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Central Slip Extensor Tendon Injury

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Other Names

  • Central Slip Extensor Tendon Injury

Background

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


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

Evaluation

Radiographs

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


References


  1. Image courtesy of www.e-ultrasonography.org, "Schematic images of Boutonnière deformity."
  2. 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
Authors:
Last edited:
3 January 2022 23:55:42
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