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FDP avulsion rupture repair (Jersey finger)
Repair of flexor digitorum profundus (FDP) tendon avulsion, where the tendon has torn away from its bony insertion at the distal phalanx (commonly a “jersey finger” injury), reattaching the tendon using suture anchors or a pull-through technique to restore active flexion of the fingertip.
At a glance
Anaesthetic
General anaesthetic
Where
The Avenue Hospital
Day case or overnight
Day case - home the same day
First post operative review
One week after surgery
Driving
Not until out of splint and adequate finger control has returned, generally 6-8 weeks
Post Operative Hand Therapy
Essential - early, closely supervised protected motion therapy is required after repair
Splinting
Yes - a protective splint is worn for approximately 4-6 weeks after repair
Pain relief
Usually paracetamol and/or ibuprofen; stronger pain relief may be needed initially
Return to repetitive & heavy loading
Usually 3 months or more before resuming unrestricted grip and sport
Repair of the flexor digitorum profundus tendon avulsed from the fingertip ("jersey finger")
FDP avulsion repair addresses a “jersey finger” injury, where the flexor digitorum profundus (FDP) tendon – which bends the tip of the finger – is torn away from its attachment at the base of the fingertip bone, classically from grabbing an opponent’s jersey while the finger is forcibly straightened. The ring finger is most commonly affected. Because the tendon can retract into the palm, this injury generally requires prompt surgical repair.
Who is this procedure for?
- People unable to actively bend the tip of the affected finger after a forced hyperextension injury, most classically during sport
- People diagnosed with an FDP avulsion, ideally within the first one to two weeks of injury, as delayed presentation makes direct repair progressively more difficult, particularly if the tendon has retracted into the palm
- People with an associated bony avulsion fragment visible on x-ray at the base of the fingertip bone
- Not needed where the tendon has been avulsed for a prolonged period and direct repair is no longer possible - other reconstructive options are then discussed
If the tendon has been avulsed for more than 1-2 weeks then the alterative surgical reconstruction options are
- two stage tendon reconstruction, or
- joint fusion.
A two stage tendon reconstruction involves two operations spaced a minimum of three months apart. The first surgery has a short recovery; the second surgery joins up the tendon and has an 8+ week recovery, just as when the surgery is done at an early stage after injury.
What does the surgery involve?
Surgery involves locating the retracted tendon end, which may have pulled back to the level of the finger, palm, or occasionally further depending on the injury pattern and time since injury, and passing it back down its tunnel (the flexor sheath) to its normal position at the base of the fingertip bone. The tendon is then reattached to bone, either with sutures anchored directly into the bone or passed through the bone and tied over a button on the fingertip. If there is a bony fragment, this may instead be fixed back into position with a small screw or wire.
Alternatives to surgery
Direct repair is the preferred option when performed early. Depending on your situation, the alternatives may include:
- Delayed reconstruction: if presentation is delayed and the tendon has retracted and scarred, options such as staged tendon grafting or fusion of the fingertip joint (DIP joint fusion) may be discussed instead of direct repair
- Non-surgical management: occasionally appropriate for very low-demand patients or specific injury patterns where the deficit is well tolerated, though this is not the norm
What happens if left untreated: without repair, the ability to actively bend the fingertip is permanently lost, and the window for straightforward direct repair narrows as time passes.
Dr Tomlinson will discuss which options suit your specific injury and timing at your consultation.
Frequently Asked Questions
Where will my surgery be done?
At The Avenue Hospital.
How much time will I need to have away from work?
This depends on what your job involves. Desk-based work may be possible within a couple of weeks with the hand splinted, but you will be severely limited in the use of your hand in the first six weeks. Manual work, gripping and sport are deferred for a longer period while the repair heals and undergoes protected rehabilitation. Dr Tomlinson will give you advice tailored to your job at your consultation.
When will I be able to drive again?
Multiple things affect this: which hand was treated, whether you’re wearing a bandage, whether you can grip the wheel and respond safely in an emergency, whether you are driving for personal or commercial purposes, the nature of the vehicle you are driving, and your pain levels and medications. You also need to be safely in control of the vehicle for insurance purposes – you should be able to grip the steering wheel strongly with both hands and be able to take evasive action in an emergency before you get behind the wheel. As a guide: plan not to drive for eight weeks after the procedure.
When can I do a full day of administrative or desk work?
Often from 2 weeks after surgery, particularly with some temporary adjustments (see below). Keeping your hand elevated and taking regular breaks helps reduce swelling and discomfort in the early days. If you need to drive to work or carry or lift objects as part of your administrative work then alternate or half days may be a prudent measure when first returning to work. However, do note that you will be relatively one handed for 8 weeks after the surgery.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include:
– Half days or alternate days to begin with
– No heavy lifting
– Lighter duties or being off tools
– More frequent breaks
– Using a headset instead of holding a phone
– Voice-to-text or dictation instead of typing
– Keeping the hand elevated at your workstation
– Avoiding repetitive gripping
– Help with carrying or moving items
– Moving temporarily to reception or phone duties if your role is normally manual
– Protecting the wound if your work exposes your hands to water or contamination (e.g. food handling, healthcare, wet trades)
We’re happy to provide a letter for your employer outlining recommended modifications.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during sedation or a general anaesthetic. In line with current ANZCA guidance, if you’re having sedation or a general anaesthetic you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication — your anaesthetist will give you specific instructions.
How long will I need to wear a splint?
A protective splint holding the wrist and finger in a specific position is worn for approximately 6-8 weeks after repair, following a closely supervised, staged rehabilitation protocol.
Will I need to see a hand therapist afterwards?
Hand therapy is essential after flexor tendon repair. Early, carefully controlled protected motion (following a specific therapy protocol) is important to reduce the risk of the repair rupturing while also minimising adhesions and stiffness – this balance requires expert supervision.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen – is all that’s needed. Some procedures are more uncomfortable and you may need stronger pain relief. We can always prescribe stronger painkillers if you need them.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of this surgery
- Re-rupture of the repaired tendon
- Reduced bending of the neighbouring, uninjured fingers (quadrigia) if the tendon is repaired under too much tension
- Stiffness of the finger, or a fixed bend at the fingertip joint (flexion contracture)
- Adhesions within the tendon sheath restricting movement, sometimes requiring further surgery (tenolysis) to free the tendon
- Bowstringing of the tendon if the pulley system is disrupted
Anaesthetic
If you are having sedation or a general anaesthetic for this procedure, your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Recovery & rehabilitation
First 48 hours
Keep your hand elevated for 48 hours to reduce bleeding and post-operative swelling. Local anaesthetic lasts 6–24 hours (occasionally 1–3 days); your hand will have numb areas during this time. Do NOT clench or grip with your hand.
First week
Keep the dressing dry and intact until your post-operative review. Do not use or move your hand except as specifically directed by your hand therapist and/or surgeon.
Second week
The hand remains in a protective splint. A structured, closely supervised hand therapy program of protected movement typically begins within the first week to balance healing against the risk of stiffness.
6 weeks
You will commence weaning out of your splint. Full grip is still not permitted. Range of movement varies at this time, relating to factors such as scar/adhesion formation, compliance with hand therapy and timing of repair. Massage assists with improving scar mobility and minimising scar firmness.
3 months
The scar firmness will start to resolve after 3 months, and will take up to 12 months to settle. Return to unrestricted grip, heavy use and contact sport are generally now permitted.
Long term
Range of movement and scars (internal and surface scarring) continue to improve with time, exercises and massage.
Want to know more about FDP Avulsion Rupture Repair (Jersey Finger)?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.