FDP Rupture
An FDP rupture is when the flexor digitorum profundus (FDP) tendon is torn. In this article we explore what an FDP rupture is, explaining the symptoms, diagnosis and treatment in more detail.
Flexor Digitorum Profundus Rupture
The FDP tendon runs from the forearm to the hand. It then divides and extends into each finger. It enables the bending of the fingers.
An FDP rupture is quite a common injury, particularly in young men. It is often dubbed the 'rugger jersey injury', indicating its prevalence amongst people who play rugby or other contact sports.
It happens when the individual's finger pulls hard against something but their movement is resisted. This causes the tendon to pull off its insertion at the base of the distal phalanx. It very rarely involves the thumb.
The tendon can either just pull away from the bone, or it can pull off with a fragment of bone attached. The tendon may displace a short distance, especially if there is a large bony fragment blocking the proximal migration of the tendon. More often it displaces into the palm and there is a tender area in the middle of the palm, in line with the injured finger.
Symptoms and presentation of a FDP rupture
The normal presentation of an FDP rupture is as follows:
The patient will present to their GP or hospital on the same day or within a few days of the injury. There will be a history of difficulty bending the finger. If there has not been a specific accident – such as during a sporting match – the patient may not remember exactly what occurred. There will be some tendering, stiffness and weakness in the finger, and there may also be a sense of numbness.
Diagnosing a FDP rupture
The presentation of the patient will aid a diagnosis. For example, on examination there will be some tenderness in the line of the tendon. Unless it is very soon after the injury there will be bruising.
The treating clinician should then test the activity of distal inter-phalangeal (DIP) joint flexion. It is not sufficient to simply ask a patient to make a fist as it can look like he/she has achieved full bending of the hand when in actual fact they have only bent the injured finger at the middle joint. If there is any doubt the patient can be asked to report back in a few days to be re-tested.
Plain radiographs should also be performed in case there has been a fracture. If there is any uncertainty about a diagnosis then an urgent ultrasound scan can be carried out. In such cases 'urgent' means within a few days and certainly within a week.
Failure to diagnose
If medical practitioners fail to diagnose an FDP rupture and this leaves a patient with a poor prognosis, there may be grounds for a claim. Contact us for more information.
Treating a FDP tendon rupture
An FDP tendon rupture is a common finger injury. For almost all patients the treatment is surgical. There may be exceptional circumstances in a very elderly patient or with multiple other injuries where non-surgical treatment will be undertaken.
The best treatment is surgical with re-attachment of the tendon, ideally within approximately 10 to 14 days of the injury. Later surgery can be undertaken but starts to become less predictable with a higher rate of complications.
During the operation the tendon is found, re-attached to the bone, either with sutures or bone anchors. It may be necessary to use a wire, but generally that will be avoided if possible.
Post-operative care after a finger tendon rupture
Post-operative care after tendon rupture surgery is very important. There needs to be early mobilisation to make sure the tendon does not stick down but it needs to be protected to make sure the repair does not fail. The patient will typically need to be splintered for six weeks. Physiotherapy during this period will almost certainly be needed.
The operation is associated with potential complications of infection, nerve injury, stiffness, a tender scar and incomplete recovery.
Long-term prognosis of finger tendon rupture
If the appropriate treatment is provided without delay, the outcome is typically good, but not necessarily excellent. There is often some stiffness, particularly having had a significant injury and then further surgical trauma. There may be some aching in the cold and wet for a few years, possibly even forever. Grip strength will be around 80 to 90% normal.
Overall the patient should be able to get their hand flat on the table, perhaps with a small bend in the finger. The patient will have good (but not quite full) bend in the finger and most of their function. He/she should be able to return to heavy activities in the long-term. Once a steady state has been achieved there should be no progressive problems.
However, the repair can fail and the patient may get a lot of stiffness which can occur from somewhat unpredictable reasons. This will mean a poor outcome, although the problem may be helped by secondary surgery.
Delay in treatment
The prognosis is much better if the injury is treated without delay. If the patient must wait a considerable amount of time before the rupture is operated on – perhaps because of a missed diagnosis – their long-term condition may be substantially worse than if earlier treatment had been carried out.
If medical failings do cause a patient to suffer unnecessary injury, there may be grounds for a claim. Contact us today to find out more.
Claiming compensation for a finger tendon injury
If you suffered a ruptured tendon and the injury was not diagnosed and/or treated properly, you could be entitled to pursue a claim for compensation. This would enable you to obtain financial redress for the damages you have wrongfully incurred.
When you contact us for a free initial enquiry, you will discuss your case with a legal expert, after which you will be told whether or not you have the grounds to take legal action. Please do not hesitate to get in touch for more information.
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