II. Pathophysiology

  1. Avulsion of the flexor digitorum profundis tendon

III. Mechanism

  1. Ring finger most commonly affected (75% of cases)
    1. Protrudes further than other fingers on grasping
  2. Forced hyperextension of an actively flexed DIP joint
  3. Example
    1. Football player grabs a player's jersey on tackle
    2. Lifting latch on car door

IV. Symptoms

  1. Pain and swelling at volar aspect of DIP
  2. Localized tenderness and fullness if tendon retraction
  3. Affected finger more extended at DIP when hand at rest
  4. Inability to flex at affected DIP joint

V. Signs

  1. Do not passively force finger into extension
    1. Avulsed tendon retracts with avascular risk
  2. Assess Profundus
    1. Hold proximal interphalangeal joint (PIP)
    2. Test active flexion of distal Interphalangeal joint
    3. Avulsion results in inability to flex at DIP
    4. FDP Tendon may retract to the palm
  3. Assess for flexor digitorum superficialis rupture
    1. Hold all fingers except affected finger in extension
    2. Test proximal interphalangeal joint (PIP) flexion

VI. Imaging: XRay digit (AP, Lateral, Oblique)

  1. Assess for bony avulsion of volar distal phalanx

VII. Management

  1. Early surgical repair in all cases
  2. Temporize by Splinting finger in current position
  3. Hand surgeon or orthopedics referral
    1. Best recovery if repaired within 7-10 days of injury

VIII. Complications

  1. Fibrosis and scarring of tendon sheath
    1. Associated with delayed surgical repair

IX. Follow-Up

  1. No sports participation until fully recovered

X. References

  1. Brandenburg (1996) Consultant p.331-340
  2. Calmbach (1996) Lecture in Minneapolis
  3. Dvorak (1996) Lecture in Minneapolis
  4. Lillegard (1996) Lecture in Minneapolis
  5. Wang (2001) Am Fam Physician 63(10):1961-66 [PubMed]

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Ontology: Rupture flexor digitorum profundus tendon (C0434353)

Concepts Injury or Poisoning (T037)
SnomedCT 202970006, 209772006
English Rupt flex digit profundus tndn, rupture of flexor digitorum profundus tendon, rupture of flexor digitorum profundus tendon (diagnosis), Rupture flexor digitorum profundus tendon, Rupture flexor digitorum profundus tendon (disorder)
Spanish ruptura del flexor comĂșn profundo de los dedos (trastorno), ruptura del flexor comĂșn profundo de los dedos