Stephen Bird

Hi Catherine,

I don’t really have any articles on this topic, but I would do the following.

Firstly for the jersey finger I would do a clinical test and see if there is any strength at all to flex the DIP joint while you hold the PIP joint in extension. This will tell you if the FDP tendon has any function. Then I would scan the FDP tendon starting at the distal insertion onto the base of the terminal Px. Then flex and extend the DIP joint while you watch to see if the tendon is attached properly and also observing the glide of the tendon. Then follow the tendon proximally in long axis and continue to do a dynamic assessment looking for glide. If you see an area where the tendon buckles rather than glides with DIP joint flexion / extension performed by yourself, this suggests some adhesion to the flexor sheath at this level. Follow it right up through the carpal tunnel and include the MTJ in the distal forearm.
Then check the volar plates, looking for a volar plate avulsion.
Check the A1 pulley to see free glide of the tendons beneath it with no buckling or bunching.
Stress test the A2 pulley with resisted flexion and measure the TP distance looking for bowstringing.
Look at the MCP, PIP and DIP joints for any evidence of arthritis, synovitis or prior ligamentous injury.

I think this is all you can do.

The dynamic component is important as it will either show free glide of the tendons within the sheath or buckling, indicating adhesion.

You can compare with the opposite hand or another finger on the same hand.

Sounds like an interesting case.


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