Jersey Finger Exercises: Rehabilitate a Flexor Tendon Avulsion

Jersey finger occurs when the flexor digitorum profundus (FDP) tendon is torn from its attachment at the fingertip, typically when grabbing an opponent's jersey while they pull away. This injury almost always requires surgical repair, and proper rehabilitation is critical for restoring finger function.

Understanding Jersey Finger

Anatomy

The FDP tendon runs from the forearm through the finger and attaches to the distal phalanx (fingertip bone). It's responsible for bending the last joint of the finger (DIP joint)—the motion used to make a tight fist.

Mechanism of Injury

Jersey finger occurs when:

• Finger is forcibly extended while actively flexing
• Most common in ring finger (75% of cases)
• Typical scenario: grabbing a jersey as opponent runs away

Types

• Type I: Tendon retracts into palm (most severe, needs urgent surgery)
• Type II: Tendon retracts to PIP joint level
• Type III: Bone fragment attached, tendon stays at DIP joint

Why Surgery Is Required

Unlike mallet finger (extensor tendon), jersey finger:

• Cannot heal without surgical repair
• Blood supply is disrupted when tendon retracts
• Early repair (within 7-10 days) has best outcomes

Critical: Post-Surgical Protocol

These exercises are for AFTER surgical repair. Follow your surgeon's specific protocol—timing may vary based on repair type and surgeon preference.

The exercises below follow a general early controlled motion protocol.

Phase 1: Protected Motion (Week 1-4)

Goals

• Protect surgical repair
• Prevent adhesions
• Maintain tendon gliding
• Control swelling

Splint Wear

Dorsal blocking splint positioning:

• Wrist at 20-30 degrees flexion
• MCP joints at 70-80 degrees flexion
• IP joints extended within splint
• Wear continuously except for exercises

Passive DIP Flexion (Within Splint)

1. Keep hand in splint
2. Use other hand to gently bend DIP joint
3. Move within allowed range (per surgeon)
4. Return to starting position

Perform: 10 reps, every 1-2 hours

Passive Composite Flexion

1. Within splint constraints
2. Use other hand to bend all finger joints together
3. Create gentle fist position
4. Return to starting position passively

Perform: 10 reps, every 1-2 hours

Active Extension (Within Splint Limits)

1. Actively straighten finger
2. Only go to limits allowed by splint
3. Keeps extensor tendon gliding

Perform: 10 reps, every 1-2 hours

Place-and-Hold Exercises

Key for early tendon activation:

1. Use other hand to position finger in flexion
2. Hold position gently with repaired tendon
3. Remove assisting hand briefly
4. Let finger straighten passively

Perform: 10 reps, 4-6 times daily

Edema Control

Reduce swelling:

• Keep hand elevated above heart
• Gentle retrograde massage
• Ice as directed (avoid incision directly)
• Compression wrap if recommended

Phase 2: Early Active Motion (Week 4-6)

Goals

• Begin active flexion
• Continue protecting repair
• Progress tendon loading gradually
• Minimize adhesion formation

Active DIP Flexion (Isolated)

First active use of repaired tendon:

1. Support finger at middle joint (PIP)
2. Actively bend DIP joint
3. Start with small range
4. Progress as allowed

Perform: 10-15 reps, 6-8 times daily

Active Composite Flexion

1. Within splint or out (per protocol)
2. Actively make a fist
3. Focus on DIP joint bending
4. Don't force range

Perform: 10-15 reps, 4-6 times daily

Hook Fist

Isolates FDP function:

1. Keep knuckles (MCP) straight
2. Bend middle (PIP) and end (DIP) joints
3. Creates hook shape
4. Straighten and repeat

Perform: 15-20 reps, 4-6 times daily

Tendon Gliding Exercises

Move through all positions:

1. Straight: All joints extended
2. Hook: PIPs and DIPs flexed, MCPs straight
3. Fist: All joints flexed
4. Tabletop: MCPs flexed, IPs straight
5. Straight fist: MCPs straight, IPs flexed

Perform: 10 cycles, 4-6 times daily

Blocking Exercises

DIP blocking:

1. Hold middle joint (PIP) straight with other hand
2. Bend end joint (DIP) actively
3. Isolates FDP tendon action
4. Straighten and repeat

Perform: 15-20 reps, 3-4 times daily

Phase 3: Progressive Strengthening (Week 6-8)

Goals

• Increase active range of motion
• Begin light resistance
• Improve tendon excursion
• Functional use of hand

Full Active Motion

1. Remove from splint for exercises (if cleared)
2. Make full fist, squeezing gently
3. Straighten completely
4. Work through full range

Perform: 20 reps, multiple times daily

Putty Exercises (Soft Resistance)

Start with lightest resistance:

Finger Hook:

1. Press fingertips into putty
2. Curl fingers into hook position
3. Pull putty toward palm

Finger Squeeze:

1. Wrap putty around injured finger
2. Squeeze gently
3. Focus on DIP flexion

Perform: 15-20 reps each, 2-3 sets

Grip Strengthening (Light)

1. Use soft stress ball
2. Squeeze gently, including injured finger
3. Hold 3-5 seconds
4. Release and repeat

Perform: 15-20 squeezes, 2-3 sets

Functional Grasp Activities

Practice light tasks:

• Picking up small objects
• Holding utensils
• Light pinching activities
• Writing

Phase 4: Advanced Strengthening (Week 8-12)

Goals

• Full strength restoration
• Sport/work-specific function
• Return to normal activities
• Prevent re-injury

Progressive Resistance

Medium Putty:

• All exercises from Phase 3
• Increased resistance

Hand Gripper:

• Light resistance initially
• Progress as tolerated

Perform: 15-20 reps, 3 sets

Pinch Strengthening

Tip Pinch:

1. Pinch small object between thumb and repaired fingertip
2. Hold and squeeze
3. Progress weight/resistance

Key Pinch:

1. Hold object between thumb and side of finger
2. Squeeze firmly

Perform: 15-20 reps each type, 3 sets

Eccentric Loading

Important for tendon strength:

1. Start with finger in flexed position
2. Resist as finger is straightened by other hand
3. Control the lengthening motion
4. Rebuild actively

Perform: 10-15 reps, 2-3 sets

Sport-Specific Training

For return to athletics:

• Gripping activities specific to sport
• Progressive loading
• Practice catching (soft to hard)
• Position-specific movements

Return to Activity Guidelines

Criteria for Return

• Full active range of motion
• Grip strength 80%+ of other hand
• Pain-free with functional activities
• Cleared by surgeon/therapist
• Typically 10-12 weeks minimum

Protective Measures

For return to contact sports:

• Buddy taping to adjacent finger
• Padded gloves
• Gradual exposure to grabbing/gripping
• Avoid early forceful gripping

High-Risk Activities

Use caution with:

• Contact sports (wait for clearance)
• Heavy gripping
• Grabbing moving objects
• Activities that caused injury

Important Considerations

Following Surgeon's Protocol

Protocols vary based on:

• Repair technique used
• Tissue quality
• Tendon retraction level
• Surgeon preference

Always follow your specific surgical protocol. General guidelines here may not match your surgeon's preferences.

Signs of Problems

Contact your surgeon if:

• Sudden loss of motion (possible rupture)
• Significant increase in swelling
• Signs of infection (redness, warmth, drainage)
• Pain that worsens significantly

Tendon Rupture Risk

Highest in first 6-8 weeks:

• Don't force range of motion
• No heavy lifting or gripping
• Follow splint wear schedule
• Progress only as directed

Adhesion Formation

Common complication:

• Scar tissue restricts tendon gliding
• Regular exercise helps prevent
• May need additional therapy or surgery if severe

Exercises to Avoid

First 6 Weeks:

• Active extension against resistance
• Heavy gripping
• Any resistance work
• Sports or lifting

Until Cleared:

• Forceful grip activities
• Contact sports
• Activities with high rupture risk

Sample Daily Schedule (Week 4-6)

Every 2 Hours

• Active DIP flexion: 10-15 reps
• Composite flexion: 10-15 reps
• Tendon gliding: 10 cycles

3-4 Times Daily

• Blocking exercises: 15-20 reps
• Hook fist: 15-20 reps
• Place-and-hold: 10 reps

Continue

• Edema control
• Splint wear per protocol
• Ice as needed

Long-Term Outcomes

With proper rehabilitation:

• Most achieve good functional recovery
• Some permanent stiffness is common
• Full strength may take 4-6 months
• Athletic return typically 3-4 months

Key Takeaways

Jersey finger rehabilitation requires patience and precision:

1. Surgery is required - Can't heal on its own
2. Protect the repair - First 6 weeks are critical
3. Move early but carefully - Controlled motion prevents adhesions
4. Follow your protocol - Surgeon's instructions are specific to you
5. Progress gradually - Tendon strength builds over months

The balance between protecting the repair and preventing stiffness from adhesions makes jersey finger rehabilitation challenging. Working with a hand therapist is strongly recommended.