What is Jersey Finger (Rugby Finger)?
‘Jersey finger’ or ‘rugby finger’ is an injury where the flexor digitorium profundus tendon or FDP (a tendon in your finger) is pulled from its attachment on the farthest bone of the finger (referred to as distal phalanx or zone I). This usually happens when a finger that’s bent is suddenly forced to straighten, like when trying to grab someone’s jersey during a fast-paced sports game. When this happens, the affected finger looks slightly straighter compared to other fingers and you won’t be able to actively bend it at the furthest joint, called the distal interphalangeal joint or DIP. The treatment of this injury usually involves surgery. The specific surgical plan depends on how soon the injury is treated, the specific area of the injury and if there are any related fractures.
What Causes Jersey Finger (Rugby Finger)?
The tip of your finger, called the distal phalanx, can experience a great deal of pressure, especially during pulling actions. This is often seen in young athletes who play contact sports, such as American football or rugby.
This type of injury usually happens when a bent finger is suddenly and forcefully straightened. Imagine a football player trying to grab the jersey of an opponent to make a tackle. In the process, they might end up extending their finger suddenly during muscle contraction. This forceful motion can lead to an injury known as flexor digitorum distal avulsion.
Risk Factors and Frequency for Jersey Finger (Rugby Finger)
Finger injuries make up about 38% of all injuries to the upper part of the arm. Each year, 33.2 out of every 100,000 people might experience tendon injuries in the hand. However, only 4% of these injuries happen in the flexor tendon zone I, which is located near the middle of the finger.
‘Jersey finger’ is a kind of injury that can occur on any finger, but it’s the most common type of injury to the closed flexor tendon. The riskiest finger for this injury is the ring finger, as it accounts for 75% of these cases. The ring finger stands out more when you grip things, which makes it more susceptible to these types of injuries. Another contributing factor is that the ring finger is located between lumbrical muscles, which can cause it to overstretch. There have been some studies which found that the ring finger’s FDP tendon – the one that helps you move your finger – doesn’t need to be strained as much as the other fingers for it to get injured.
Signs and Symptoms of Jersey Finger (Rugby Finger)
When dealing with athletes suffering from finger pain, it’s important to consider the possibility of a jersey finger, an injury often associated with sports. Common signs include pain on the underside of the affected finger and tenderness. When at rest, the injured finger tends to stay straight while the other fingers curl normally. In certain cases, the retracted tendon might even be felt below the finger’s point of injury. Additionally, the joint at the end of the finger may not bend, and attempts to grip or flex the finger against a resisting force could cause discomfort.
Testing for Jersey Finger (Rugby Finger)
If your doctor suspects you might have a jersey finger injury, a physical exam is usually the key first step for diagnosis. However, X-rays and ultrasounds can also be very helpful. X-rays are necessary to rule out any bone fractures. When an X-ray is taken from the front-to-back (antero-posterior) and from the side (lateral), it can show if there are any bone fragments present.
An ultrasound can add further details about the state of your tendons, especially if there’s no fracture. In cases where the injury is old, the ultrasound is valuable because it can show how much the tendon has retracted or pulled back, which can influence the course of treatment.
While it’s not common, MRI (Magnetic Resonance Imaging) can sometimes be performed. An MRI is a special kind of scan that creates detailed images of the inside of your body. In this scenario, it could be used to measure the distance between the tendon and the bone more precisely.
Treatment Options for Jersey Finger (Rugby Finger)
Jersey finger injuries are commonly treated with surgery due to the urgency of restoring blood flow and functionality to the affected finger. The flexor tendons of the fingers, vital for finger movements, maintain their health through blood supply from internal vessels in a structure called the mesotendon. There is minimal report of non-surgical treatment for this kind of injury, mostly reserved for patients who are at high-risk during surgery.
In the immediate aftermath of the injury, within 3 weeks, the surgical approach can take a couple of different forms. If there is no fractured bone, the damaged tendon can be directly repaired or reattached with a technique involving what’s referred to as a mini-suture anchor. If there is a broken piece of bone, surgery can involve repositioning and securing the bone fragment using small screws or wires. Suture anchors can also be used in cases where the injury involves bony avulsions – where a piece of bone is ripped away as a result of the injury.
There are several effective methods of treating these acute (new) injuries, but none appears to be significantly better than the others.
For older injuries, those present for over 3 months, the surgical approach depends on the state of the finger’s movement and flexibility. If the full range of motion is still present, a two-stage tendon grafting procedure may be used. This involves using a piece of tendon from another location to repair the damaged tendon. On the other hand, if there is chronic stiffness in the joint, joint fusion (or arthrodesis) might be required. This procedure involves fusing the bones of the joint together to reduce pain.
However, the decision to perform joint fusion needs careful discussion with the patient as it could impact their ability to carry out certain occupations or hobbies. In such cases, reconstructing the tendon may be a more appropriate option, but it requires a significant commitment from the patient for a successful long-term recovery since the rehabilitation process can be lengthy.
What else can Jersey Finger (Rugby Finger) be?
Some people might underestimate the severity of a Jersey finger injury, thinking it’s just a minor sprain or a broken finger bone. There have even been instances where athletes have continued to compete despite having this injury.
What to expect with Jersey Finger (Rugby Finger)
Diagnosing an injury early often leads to faster treatment and a great chance of recovering full functionality. Studies show that patients who undergo surgery within 10 days of their injury typically report excellent outcomes.
After treatment, patients can usually expect to return to their sports or other physical activities, without any pain and with a fully restored range of movement, within approximately 8 to 12 weeks.
It’s important to note that if there’s a loss of movement in the DIP joint (a joint in your fingers), this can negatively impact the ability to control fine movements (dexterity) and weaken the strength of a pinch grip.
The successful treatment of these injuries generally depends on a few things: proper realignment (accurate reduction) of the injury, the quality of the repair, and a proper rehabilitation plan. Another key factor to maintaining finger function is preventing the formation of contracture scars, which are scars that restrict movement due to the skin and underlying tissues pulling together during healing.
Possible Complications When Diagnosed with Jersey Finger (Rugby Finger)
Moving a tendon over 1 cm may carry the risk of something called quadriga. This term represents a condition where the fingers next to the affected finger can’t bend due to increased tension on the repaired tendon.
Other common surgical complications may include infection, skin tissue death, rupture of the repaired tendon, injury to the nail’s growth area, and tissue sticking together.
Common Surgical Complications:
- Quadriga (a condition affecting finger movement)
- Infection
- Skin tissue death (skin necrosis)
- Rupture of the repaired tendon
- Injury to the nail’s growth area (nail matrix injury)
- Tissue sticking together (adhesions)
Recovery from Jersey Finger (Rugby Finger)
The force and movement applied in physical therapy after surgery play a big role in managing a jersey finger injury. It’s also crucial to consider the state of the wound and how well the patient follows the treatment plan. If too much force is applied, it could cause the tendon to tear again. The correct positioning of the wrist, finger, and knuckle can help in managing the amount of force used during recovery.
Preventing Jersey Finger (Rugby Finger)
It’s important for patients to know that if a jersey finger injury isn’t treated quickly, they could end up with chronic (long-term) pain and a loss of grip strength in their hand. A jersey finger injury is when one of the tendons that allow you to bend your fingers towards your palm gets damaged. If the tendon pulls away a piece of bone (a ‘bony-avulsion’ type injury), it’s unlikely that the bone will fail to rejoin (‘nonunion’). However, regardless of the type of injury, patients are encouraged to quit smoking to help the bone heal faster.
