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

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HardSoft Tissue InjuryClosed flexor digitorum profundus avulsion (jersey/rugby finger)MSRA

A 29-year-old right-hand-dominant rugby player attends a GP-led urgent treatment centre 2 hours after tackling an opponent. His left ring finger became caught in the opponent’s shirt as the opponent pulled away. The finger was forcibly extended while he was trying to maintain his grip. He has swelling and tenderness over the volar aspect of the distal phalanx but no wound or deformity. The ring finger rests slightly more extended than the contralateral side. With the proximal interphalangeal joint held in extension, he cannot actively flex the distal interphalangeal joint. Proximal interphalangeal joint flexion is preserved when the other fingers are held extended. Sensation and capillary refill are normal. True anteroposterior and lateral radiographs show no fracture, avulsion fragment or dislocation. What is the most appropriate management today?

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Reveal the answer and explanation

Correct answer: E — Immobilise the finger protectively, provide analgesia and discuss with the on-call plastic/hand service today for operative assessment

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

This is a closed flexor digitorum profundus (FDP) avulsion ('jersey' or rugby finger). The key linked features are forced extension of a finger that was actively flexing while gripping, loss of isolated active distal interphalangeal (DIP) flexion, and preservation of proximal interphalangeal flexion, showing that flexor digitorum superficialis function remains intact. A normal radiograph does not exclude FDP avulsion because there may be no bony fragment. This is not a simple sprain suitable for buddy strapping and early mobilisation (B or E). Nor is it a mallet injury (C): mallet finger causes loss of active DIP extension after forced flexion, whereas this patient cannot flex the DIP joint. Ultrasound can sometimes help localise a tendon injury, but arranging outpatient imaging before referral (D) delays specialist assessment in an injury for which operative management is generally required. UK hand-injury referral guidance advises referral of flexor tendon injuries to plastics. The appropriate action is protective immobilisation, analgesia and same-day discussion with the on-call hand/plastic service.

Reference: HAND INJURIES (December 2024) — https://www.rightdecisions.scot.nhs.uk/media/jujp5l25/hand-injuries-dec-24.pdf Flexor Tendon Injuries (Checked August 2026) — https://www.gloshospitals.nhs.uk/our-services/services-we-offer/trauma-orthopaedics/hand-clinic/hand-trauma/flexor-tendon-injuries/ A review of mallet finger and jersey finger injuries in the athlete (2017) — https://pubmed.ncbi.nlm.nih.gov/28188545/