriais: ), is an island country and self-governing Crown Dependencies, Crown Dependency near the coast of north-west F ...

with the tips of one or more fingers while that player is pulling or running away. It is the most common closed flexor tendon injury and occurs in the ring finger in 75% of cases.

Signs and symptoms

* A pop or rip felt in the finger at the time of the injury * Pain when moving the injured finger and the inability to bend the DIPjoint * Tenderness, swelling. and warmth of the injured finger *

Bruising A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur clos ...

after 48 hours * Occasionally a lump felt in the palm of the finger

Cause

A Jersey finger is a traumatic rupture of the

flexor digitorum profundus The flexor digitorum profundus is a muscle in the forearm of humans that flexes the fingers (also known as digits). It is considered an extrinsic hand muscle because it acts on the hand while its muscle belly is located in the forearm. Together t ...

(FDP) tendon at its point of attachment to the

distal phalanx The phalanges (singular: ''phalanx'' ) are digital bones in the hands and feet of most vertebrates. In primates, the thumbs and big toes have two phalanges while the other digits have three phalanges. The phalanges are classed as long bones. ...

. This injury often occurs in

American football American football (referred to simply as football in the United States and Canada), also known as gridiron, is a team sport played by two teams of eleven players on a rectangular field with goalposts at each end. The offense, the team with ...

when a player grabs another player's

with the tips of one or more fingers while that player is pulling or running away. The force of this action hyperextends the tip of the finger at the DIP joint while the proximal portion of the finger is flexed. This action can partially or completely

rupture Rupture may refer to: General * Rupture (engineering), a failure of tough ductile materials loaded in tension Anatomy and medicine * Abdominal hernia, formerly referred to as "a rupture" * Achilles tendon rupture * Rupture of membranes, a "wate ...

the FDP tendon at or near its attachment point on the distal phalanx. Sometimes, the force is great enough to pull off or avulse a piece of phalangeal bone to which the tendon can remain attached. Although it is a common football injury, this injury can occur during other sports or activities as well. After the injury occurs, the torn FDP tendon may retract slightly, remaining in the finger near the PIP joint, or can retract more fully into the palm of the hand. A person who suffers a jersey finger injury in which the FDP tendon is completely ruptured cannot flex the affected digit at the DIP joint without assistance.

Anatomy

All four non-

thumb The thumb is the first digit of the hand, next to the index finger. When a person is standing in the medical anatomical position (where the palm is facing to the front), the thumb is the outermost digit. The Medical Latin English noun for thumb ...

digits (

index finger The index finger (also referred to as forefinger, first finger, second finger, pointer finger, trigger finger, digitus secundus, digitus II, and many other terms) is the second digit of a human hand. It is located between the thumb and the mid ...

middle finger The middle finger, long finger, second finger, third finger, toll finger or tall man is the third digit of the human hand, located between the index finger and the ring finger. It is typically the longest digit. In anatomy, it is also called ...

ring finger The ring finger, third finger, fourth finger, leech finger, or annulary is the fourth digit of the human hand, located between the middle finger and the little finger. Sometimes the term ring finger only refers to the fourth digit of a left-han ...

and

little finger The little finger, or pinkie, also known as the baby finger, fifth digit, or pinky finger, is the most ulnar and smallest digit of the human hand, and next to the ring finger. Etymology The word "pinkie" is derived from the Dutch word ''pink ...

) contain three bones called the ''

phalanges The phalanges (singular: ''phalanx'' ) are digital bones in the hands and feet of most vertebrates. In primates, the thumbs and big toes have two phalanges while the other digits have three phalanges. The phalanges are classed as long bones. ...

'' that are aligned in a linear row like box cars in a train. These bones are designated the

proximal phalanx The phalanges (singular: ''phalanx'' ) are digital bones in the hands and feet of most vertebrates. In primates, the thumbs and big toes have two phalanges while the other digits have three phalanges. The phalanges are classed as long bones. ...

(closest to the palm), the middle phalanx, and the

(farthest from the palm). The joints between these bones are referred to as the

proximal interphalangeal joint The interphalangeal joints of the hand are the hinge joints between the phalanges of the fingers that provide flexion towards the palm of the hand. There are two sets in each finger (except in the thumb, which has only one joint): * "proximal int ...

(PIP, between the proximal and middle phalanx) and the

distal interphalangeal joint Distal interphalangeal joints are the articulations between the phalanges of the hand or foot. This term therefore includes: * Interphalangeal joints of the hand * Interphalangeal joints of the foot The interphalangeal joints of the foot are bet ...

(DIP, between the middle and distal phalanx).

muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of muscl ...

s that begin in the

forearm The forearm is the region of the upper limb between the elbow and the wrist. The term forearm is used in anatomy to distinguish it from the arm, a word which is most often used to describe the entire appendage of the upper limb, but which in anat ...

send long

tendon A tendon or sinew is a tough, high-tensile-strength band of dense fibrous connective tissue that connects muscle to bone. It is able to transmit the mechanical forces of muscle contraction to the skeletal system without sacrificing its ability ...

s to the fingers and these tendons attach at different points on these bones. Flexing and extending these digits occurs when these muscles contract and their tendons pull on their bony attachments. The deepest of the

flexor muscle Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relative ...

s in the anterior forearm is called the

flexor digitorum profundus muscle The flexor digitorum profundus is a muscle in the forearm of humans that flexes the fingers (also known as digits). It is considered an extrinsic hand muscle because it acts on the hand while its muscle belly is located in the forearm. Together t ...

(FDP); it gives off four tendons that travel through the

carpal tunnel In the human body, the carpal tunnel or carpal canal is the passageway on the palmar side of the wrist that connects the forearm to the hand. The tunnel is bounded by the bones of the wrist and flexor retinaculum from connective tissue. Normall ...

into the hand and attach to the distal phalanx in each of the four non-thumb digits.

Treatment

The classically used Leddy and Packer Classification classifies Jersey finger tendon injuries based on the degree of tendon injury, retraction, and presence of a concomitant fracture. Whether surgical fixation provides benefit over non-operative management remains unclear. Sometimes, internal fixation of the tendon (with sutures) and or fractures is chosen. Post surgical complications can include rupture (1%),

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...

, pin failure and nail and joint

deformity A deformity, dysmorphism, or dysmorphic feature is a major abnormality of an organism that makes a part of the body appear or function differently than how it is supposed to. Causes Deformity can be caused by a variety of factors: *Arthritis an ...

. Surgery is often accompanied by a rehabilitation protocol to strengthen the injured muscle and help the patient regain as much range of motion (ROM) as possible at the affected joint. The finger may never return normal extension or range of motion (ROM). Repair is commonly done under local anesthesia and a Bruner approach is utilized. Local anesthetic is injected prior to draping and again prior to incision for augmentation of the first injection. An incision is made along the finger and the subcutaneous tissue is dissected to the depth of the flexor sheath. The ruptured tendon is identified, and a tag stitch is placed, next the tendon is pulled through the pulleys using a shoehorn technique. The flexor tendon is then reattached to the distal phalanx using the pants-over-vest technique using a suture anchor repair and over-the-top and pull-out repair. Adequate repair is assessed by asking the patient to make a fist and then wound closure is done.
Ilyas A, Drummey R. Jersey Finger Repair. J Med Ins. 2020;2020(297) doi:https://jomi.com/article/297

References

{{Reflist Fingers Injuries of wrist and hand Musculoskeletal disorders