Transcription:
“Jersey Finger” – A Common Injury for Athletes

Melanie Cole (Host):  While playing sports such as basketball or soccer, it’s easy to snag a finger on an opponent’s jersey and suffer an injury. Do you need ice or do you need to go to a doctor? My guest today is Dr. Bobby Chhabra. He’s chair of UVA’s Department of Orthopedic Surgery and is a board certified orthopedic surgeon. Welcome to the show, Dr. Chhabra. Explain the injury commonly referred to as “jersey finger.”

Dr. Bobby Chhabra (Guest):  Thank you very much, Melanie. Jersey finger is a fairly uncommon injury, except in certain sports, particularly football or soccer, but mainly football. It’s when an individual player is trying to tackle another player and the finger gets caught on the jersey and then gets hyperextended at the most distal joint. The finger, while they are gripping, gets forcibly hyperextended while they are trying to make a tackle. What ends up happening is, the tendon that inserts on the bone, the most distal bone in the finger, gets ruptured off of the bone so you lose flexor tendon function. It’s fairly common in football players.   

Melanie:  Are there certain positions that are more susceptible to this than others?

Dr. Chhabra:  Really, any time someone is trying to make a tackle. So, really any of the defensive players would be susceptible to this and the ring finger is the most common. It’s felt that it’s the finger that is needed the most for forced grip and it’s the one that is injured most frequently. Often people just think they’ve sprained their joint and it will get better on its own. It often takes a while before they realize that they cannot make a full fist and they can’t bend that last joint of the finger.   

Melanie:  That was my next question – symptoms. Maybe it gets caught, maybe they keep playing and then it’s sore--really sore. What are some of the symptoms that people would notice that would send them to see a doctor instead of just using ice?

Dr. Chhabra:  A very good question because you’re right. Frequently, these players will keep playing. They think they’ve just jammed their finger or sprained their finger which are very common injuries. Later on, after the game, after the adrenaline has worn off, they’ll notice that they’re sore. They may have some swelling and then ecchymosis, or black and blue around the distal fingertip and tenderness along the palm side of the finger where their tendon had been pulled off the bone. So, they would be tender along the course of the finger and when they try to make a fist, they’ll be able to bend the joint closer to the palm but they won’t be able to bend the furthest joint from the palm. They may not notice that they can’t do that for some time. They think that they are just sore but if they are having persistent swelling and pain along the flexor tendon there and they notice they have the inability to make a full fist, it’s important--it’s imperative--that they see a hand surgeon, truly. These are injuries that are not handled by general orthopedic surgeons or primary care physicians. These jersey fingers always require surgery in the young athletic individual. Normally, these injuries occur only in the young athletes. 

Melanie:  Tell us a little bit, quickly, about hand surgeons and orthopedic surgeons. Are hand surgeons also orthopods and vice versa?

Dr. Chhabra:  That’s a very good question and it’s not a straightforward answer. Hand surgery or hand, wrist and elbow surgery is a subspecialty and requires fellowship training after you’ve completed either a full orthopedic surgery training residency program or a plastic surgery training residency program. About 85-90% of hand surgeons in this country have completed an orthopedic surgery training program first and they are board certified in orthopedic surgery and they have also done an additional year of training in hand surgery which often includes hand, wrist and elbow surgery. The Hand Society has a certificate of added qualification or a subspecialty certification which, once you have completed your hand fellowship, you can take an exam and have your practice reviewed and be board certified in hand surgery as well. So, for instance, I’m board certified in orthopedic surgery and board certified in hand and upper extremity surgery.

Melanie:  Thank you for clearing that up for us, Dr. Chhabra. If someone has jersey finger, do you recommend that they ice while they see the doctor while they are going through whatever treatment you have decided – we’ll speak about treatments - but is ice something that is going to be the first line of defense?  Something you want them to do right away?

Dr. Chhabra:  Frequently, they may not know the severity of their injury, so ice always helps when you’ve jammed the finger or when you feel like you have injured a joint. Ice will help initially to keep the swelling down and resting that joint so you don’t aggravate symptoms will be important as well for a first line of treatment. But, ultimately, and particularly for jersey finger--and I know we’ll discuss this in just a minute—but, these require more significant treatment options than just rest and ice.  

Melanie:  So, let’s discuss those treatment options. What do you do for it?

Dr. Chhabra:  The one thing that’s very important is, it needs to be diagnosed early because, frequently, the tendon gets ripped off the bone and because there is tension on the tendon because the muscles are in the forearm, the tendon is going to pull back. If it pulls back into the palm, then you have a limited time window to fix that. Really, within seven to ten days that should be surgically repaired. So, the tendon is actually retrieved from the palm and attached back to the bone with various techniques and then requires a very involved therapy program that will last about three months. So, return to full activity will not be sooner than three to four months after an injury like this, if it needs surgical repair. Sometimes the tendon doesn’t pull back or retract back that far and maybe you can wait a little bit longer–a couple of weeks--to have it fixed. But, it is imperative that you are seen soon by a hand surgeon – these injuries are fixed by hand surgeons and those who are certified in hand surgery – because they require various techniques. There is a high rate of stiffness if appropriate therapy is not done. When the results aren’t what you desire after treatment, sometimes a second surgery is needed to relieve scar tissue to allow the tendon to glide so that the full range of motion can be obtained.

Melanie:  Are you splinted after surgery?

Dr. Chhabra: Yes, you are splinted in a splint initially and therapy starts usually three to five days after the surgery and you do what is called “passive motion” for a while in most scenarios where you don’t actively move that finger but you use your other hand to bend the tip so the tendon glides a little bit. But, you can’t do active motion right away because you need the tendon to heal and if you put too much stress on the tendon it will just rip off the bone again while it’s healing. Usually, more aggressive therapy doesn’t start until about four weeks and you’re splinted for almost six weeks after this injury. You’re wearing a splint to protect that tendon repair.

Melanie:  Dr. Chhabra, it’s absolutely fascinating information and you’re so well spoken. In just the last few minutes, please give your best advice for people that think that they may have suffered jersey finger or who want to prevent it and why they should come to UVA Orthopedics for their treatment.

Dr. Chhabra:  Thank you, Melanie. If you’ve injured a finger, the first thing to know is whether you have full motion of that finger. You are going to be stiff and swollen, so it will be hard to make a full fist and to move every joint. But, you should be able to move it once your swelling is better, and you have some ice and it is calmed down a little bit--maybe some anti-inflammatory medication – ibuprofen, Aleve, if you can take that. You should know within a day or two whether you can move every joint. If for some reason, you can’t move the joint, you should be concerned for either a fracture in the finger or a tendon injury. That’s when you should see a hand surgeon soon. If there is any suspicion that you have a tendon injury, then you should see your local hand surgeon soon. As I mentioned, some of these injuries are very time sensitive for surgery, so the sooner you get in the better because if you delay surgery for these injuries, particularly if the tendon is retracted back into the palm, if you wait two or three weeks to have it fixed, then there is a higher rate of stiffness and overall less than desirable outcome. If you can’t move all of your joints, if your pain persists for a couple of days, then you should see a hand surgeon very soon. As for UVA Orthopedics, I’m fortunate to work in a department - I’ve spent my entire career there at UVA. We were just recently named one of the top 100 great orthopedic programs by Becker’s Hospital Review. We’re fortunate in that we have every specialty represented. We have joint surgeons, hand surgeons, joint replacement surgeons, sport surgeons, spine surgeons. I work at the UVA Hand Center which has six specialty-trained hand surgeons. We have experts in every field of orthopedics that can provide the highest level of care. I am also thankful that we were recognized by the Women’s Choice Award recently for the National Patient Satisfaction Award. So, I feel you’ll get great comprehensive care at UVA Orthopedics. You’ll have specialists who are fellowship trained in an individual joint or problem and you’ll have the best chance of having the best outcome.

Melanie:  Thank you so much. You’re listening to UVA Health Systems Radio. For more information you can go to UVAHealth.com. That’s UVAHealth.Com. This is Melanie Cole. Thanks so much for listening.