Jersey Finger

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Jersey finger is a tendon rupture injury also known as a flexor tendon rupture. This is a common injury involving the fingers, as it occurs in contact sports whenever a player intends to grab the jersey of an opponent and injuries his / her finger; hence the name Jersey Finger. Jersey finger is the avulsion of the FDP (Flexor Digitorum Profundus) which is the tendon that inserts at the base of the distal phalanx or at the end of the finger. The ring finger is involved in a great percentage of these cases due to the anatomy of our fists. In most patients, the ring fingertip is 5mm more prominent than the other digits when the hand is closed, which causes more exposure of the fingertip during a strong grasp. The area injured is known as the flexor tendon zone which involves the tip of the fingers. This zone is prone to avulsions and lacerations injuries to the tendons. The jersey finger is classified from type I to type V, based on the level of tendon retraction in the hand and the presentation of fracture on the distal phalanx. The treatment of this type of injury is based on the level of tendon retraction / classification level. The most common symptoms of a jersey finger include not being able to bend a finger down to your palm, as well as pain and swelling. Usually, when your hand is at rest, your fingers are always in a flexed position. Therefore, when the flexor tendon is injured, the finger will straighten excessively whilst at rest. If jersey finger is not corrected surgically, the finger will still be able to function, however, the active motion of the injured finger will become highly limited. Surgery to repair the injured tendon includes the following:

 

  • Locating the tendon at the base of the finger or palm.

 

  • Thread the tendon into the proper position.

 

  • Reattaching the tendon to the tip of the finger.

Causes & Symptoms

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As mentioned earlier, there are 5 types of jersey finger, classified from mild to severe, including the following:

 

Type I – After the injury, the flexor digitorum tendon is retracted to the palm. The long and short vincula are both ruptured, leading to compromised tendon nutrition. This injury requires treatment within 7-10 days as the tendon contracts and becomes less viable.

 

Type II – Type II of jersey finger injury is the most common type of jersey finger injury; the tendon retracts to the level of the proximal joint. There is the preservation of the long vinculum and retaining more of its blood supply – as the blood supply is not affected, the tendon can be successfully repaired for up to a few months following the injury.

 

Type III – A large bony fragment is avulsed off the distal phalanx. The distal pulley prevents retraction beyond the middle phalanx and can be repaired within several weeks with an optimal outcome.

 

Type IV – There is a bony fragment and also a simultaneous avulsion of the tendon from the fracture fragment (also called double avulsion and the tendon subsequently retracts into the palm). Treatment for this type of jersey finger injury involves open reduction and internal fixation of the fracture fragment and then tendon surgery.

 

Type V – There is a ruptured tendon with avulsion of the bone with bony com Inuit on of the remaining distal phalanx. The injury could be extra-articular or intra-articular.

 

Movement in the hand and fingers is controlled by a system of muscles and tendons located in the forearm, wrist, and hand. Tendons connect muscles to the bone, so when a muscle contracts, or tightens, the muscles power the tendons to move our bones. The ability to bend our fingers to make a fist is controlled by the flexor tendon. Most commonly, a flexor tendon injury results from lacerations (cuts). A laceration to the forearm, hand, or wrist may result in injury to the flexor tendons. When a flexor tendon injury occurs, there can be an inability to bend the fingers, thumb, or wrist. Even small lacerations can result in significant problems with movement if they occur in an important location. Not all tendon injuries are due to lacerations. In some cases, the jersey finger injury can occur if the tendon end pulls away from the bone, if the tendon ruptures due to wear, or if the tendon-muscle interface separates. In the hand, wrist, or forearm, lacerations are the most common cause of jersey finger. However, if you lose motion in a part of your arm, then tendon injury, even without a laceration, should be considered as a possible cause.

If a tendon is completely ruptured or lacerated, you will not be able to bend part of your arm or hand. This lack of movement may involve just a small area in your hand, or it can be the inability to move multiple joints in the arm. The level of impairment depends on where the injury is located. The flexor tendons in the arm, wrist, and hand are close in proximity to the nerves and arteries. It is not unusual to have numbness, tingling, and a lot of bleeding after a tendon is lacerated – this is because there can be an injury to these other vital structures as well. These additional injuries are less common in a jersey finger injury not caused by laceration. For any laceration, it is recommended to seek medical care as soon as you can, particularly if you notice any change in function of the arm. In addition to cuts, certain sports activities may cause jersey finger injuries. Participants in football, wrestling, rugby, and other similar sports may suffer from jersey finger injuries. During rock climbing and other activities that require extensive arm and hanged strength, the tendons and / or sheaths may be stretched or torn. Certain health conditions (such as rheumatoid arthritis) can weaken the flexor tendons, making them more susceptible to tearing. Without a warning or injury, a person may realize the finger no longer bends, without knowing how it occurred.

Who Gets Jersey Finger?

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As mentioned earlier, jersey finger is an injury to the flexor tendon that starts at the tip of the finger and runs to the base, typically resulting in a tear. Whilst jersey finger isn’t an injury exclusive to athletes, it is largely seen in sports including American football, rugby, basketball, and soccer. Athletes in such sports typically suffer from jersey fingers when grabbing another player’s jersey as that player is running in the opposite direction. Similarly, an athlete can sustain a jersey finger injury if they grab another player’s uniform and that player suddenly pulls away. As to gender and age, this condition can affect both men and women, meanwhile, patients older than 65 years are at a higher risk of experiencing a jersey finger, depending on the severity level during performing activities.

How Does It Affect You? How Serious Is It?

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Despite all the symptoms mentioned earlier, there is one risk factor that is associated whilst in the midst of experiencing a jersey finger, and that risk factor is Rheumatoid Arthritis. This condition has been commonly linked to many patients who are already experiencing a jersey finger, as it is a chronic systemic autoimmune disease that primarily affects in a patient’s finger. Additionally, rheumatoid arthritis symptoms appear in the hand when the immune system mistakenly attacks joint tissues in the finger, thumb, and / or wrist, especially when an individual is experiencing a jersey finger.

Recommended Treatment & Rehabilitation

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In most cases, the diagnosis is made clinically based on physical examination findings. In rare cases, additional imaging such as MRI or Ultrasound is used to confirm the diagnosis. If a flexor tendon is completely lacerated or ruptured, then surgery is generally advised in order to regain motion and maximize long-term function. While overall outcomes with surgery are generally fortunate, rehabilitation can be lengthy and requires dedicated hand therapy; most people will regain the ability to use the affected digit, however, the motion may not return to normal. Occasionally, patients develop significant scar tissue that can affect their function and may require additional surgery to release. If the flexor tendon was only partially torn, surgery may not be necessary for treatment. Instead, a doctor may recommend the patient wear a splint. This helps stabilize the finger and allows the damaged tendon to repair itself. Any pain or discomfort caused by the jersey finger injury can be alleviated using non-steroidal anti-inflammatory drugs (NSAIDs). The use of a splint will be accompanied by physiotherapy to help restore strength and movement to the affected finger.

When the flexor tendon is torn, surgical repair or reattachment is required. Many surgeries for jersey finger are performed within 10 days of the injury. Generally, the sooner the tendon repair surgery is performed, the better the outcomes.

The nature of the surgery can vary depending on the injury; however, the aim of flexor tendon repair is to reattach the tendon to the bone. Sutures or stitches are used to help the tendon stay in place. Most tendon repair surgeries are performed on an outpatient basis. A splint is then placed following surgery to stabilize the hand / finger and ensure proper healing.

It can take a few months to heal from tendon repair surgery since the tendon must reattach and strength must be restored to the fingers. Physiotherapy will be initiated after surgery to help restore movement and strength to the affected hand.

Stretching and strengthening exercises may need to be performed during the recovery phase to gain complete motion of the jersey finger – here are some examples of exercises for you to try:

 

  • Finger Extension – This exercise is performed by placing the hand on a table with the palm facing downwards. Raise and drop the injured finger from the table. Perform this exercise about 8 to 12 times.

 

  • Towel Grab – This exercise is performed by folding the towel in half and putting it flat on a table. Afterwards, place the injured hand on the towel with the palm facing downwards. By grabbing the towel, scrunch it as far as possible, applying pressure towards the fist until a mild to moderate pain-free stretch is felt. Gradually straighten the fingers releasing the towel back on the table. Perform this exercise about 8 to 12 times.

 

  • Tennis Ball Squeezes – This exercise involves holding a tennis ball in the hand and squeezing it as hard as possible, ensuring comfort without pain. Hold for 5 seconds and release. It is recommended to repeat 5 to 10 times ensuring there is no exacerbation of symptoms.

 

  • Finger Spring – This exercise is performed by wearing a rubber band around the outer surface of the fingers (including the thumb) – stretch the rubber band by stretching the fingers. Perform 2 sets of 15 repetitions.

Alternative & Homeopathic Treatment

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A doctor will normally recommend treating jersey finger non-surgically when a patient starts having problems with the condition; you can try most of these methods at home or elsewhere:

 

Rest – A jersey finger can result from mild tears; you can simply rest the hand and finger to reduce symptoms linked to this type of injury. Patients may need to rest this part of the body for 1-2 weeks to see results occur.

 

Over-the-counter – Taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can strongly help reduce pain and inflammation from jersey finger (always ensure you’ve read the labels and consulted your doctor).

 

Splinting – A finger splint normally wraps around the palm and has a small covering for the lower portion of the affected finger; this allows an individual to bend the top portion of their finger without moving the part closest to the palm.

 

Using ice packs – Applying a cloth-covered ice pack to the affected finger and palm for 10-15 minutes at a time may help reduce inflammation. A patient should try to ice their finger between 3-5 times per day.

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