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Central Slip Extensor Tendon Injury
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Contents
Other Names
- Central Slip Extensor Tendon Injury
Background
- This page refers to injury of the extensor mechanism as it crosses over proximal interphalangeal joint of digits 2-4
History
Epidemiology
- Unknown
Pathophysiology
Illustration of normal anatomy and central slip lesion[1]
- General
- Typically occurs as a result of forced passive PIP flexion against active extension
- Subsequent disruption of the central slip of the extensor tendon.
Mechanism
- Closed injury: hyperflexion, direct blunt trauma
- Open injury: penetrating trauma
Pathoanatomy
- Extensor Tendon
- Trifurcates into 1 central slip and 2 lateral bands
- Central slip attaches to the dorsal side of the middle phalanx
- Lateral bands attach to the sides of the distal phalanx
Risk Factors
- Unknown
Differential Diagnosis
- Fractures
- Dislocations
- Tendinopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Nail Bed Injuries
- Pediatric Considerations
- Other
Clinical Features
- History
- Typically describe some form of trauma
- Reports pain, swelling, ecchymosis
- General: Physical Examination Hand
- Inability to extend at PIPJ of affected joint
- Special Tests
- Elsons Test can help confirm diagnosis
Evaluation
Radiographs
- Standard Radiographs Hand
- Typically normal
- May show avulsion fracture
MRI
- Can consider if diagnosis is uncertain or to further clarify injury
US
- May be used to help confirm tendon injury
Classification
Management
Nonoperative
- Indications
- Most cases
- Immobilization
- PIP Extension Splinting, DIP in partial flexion
- Dynamic splinting vs progressive static splinting (serial splinting)
- Typically for 6 weeks
Operative
- Indications
- Open injury
- Some avulsion fractures
- Technique[2]
- Acute central slip repair
- Open reduction and internal fixation (ORIF)
- Tendon reconstruction
- Arthrodesis
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play/ Work
- Needs to be updated
Complications and Prognosis
Prognosis
- Needs tob e updated
Complications
See Also
External
- Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/
References
- ↑ Image courtesy of www.e-ultrasonography.org, "Schematic images of Boutonnière deformity."
- ↑ Geoghegan, L., Wormald, J. C. R., Adami, R. Z., & Rodrigues, J. N. (2019). Central slip extensor tendon injuries: a systematic review of treatments. Journal of Hand Surgery (European Volume), 175319341984531. doi:10.1177/1753193419845311
Created by:
John Kiel on 20 August 2019 20:35:11
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Last edited:
16 October 2022 00:17:51
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