Raiyyan Tahsan

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TC(1075).(05).Orthopedics Case No 151:- Jersey Finger

Jersey Finger — বাংলা Clinical Note

1) Definition

Jersey finger হলো Flexor Digitorum Profundus বা FDP tendon-এর avulsion injury, যেখানে tendon টি distal phalanx-এর volar/base insertion থেকে ছিঁড়ে যায়। ফলে রোগী আক্রান্ত আঙুলের DIP joint actively flex করতে পারে না। এটি সাধারণত closed flexor tendon injury এবং definitive treatment বেশিরভাগ ক্ষেত্রে early surgical repair।

2) Cause / Etiology & Pathophysiology — বাংলায় Point আকারে

  • Forced extension of a flexed finger
    আঙুল ভাঁজ করা অবস্থায় হঠাৎ জোরে সোজা হয়ে গেলে FDP tendon ছিঁড়ে যায়।
  • Sports injury — classic mechanism
    Rugby/football-এ opponent-এর jersey ধরার সময় opponent টান দিলে আঙুল জোরে hyperextend হয়—তাই নাম Jersey finger।
  • Ring finger বেশি আক্রান্ত
    Ring finger gripping position-এ বেশি prominent থাকে, তাই traction injury বেশি হয়; StatPearls অনুযায়ী ring finger প্রায় 75% ক্ষেত্রে involved।
  • Weakest point
    FDP tendon distal phalanx-এর base/insertion অংশে weakest থাকে; তাই DIP hyperextension during maximal FDP contraction হলে tendon avulse হয়।

3) Symptoms / Clinical Features — বাংলায় Point আকারে

  • DIP joint flex করতে না পারা
    রোগী আক্রান্ত আঙুলের শেষ জয়েন্ট ভাঁজ করতে পারে না—এটাই সবচেয়ে গুরুত্বপূর্ণ sign।
  • Volar side pain/tenderness
    আঙুলের palmar/volar পাশে ব্যথা ও tenderness থাকে।
  • Swelling, bruising/ecchymosis
    আঘাতের পরে ফুলে যাওয়া ও কালচে দাগ থাকতে পারে।
  • Finger resting position abnormal
    আক্রান্ত আঙুল rest position-এ অন্য আঙুলের তুলনায় বেশি সোজা/extended থাকতে পারে।
  • Grip করলে ব্যথা
    মুঠো করতে গেলে বা resistance-এর বিরুদ্ধে flexion করতে গেলে ব্যথা বাড়ে।
  • “Pop” অনুভব করা
    অনেক রোগী injury সময় আঙুলে “pop/tear” অনুভব করার কথা বলে।

4) Clinical Diagnosis — Specific

Bedside clinical test

  1. Isolate DIP joint test
    • PIP joint stabilize করে রোগীকে DIP joint flex করতে বলা হয়।
    • DIP flexion absent = Jersey finger highly suspected।
  2. FDS vs FDP differentiation
    • FDP কাজ করে DIP flexion।
    • FDS কাজ করে PIP flexion।
    • Jersey finger-এ PIP flexion থাকতে পারে, কিন্তু DIP flexion থাকে না।
  3. Palpation
    • Volar side palpate করলে retracted tendon stump কোথায় আছে বোঝা যেতে পারে; maximal tenderness tendon stump-এর level hint করতে পারে।

5) Investigations — Specific

  • X-ray: AP + Lateral view of finger
    • Mandatory, কারণ bony avulsion fracture আছে কি না দেখতে হবে।
  • Ultrasound
    • Tendon continuity, tendon retraction, stump location দেখতে useful।
    • Chronic case-এ tendon retraction planning-এর জন্য খুব helpful।
  • MRI
    • Routine না, কিন্তু uncertain diagnosis, chronic case, surgical planning বা ultrasound inconclusive হলে tendon-bone distance/retraction ভালোভাবে দেখায়।

6) Differential Diagnosis

  • Mallet finger — extensor tendon injury; DIP extension loss থাকে, flexion loss নয়।
  • Distal phalanx fracture
  • Finger sprain / collateral ligament injury
  • FDP laceration — open cut/wound থাকলে।
  • Pulley injury — bowstringing/pain with flexion থাকে।
  • A2/A4 pulley rupture in climbers
  • Trigger finger — locking/catching, acute traumatic DIP flexion loss নয়।

7) Complications — বাংলায় বুঝিয়ে

  • Permanent DIP flexion loss
    Surgery delay হলে শেষ জয়েন্ট আর ভাঁজ নাও হতে পারে।
  • Grip strength কমে যাওয়া
    FDP tendon grip strength-এর জন্য important; repair না করলে মুঠো করার ক্ষমতা কমে যায়।
  • Chronic pain and stiffness
    Scar tissue ও tendon retraction-এর কারণে chronic pain/stiffness হতে পারে।
  • Tendon adhesion
    Surgery-এর পরে tendon surrounding tissue-এর সাথে আটকে গেলে movement কমে যায়।
  • Joint contracture
    দীর্ঘদিন immobilization বা poor rehabilitation হলে DIP/PIP stiff হয়ে যেতে পারে।
  • Re-rupture / repair failure
    early overuse, poor compliance বা weak repair হলে tendon আবার ছিঁড়তে পারে।
  • Infection
    open wound বা post-operative wound infection হতে পারে।
  • Quadriga effect
    repaired tendon অতিরিক্ত tight হলে adjacent finger flexion কমে যেতে পারে।

8) Management / Treatment — Guideline-based

A) Immediate First Aid

  • আঙুল rest দিতে হবে।
  • Ice pack 15–20 মিনিট করে দিতে পারে।
  • Elevation করতে হবে।
  • Ring থাকলে খুলে ফেলতে হবে।
  • Splint দিয়ে immobilize করতে হবে।
  • Open wound থাকলে clean dressing, wound wash, tetanus assessment।
  • Urgent hand surgeon/orthopedic referral — কারণ early repair outcome ভালো।

B) Definitive Treatment

Acute injury: usually within 3 weeks

  • No fracture: direct tendon repair বা tendon reinsertion using suture anchor/pull-out technique।
  • Bony avulsion fracture: ORIF with mini-screw/K-wire/anchor depending on fragment size।
  • Best outcome: early diagnosis + prompt repair + supervised hand therapy।

Chronic injury: usually >3 months

  • Good passive ROM থাকলে: staged tendon grafting / reconstruction।
  • Severe stiffness বা low demand patient: DIP arthrodesis may be considered।

9) Pharmacological Treatment — Bangladesh Practice-Oriented

Important: Jersey finger-এর curative treatment medicine নয়। Drugs ব্যবহার হয় pain control, inflammation control, gastric protection, wound/post-op infection prevention, tetanus prophylaxis এর জন্য।

9.1 Pain & Inflammation Drugs

1) Generic name: Paracetamol

  • Therapeutic category: Analgesic, antipyretic
  • Pharmacological class: Non-opioid analgesic; para-aminophenol derivative
  • Why used: Mild–moderate pain control; NSAID contraindicated হলে safer option
  • Adult dose: 500 mg–1 g orally every 6–8 hours PRN
  • Max dose: সাধারণত 3–4 g/day; liver disease/alcohol use-এ কম
  • Duration: 3–5 days PRN
  • Bangladesh Available Brand:
    • Napa 500 mg tablet — Paracetamol 500 mg
    • Other strengths: 665 mg XR, 1000 mg also listed by MedEx.

Side effects: nausea, rash, hepatotoxicity in overdose.
Interaction: alcohol, warfarin with prolonged high-dose use, enzyme inducers such as rifampicin/phenytoin/carbamazepine.

2) Generic name: Ibuprofen

  • Therapeutic category: Analgesic, anti-inflammatory
  • Pharmacological class: NSAID; propionic acid derivative
  • Why used: Pain + swelling/inflammation কমাতে
  • Adult dose: 400 mg orally 2–3 times daily after food
  • Duration: 3–5 days; lowest effective dose
  • Bangladesh Available Brand:
    • G-Ibuprofen 400 mg tablet — Ibuprofen 400 mg
    • Profen 400 mg tablet — Ibuprofen 400 mg listed in MedEx search result.

Side effects: dyspepsia, gastritis, GI bleeding, renal impairment, BP rise, bronchospasm in NSAID-sensitive asthma.
Interaction: anticoagulants, antiplatelets, steroid, SSRI, ACEi/ARB + diuretic, lithium, methotrexate.
Avoid: PUD, CKD, uncontrolled HTN, heart failure, 3rd trimester pregnancy.

3) Generic name: Naproxen Sodium

  • Therapeutic category: Analgesic, anti-inflammatory
  • Pharmacological class: NSAID; propionic acid derivative
  • Why used: Longer acting NSAID for pain/swelling
  • Adult dose: 250–500 mg orally twice daily after food
  • Max: 1000 mg/day usually
  • Duration: 3–5 days
  • Bangladesh Available Brands:
    • Naproxen 500 mg tablet
    • Naproxin 250 mg / 500 mg tablet
    • Naxo 500 mg tablet
    • Naxsil 500 mg tablet
    • Pairox 250 mg / 500 mg tablet
    • Proxen 500 mg tablet

Side effects: GI irritation/bleeding, renal impairment, edema, BP rise.
Interaction: same NSAID interactions; do not combine with ibuprofen/diclofenac.

4) Generic name: Diclofenac Sodium

  • Therapeutic category: Analgesic, anti-inflammatory
  • Pharmacological class: NSAID; phenylacetic acid derivative
  • Why used: Short course for acute pain/swelling; injection sometimes post-trauma/post-op under supervision
  • Adult oral dose: 50 mg orally 2–3 times daily after food
  • Max: 150 mg/day
  • Duration: 3–5 days
  • Bangladesh Available Brand:
    • Diclofen 50 mg tablet — Diclofenac sodium 50 mg
    • Other forms listed: 100 mg SR, 75 mg/3 ml injection, 1% gel.

Side effects: gastritis, GI bleed, renal injury, liver enzyme rise, edema, cardiovascular risk.
Interaction: anticoagulants, aspirin/antiplatelets, ACEi/ARB, diuretics, steroids, lithium, methotrexate.
Avoid: ischemic heart disease, high GI bleed risk, CKD, PUD.

9.2 Gastric Protection if NSAID is Used

5) Generic name: Pantoprazole

  • Therapeutic category: Antiulcerant / acid suppressant
  • Pharmacological class: Proton pump inhibitor, PPI
  • Why used: NSAID-induced gastritis/ulcer risk কমাতে, especially high-risk patient
  • Adult dose: 20–40 mg orally once daily before breakfast
  • Duration: NSAID চলাকালীন 3–7 days; high-risk হলে physician decision
  • Bangladesh Available Brand:
    • Pantonix 20 mg EC tablet — Pantoprazole 20 mg

Side effects: headache, diarrhea/constipation, long-term use-এ hypomagnesemia, B12 deficiency, fracture risk.
Interaction: clopidogrel interaction concern PPIs-এ থাকে; pantoprazole relatively preferred, but clinical context needed.

9.3 Antibiotics — Only if Indicated

Closed Jersey finger-এ routine antibiotic দরকার হয় না। Antibiotic দরকার হতে পারে যদি open wound, contaminated wound, bite injury, surgical wound, cellulitis, post-op prophylaxis থাকে। Hand bite/wound infection prophylaxis-এ co-amoxiclav commonly first-line in many guidelines; prophylaxis often 3 days, infection হলে 5–7 days।

6) Generic name: Amoxicillin + Clavulanic Acid

  • Therapeutic category: Antibacterial
  • Pharmacological class: Aminopenicillin + beta-lactamase inhibitor
  • Why used: Open/contaminated hand wound, bite wound, post-op infection risk, skin-soft tissue infection coverage
  • Adult dose:
    • 625 mg orally every 8 hours or
    • 875/125 mg every 12 hours
  • Duration: Prophylaxis 3 days; infection 5–7 days depending on severity
  • Bangladesh Available Brands:
    • Moxaclav 500 mg + 125 mg tablet
    • Clavoxil 500 mg + 125 mg tablet
    • Clamox 500 mg + 125 mg tablet
    • Demoxiclave 500 mg + 125 mg / 875 mg + 125 mg tablet
    • Fimoxyclav 500 mg + 125 mg / 875 mg + 125 mg tablet

Side effects: diarrhea, nausea, rash, candidiasis, cholestatic hepatitis rarely.
Interaction: warfarin INR increase, methotrexate toxicity risk, allopurinol rash risk.
Avoid/caution: penicillin allergy, previous cholestatic jaundice with co-amoxiclav, renal impairment dose adjustment.

7) Generic name: Cefuroxime Axetil

  • Therapeutic category: Antibacterial
  • Pharmacological class: 2nd generation cephalosporin
  • Why used: Alternative antibiotic for susceptible skin/soft tissue infection or perioperative/wound infection context; clinician decision
  • Adult dose: 500 mg orally twice daily after food
  • Duration: 5–7 days if infection; perioperative prophylaxis regimen differs
  • Bangladesh Available Brands:
    • Cefobac 250 mg / 500 mg tablet
    • Turbocef 250 mg / 500 mg tablet
    • Rofurox 250 mg / 500 mg tablet
    • Uroxime 250 mg / 500 mg tablet
    • Vexotil 250 mg / 500 mg tablet
    • Ximetil 250 mg / 500 mg tablet; 750 mg/vial injection

Side effects: diarrhea, nausea, rash, candidiasis, C. difficile diarrhea rarely.
Interaction: antacids/PPI may reduce absorption of oral cefuroxime axetil; warfarin INR may increase.
Avoid/caution: cephalosporin allergy; severe penicillin anaphylaxis history হলে caution।

9.4 Tetanus Prophylaxis — Open/Dirty Wound হলে

CDC wound guidance অনুযায়ী tetanus prevention-এর জন্য wound cleaning, vaccination status assessment, এবং প্রয়োজন হলে TIG ব্যবহার করা হয়; antibiotic tetanus prevention-এর জন্য recommended নয়।

8) Generic name: Adsorbed Tetanus Vaccine

  • Therapeutic category: Vaccine
  • Pharmacological class: Toxoid vaccine
  • Why used: Tetanus prevention after injury if vaccination incomplete/unknown or booster due
  • Dose: 0.5 ml IM once, vaccination history অনুযায়ী
  • Bangladesh Available Brands:
    • TTvax IM injection 40 IU/0.5 ml
    • Vaxitet IM injection 40 IU/0.5 ml

Side effects: injection site pain, fever, malaise, allergic reaction rare.
Interaction: major drug interaction নেই; immunization schedule follow করতে হবে।

9) Generic name: Human Tetanus Immunoglobulin, TIG

  • Therapeutic category: Immunoglobulin / passive immunization
  • Pharmacological class: Human immunoglobulin
  • Why used: Dirty/contaminated wound + unknown/incomplete tetanus immunization হলে passive protection
  • Dose: 250 IU IM single dose; severe contaminated wound/late debridement হলে 500 IU may be considered depending on protocol
  • Bangladesh Available Brands:
    • Protet-IG 250 IU/ml IM injection
    • Tetagam-P 250 IU/ml IM injection

Side effects: injection site pain, fever, allergic reaction, anaphylaxis rare.
Interaction: live attenuated vaccines—measles/mumps/rubella/varicella efficacy reduce হতে পারে; spacing দরকার।

10) Bangladesh Doctors Common Prescription Pattern — Point আকারে

Closed Jersey finger, no wound:

  • Paracetamol — pain control
  • Short NSAID: ibuprofen/naproxen/diclofenac — swelling + inflammatory pain
  • PPI if NSAID risk — gastritis/ulcer prevention
  • Splint + urgent hand surgeon referral

Open wound / contaminated injury:

  • Wound wash + dressing
  • Tetanus vaccine ± TIG based on immunization status
  • Antibiotic such as amoxicillin-clavulanate; cefuroxime may be used based on wound type/local practice
  • Surgical exploration/repair

Post-operative:

  • Analgesic: paracetamol ± NSAID
  • Antibiotic if surgeon prescribes
  • Splint
  • Hand therapy protocol
  • Follow-up for tendon glide, stiffness, infection, repair integrity

11) Prevention — বাংলায়

  • Contact sports-এ proper technique শেখা—jersey/cloth ধরে tackle কম করা।
  • Finger taping বা protective splint ব্যবহার, especially previous finger injury থাকলে।
  • Sports gloves ব্যবহার করা।
  • Finger injury হলে “sprain” ভেবে neglect না করা; DIP flex করতে না পারলে same day hand surgeon/orthopedic review।
  • Diabetes/smoker patient হলে wound healing risk বেশি—early care দরকার।
  • Open wound হলে clean dressing, tetanus status update, infection signs monitor করা।

Overview / Summary

Jersey finger = FDP tendon avulsion from distal phalanx, classic sign হলো DIP joint actively flex করতে না পারা। X-ray mandatory to rule out bony avulsion; ultrasound/MRI tendon retraction দেখাতে পারে। Definitive treatment সাধারণত early surgical repair, ideally acute phase within 3 weeks; medicines শুধু pain, inflammation, gastric protection, wound/post-op infection prevention, tetanus prophylaxis-এর জন্য।

Actionable Plan / Steps

  1. DIP flexion test করুন — PIP stabilize করে DIP flex করাতে বলুন।
  2. X-ray AP/Lateral finger urgently করুন।
  3. Hand surgeon/orthopedic referral same day/early — delay হলে functional loss হয়।
  4. Pain control: paracetamol ± short-course NSAID if no contraindication।
  5. Open/dirty wound হলে: wound toilet + tetanus status + antibiotic only if indicated।
  6. Surgery-এর পরে: splint + supervised hand therapy; uncontrolled active use avoid।

Reference List — Textbook + Guideline + DOI

Textbooks

  1. Green’s Operative Hand Surgery, 8th ed. Chapter: Flexor tendon injuries / Zone I FDP avulsion.
  2. Apley & Solomon’s System of Orthopaedics and Trauma, latest ed. Chapter: Hand injuries / tendon injuries.
  3. Campbell’s Operative Orthopaedics, latest ed. Section: Hand tendon injuries.
  4. Katzung & Trevor’s Basic & Clinical Pharmacology, latest ed. NSAIDs, analgesics, antimicrobial pharmacology.
  5. Goodman & Gilman’s The Pharmacological Basis of Therapeutics, latest ed. Analgesics, NSAIDs, beta-lactam antibiotics.

Guidelines / Clinical References

  1. MSD Manual Professional Edition: FDP Avulsion—radiographs to exclude avulsion fracture; treatment with surgery.
  2. StatPearls/NCBI Bookshelf: Jersey Finger—evaluation and surgical management.
  3. CDC Clinical Guidance for Wound Management to Prevent Tetanus, updated 2025.
  4. NICE NG184: Human and animal bites—antimicrobial prescribing, 2020; hand/bite wound prophylaxis context.

Peer-reviewed / DOI

  1. Ruchelsman DE, Christoforou D, Wasserman B, Lee SK, Rettig ME. Avulsion injuries of the flexor digitorum profundus tendon. J Am Acad Orthop Surg. 2011;19(3):152–162. DOI: 10.5435/00124635-201103000-00004.
  2. Drummey RM, Ilyas AM. Jersey finger repair. Journal of Medical Insight. 2021;2021(297). DOI: 10.24296/jomi/297.
  3. Freilich AM. Evaluation and treatment of jersey finger and pulley injuries in athletes. Clin Sports Med. 2015;34(1):151–166. DOI: 10.1016/j.csm.2014.09.001.

Md.Rafiqul Islam Lipu,Date:-23-06-2026 Tuesday,Time:-11-47-12 Am

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