Presentation

Patients usually report an inability to actively flex the distal inter-phalangeal joint (DIPJ) of the injured finger, which cannot be incorporated into a normal grip. Patients will often explain that the injury was consequence of forced extension of the DIPJ whilst attempting a strong power grip (for example as consequence of their finger being caught in an opponents clothes whilst attempting a rugby-tackle).

Investigation

A lateral x-ray of the finger can be helpful to exclude the presence of a fracture at the DIPJ. The avulsed tendon can become lodged close to the DIPJ, or in the finger, or in the palm. Identification of it’s location helps plan the extent of surgery.

In some patients the avulsed tendon will pull off a small fragment of bone, which can be seen on x-ray, helping to identify the position of the avulsed tendon.

If uncertainty persists an ultra-sound scan can help identify the position of the tendon end before surgery.

Surgery

The tendon can usually be reattached using a commercial “bone anchor”. The operation is usually carried out under general anaesthetic as a day case. The Hand is protected after surgery with a splint. Patients may need hand therapy at weekly or fortnightly intervals for up to eight weeks. The hand is usually protected with a splint for six weeks.

Risks

If there is a prolonged delay (weeks) between the injury and presentation, then it may not be possible to reattach the tendon due to collapse and scarring of the flexor tendon sheath within the finger, or shortening of the muscle and tendon.