The FDP tendons pass through the carpal tunnel deep to the FDS tendons, then pass through the split in the FDS (Camper chiasm) within the fibro-osseous sheath to insert on the palmar base of each distal phalanx. FDP is the only flexor of the DIP joint. The index FDP has its own muscle belly and can act independently, while the middle, ring and little finger tendons share a common belly, linking their excursion (the quadriga effect).
| Muscle | |
|---|---|
| Attachment | Enters the carpal tunnel, passes through the FDS chiasm to reach the distal phalanges of all four fingers |
DIP joint flexion of all fingers; the deepest flexor tendon in each finger
Jersey finger (FDP avulsion from the distal phalanx) classically involves the ring finger during rugby or American football tackling when a jersey is grabbed and the finger is forcibly extended. Leddy-Packer classification guides urgency: Type I (retracted into palm with lost blood supply) requires repair within 7 to 10 days; Type II (at PIP level) can be repaired later; Type III (bony avulsion) can be fixed as a fracture. Zone II injuries, inside the tight sheath between the A1 pulley and the FDS insertion, are the most demanding to repair and need a multi-strand core suture with an epitendinous suture followed by early active motion. Repairing one tendon too tight, or adhesions, can limit flexion of the neighbouring fingers through the quadriga effect.
FDP avulsion from the distal phalanx during forced finger extension producing DIP flexion inability managed with surgical reinsertion with urgency depending on retraction level.
Laceration of FDP, often with FDS, inside the digital sheath, repaired with a multi-strand core and epitendinous suture and early controlled active motion.
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