FDP adhesions, Pulleys and Volar Plates

[Catherine Camilleri]

Patient history: Oz Tag injury to ring finger. Required surgical repair of his MP # ring finger in December 2023. Now presents with a Jersey finger and the patient mentioned that the finger had been this way since the injury. The referral:? FDP rupture? adhesions.

Conclusion: The distal FDP was intact, and a scan was carried up through to the wrist. We concluded A2 & A3 pulley injury and volar plate at the DIPJ were irregular consistent with possible previous injury.

Question – Can ultrasound diagnose flexor tendon adhesions? Can a DIPJ volar plate small and irregular, lifting off the MP be a cause of Jersey finger?

[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.

Steve.

[Marek Czeladzki]

Hi Steve

Do you have any videos showing buckling of the tendon on dynamic testing? Do you see adhesions often in clinical practice?

[Stephen Bird]

Here are some examples of friction.

I haven’t kept a clip of the buckling,

I will look out for one.

You get the buckle when you manually flex the finger and the tendon fails to slide, causing it to buckle.

Steve

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[Stephen Bird]

Here are the other videos.

Steve

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