The flexor pollicis longus (FPL) distal tendon inserts into the base of the distal phalanx of the thumb within zone 1 and zone 2 of the flexor sheath system. In zone 2 it runs within the fibro-osseous sheath between the A1 and oblique pulleys; in zone 1 it exits the oblique pulley to insert at the distal phalanx. The FPL is the only extrinsic flexor of the thumb IP joint.
FPL tendon laceration in zone 1-2 (the thumb equivalent of jersey finger) produces inability to flex the thumb IP joint. FPL avulsion at the distal phalanx base is rare (thumb jersey finger) and presents with a palpable tendon mass at the MCP or in the carpal canal if the tendon retracts proximally. Repair principles mirror FDP zone 2 repair: early primary repair with core and epitenon sutures within the fibro-osseous sheath for zone 2 injuries; bone anchor reattachment for zone 1 distal avulsions. Neonatal FPL palsy (clasped thumb from intrauterine positioning) resolves spontaneously.
Forced hyperextension of the thumb IP joint avulses the FPL from the distal phalanx base producing thumb jersey finger with inability to actively flex the IP joint; the retracted tendon may be palpable in the palm or wrist if retraction is complete, requiring urgent repair within 10 days before muscle fibrosis and tendon shortening prevent anatomic reattachment.
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