Flexor Tendon Injuries in Zone 3 - A Comprehensive Review and Case Report on Flexor Digitorum Profundus Rupture of the Middle Finger

Sep 29, 2026

Isolated rupture of the flexor digitorumprofundus tendon in flexor zone 3 is exceptionally rare and commonly mistaken for the more typical zone 1 “Jersey finger” injury. Only two middle-finger cases had been documented over the prior six decades. This report presents an additional middle-finger case and synthesizes relevant literature to outline diagnostic pitfalls and emphasize timely, tendon-preserving management to optimize functional recovery.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Learning Point of the Article

Abstract

Introduction

Case Report

Clinical Presentation and Diagnosis

Surgical Management and Repair

Post-operative Rehabilitation and Outcome

Conclusion

Keywords

Case Report Journal of Orthopaedic Case Reports 2025 December:15( 12) :Page 46-56 Flexor Tendon Injuries in Zone 3: A Comprehensive Review and Case Report on Flexor Digitorum Profundus Rupture of the Middle Finger Nirav Mungalpara1, Dmitriy Peresada1, Alfonso Mejia1 Learning Point of the Article: Isolated Zone 3 flexor digitorum profundus ruptures can mimic Zone 1 “Jersey finger” injuries clinically, prompt imaging to localize and early direct repair yield the best functional outcomes. Abstract Introduction: Isolated rupture of the flexor digitorumprofundus tendon within flexor zone 3 is exceptionally rare and easily mistaken for the far more common zone 1 “Jersey finger” lesion. To thebest ofour knowledge, only two such middle-finger cases have been documented over the past six decades. Reporting this case, together with a literature synthesis, highlights the diagnostic pitfalls and supports timely, tendonpreserving intervention. Case Report: A 65-year-old right-hand-dominant White male felt a sudden snap in his right palm while restraining a dog leash, followed by an inability to flex the distal interphalangeal joint of the middle finger. Clinical examination showed loss of the tenodesis effect, but plain radiographs excluded fracture. Initial exploration aimed at tendon reinsertion in zone 1 revealed an intact insertion, prompting proximal extension of the incision. A complete mid-substance rupture was identified in zone 3, approximately one centimeterproximaltothe origin of the lumbrical muscle. Primary repair was performed using a four-strand cruciate core technique reinforced with circumferential epitendinous sutures. Post-operative rehabilitation employed early-motion protocols. Twelve months after surgery, the patientregained full strength, achieved a total active fingermotion of 230°, and reported 95percent functionalrecovery. Conclusion: This case illustrates how a concealed zone 3 rupture can masquerade as a distal avulsion, emphasizing the need for high clinical suspicion and, when feasible, pre-operative ultrasonography or magneticresonanceimaging to guide incisionplanning. Early direct repairwithin days of injury provided an excellent functional result, underscoring that prompt recognition prevents unnecessary grafting or transfer procedures. By adding the first modern case of isolated middle-finger zone 3 rupture and proposing a minimum reporting dataset, this report broadens surgeons’awareness of an uncommon injury and supports evidence-based management strategies that may preserve grip strength and hand function across orthopedic practice. Keywords: Tendon injury, flexorzone3 of hand, tendon repair, tendon transfer, tendon graft, flexor digitorumprofundus. Introduction Flexor digitorum profundus (FDP) tendon ruptures are one of the most common injuries in hand surgery practices. The most common traumatic FDP tendon injuries are those that involve the insertion of the tendon (zone 1), with or without a bony avulsion fragment. It is also commonlytermed‘Jersey finger’ [1]. Compared to Zone 1, intrasubstance FDP ruptures in other zones are rare and, as a result, frequently misdiagnosed at initial presentation. Unlike insertional tears, which typically occur in otherwise healthy tendons, mid-substance tears are typically |
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Website: [www.jocr.co.in](www.jocr.co.in)

DOI:
[https://doi.org/10.13107/jocr.2025.v15.i12.6450](https://doi.org/10.13107/jocr.2025.v15.i12.6450) | Author’s Photo Gallery | | | | --- | --- | --- | --- | | | | | | | | | | | | Submitted: 10/09/2025; Review: 26/10/2025; Accepted: November 2025; Published: December 2025 | | | | | DOI: [https://doi.org/10.13107/jocr.2025.v15.i12.6450](https://doi.org/10.13107/jocr.2025.v15.i12.6450)
© The Author(s). 2025 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ([https://creativecommons.org/licenses/by

FAQs

Why can a zone 3 flexor digitorum profundus rupture be mistaken for a zone 1 “Jersey finger”?

Clinically, isolated zone 3 FDP ruptures can mimic the distal avulsion pattern of “Jersey finger.” The case emphasizes the need for high clinical suspicion and appropriate imaging to localize the injury.

What was the key intraoperative finding in the reported case?

Exploration intended for a zone 1 reinsertion revealed an intact insertion; proximal extension identified a complete mid-substance rupture in zone 3 about one centimeter proximal to the lumbrical muscle origin.

How was the tendon rupture managed and what was the outcome after 12 months?

A primary repair used a four-strand cruciate core reinforced with circumferential epitendinous sutures, followed by early-motion rehabilitation. At 12 months, the patient regained full strength, achieved total active motion of 230°, and reported 95% functional recovery.

Sep 29, 2026

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