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This case report describes a 56-year-old right-hand dominant man with transverse volar lacerations after a “panga” assault. Examination identified the distinctive “Spiderman Sign” posture, with complete FDS and FDP transection in the index finger and isolated FDS transection in the little finger. Four-strand core repair with epitendinous reinforcement plus early mobilization achieved excellent functional recovery by 12 weeks.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/spiderman-sign-a-case-report-of-ipsilateral-index-and-little-finger-flexor-tendon-injury/447388/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/spiderman-sign-a-case-report-of-ipsilateral-index-and-little-finger-flexor-tendon-injury/447388.png","ImageObject",300,407,{"name":92,"@type":93},"mieayamfan","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-09","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is the “Spiderman Sign” in this case report?","Question",{"text":113,"@type":114},"It is a distinctive posture in which the index and little fingers remain extended while the middle and ring fingers flex, mimicking the web-shooting gesture. The report links this sign to combined Zone II flexor tendon injuries of the index and little fingers.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Which tendons were injured in the index and little fingers?",{"text":118,"@type":114},"Operative exploration confirmed complete transection of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) of the index finger. The little finger had isolated FDS transection with preservation of FDP.",{"name":120,"@type":111,"acceptedAnswer":121},"How was the tendon injury treated and what was the outcome?",{"text":122,"@type":114},"The surgeons performed tendon repair using a four-strand core technique with epitendinous reinforcement, followed by early mobilization. By 12 weeks, the patient regained composite flexion, grip strength, and functional independence with excellent outcome.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},447388,1790822120,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},962090893677,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Case Report  Journal of Orthopaedic Case Reports 2025 December:15( 12) :Page 192-196   \n“Spiderman Sign:”A Case Report ofIpsilateral Index and Little Finger  \nFlexor Tendon Injury  \nRiven Ragunandan1, Maradona Mncedisi Mashigo1  \nLearning Point of the Article:  \nRecognition of the “Spiderman Sign” may facilitate early diagnosis of rare, simultaneous flexor tendon injuries of the index and little fingers.  \nAbstract  \nIntroduction: Flexor tendon injuries in Zone II remain among the most technically demanding conditions in hand surgery. Simultaneous involvement of the indexand little fingers is rare and functionally disabling.  \nCase Report: A 56-year-old right-hand dominant male sustained transverse volar lacerations to the index and little fingers following a “panga”assault. Examination revealed a distinctive posture where the index and little fingers remained extendedwhile the middle and ring fingers flexed, mimicking the Spiderman web-shooting gesture. Operative exploration confirmed complete transection of the flexor digitorum superficialis (FDS) and flexor digitorumprofundus of the index finger and isolated FDStransection of the little finger. Tendon repair using a four-strand core technique withepitendinous reinforcement was performed, followed by earlymobilization. At 12weeks, the patientregained compositeflexion, grip strength, and functionalindependence.  \nConclusion: The “Spiderman Sign” represents a novel diagnostic clue for combined index and little finger tendon injuries. Early recognition, robust surgical repair, and structured rehabilitation led to excellent outcomesin this case.  \nKeywords: Flexor tendon injury, zone II,index finger, little finger, Spiderman sign,hand trauma.  \nIntroduction  \nFlexor tendon injuries are relatively uncommon but carry disproportionately high morbidity due to the intricate anatomy and biomechanical function of the flexor system, particularly within Zone II, historically referred to as “no man’s land” [1, 2]. Theseinjuries remain surgically challenging becausethe tendons pass through a confined fibro-osseous tunnel, increasing the risk ofadhesions, repair failure, and functional stiffness [3].  \nFrom a functional perspective, each digit plays a critical role in hand biomechanics. The index finger contributes to precision pinch and fine dexterity, while the little finger provides nearly  \none-third ofoverall grip strength and augments hand stability [4, 5]. Consequently, simultaneous disruption of these two digits severely compromises both dexterity and power grip. Previous reports have described isolated flexor tendon injuries to the index or little finger, but combined ipsilateral involvement of both digits is rare [6, 7].  \nFlexor tendon repair techniques have evolved substantially, with multi-strand core repairs combined with epitendinous suturing now regarded asthe gold standard to improve repair strength and allow early mobilization [8, 9, 10, 11]. Rehabilitation protocols, including early active mobilization, are crucial to minimize  \n\n| \u003Cbr>Access this article online\u003Cbr>\u003Cbr>Website: [www.jocr.co.in](www.jocr.co.in)\u003Cbr>\u003Cbr>DOI:\u003Cbr>[https://doi.org/10.13107/jocr.2025.v15.i12.6504](https://doi.org/10.13107/jocr.2025.v15.i12.6504) | Author’s Photo Gallery |  |\n| --- | --- | --- |\n|  | \u003Cbr>Dr. Riven Ragunandan | \u003Cbr>Dr. Maradona Mncedisi Mashigo |\n|  | \u003Cbr>1Division of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa.\u003Cbr>Address of Correspondence:\u003Cbr>Dr. Riven Ragunandan,\u003Cbr>Department of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, 7 York Road, Parktown, Johannesburg, 2193, South Africa.\u003Cbr>E-mail: [riven52@gmail.com](riven52@gmail.com) |  |\n| Submitted: 01/09/2025; Review: 19/10/2025; Accepted: November 2025; Published: December 2025 |  |  |\n| DOI: [https://doi.org/10.13107/jocr.2025.v15.i12.6504](https://doi.org/10.13107/jocr.2025.v15.i12.6504)\u003Cbr>© The Author(s). 2025 Open Access. This article is distributed under the ter","cbCaipPwLmLkuEbB","https://ap.wps.com/l/cbCaipPwLmLkuEbB","pdf",6384558,"English","# Introduction\n## Background on Zone II flexor tendon injuries\n## Rarity of ipsilateral index and little finger involvement\n# Case Report\n## Patient presentation and injury mechanism\n## Clinical findings: the “Spiderman Sign”\n## Operative findings and tendon repair\n## Postoperative management and 12-week outcome\n# Conclusion\n## Diagnostic value and outcome summary","[{\"question\":\"What is the “Spiderman Sign” in this case report?\",\"answer\":\"It is a distinctive posture in which the index and little fingers remain extended while the middle and ring fingers flex, mimicking the web-shooting gesture. The report links this sign to combined Zone II flexor tendon injuries of the index and little fingers.\"},{\"question\":\"Which tendons were injured in the index and little fingers?\",\"answer\":\"Operative exploration confirmed complete transection of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) of the index finger. The little finger had isolated FDS transection with preservation of FDP.\"},{\"question\":\"How was the tendon injury treated and what was the outcome?\",\"answer\":\"The surgeons performed tendon repair using a four-strand core technique with epitendinous reinforcement, followed by early mobilization. By 12 weeks, the patient regained composite flexion, grip strength, and functional independence with excellent outcome.\"}]","Spiderman Sign - A Case Report of Ipsilateral Index and Little Finger Flexor Tendon Injury | PDF",1790720075,13]