"Spiderman Sign:" A Case Report of Ipsilateral Index and Little Finger Flexor Tendon Injury

Flexor tendon injuries in Zone II remain among the most technically demanding conditions in hand surgery. Simultaneous involvement of the index and little fingers is rare and functionally disabling.

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 extended while 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 digitorum profundus of the index finger and isolated FDS transection of the little finger. Tendon repair using a four-strand core technique with epitendinous reinforcement was performed, followed by early mobilization. At 12 weeks, the patient regained composite flexion, grip strength, and functional independence.

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 outcomes in this case.