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Closed flexor digitorum profundus avulsion (jersey finger) — MSRA MCQ

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ModerateSoft Tissue InjuryClosed flexor digitorum profundus avulsion (jersey finger)MSRA

A 27-year-old right-hand-dominant amateur rugby player attends a GP-led urgent treatment centre 3 hours after his left ring finger caught in an opponent’s shirt during a tackle. The finger was forcibly extended while he was actively gripping. He has volar tenderness and swelling around the distal phalanx but no wound or deformity. Passive movement at the distal interphalangeal (DIP) joint is full. When the proximal interphalangeal joint is held in extension to isolate flexor digitorum profundus function, he cannot actively flex the DIP joint. Active proximal interphalangeal flexion is preserved. Sensation and capillary refill are normal. True anteroposterior and lateral finger radiographs show no fracture, avulsion fragment or dislocation. What is the most appropriate management now?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Protect the finger in a splint and arrange urgent assessment by the on-call hand surgery service

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · B = shown as D

This is a closed flexor digitorum profundus (FDP) avulsion, commonly termed jersey finger. The discriminating features are forced extension of a flexed gripping finger during rugby and absent isolated active DIP flexion despite preserved passive DIP movement and preserved PIP flexion. A normal radiograph does not exclude FDP avulsion because there may be no bony fragment. This represents a significant acute soft-tissue hand injury requiring urgent specialist hand assessment; delay can permit tendon retraction and complicate primary repair. A is appropriate for a stable minor ligament sprain, but not for loss of tendon function. B may be used for selected stable volar-plate injuries, typically involving the PIP joint, but does not address an FDP avulsion. C is treatment for mallet finger, in which active DIP extension—not flexion—is lost after forced flexion of an extended DIP joint. E is attractive because ultrasound may help localise an atypical tendon injury, but imaging should not delay urgent hand-service assessment when the clinical diagnosis is clear. The immediate priority is protection and urgent referral rather than definitive imaging or routine follow-up.

Reference: NHS Tayside RefGuide: Hand (accessed 15 August 2026) — https://www.rightdecisions.scot.nhs.uk/nhs-tayside-refguide/surgery-and-orthopaedics/orthopaedic-and-trauma-surgery/hand/?UNLID=236413506202621518319 Closed rupture of flexor digitorum profundus in zone III (2020) — https://pubmed.ncbi.nlm.nih.gov/32295800/ Closed traumatic avulsion of both ring finger flexors with successful primary repair more than 4 weeks after injury and a review of the literature (2020) — https://pubmed.ncbi.nlm.nih.gov/32699602/