Functional anatomy of the sagittal bands and mechanisms of extensor tendon dislocation: a cadaveric study

We investigated the functional anatomy of the radial sagittal band and possible mechanisms involved in its spontaneous and traumatic rupture using seven cadaveric hands. First, the extensor tendon excursion and the change in angle between the sagittal bands and the tendon path were measured during metacarpophalangeal joint flexion. The radial bands were then divided in two different ways that mimicked spontaneous or traumatic rupture. We found no significant correlation between the extensor tendon excursion and the change in angle of the sagittal bands in the middle and ring fingers. Dislocation could occur when the radial sagittal band was only partially divided. This may explain why conservative treatment of tendon dislocation in the middle and ring fingers is feasible. Complete section of the sagittal bands in the little finger caused ulnar dislocation of the extensor tendon in only one out of seven hands.

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Tethering the Extensor Apparatus Limits PIP Flexion Following K-wire Placement for Pinning Extra-articular Fractures at the Base of the Proximal Phalanx

Hand ◽

10.1177/1558944716628498 ◽

2016 ◽

Vol 11 (4) ◽

pp. 433-437 ◽

Cited By ~ 4

Author(s):

Yaron Sela ◽

Caitlin Peterson ◽

Mark E. Baratz

Keyword(s):

Insertion Site ◽

Proximal Phalanx ◽

Extensor Tendon ◽

Metacarpophalangeal Joint ◽

Minimally Invasive Surgical ◽

Articular Fractures ◽

Pip Joint ◽

Joint Flexion ◽

The Mean ◽

K Wires

Background: Closed reduction with percutaneous Kirschner wires (K-wires) is the most minimally invasive surgical option for stabilizing phalanx fractures. This study examines the effect of K-wire placement on proximal interphalangeal (PIP) joint motion. Methods: PIP joint flexion was measured in the digits of 4 fresh-frozen cadaver hands after placing a suture loop through the flexor tendons and placing tension on the flexors via a mechanical scale. The load necessary to flex the PIP joint to 90° or to maximum flexion was recorded. The load was removed and K-wires were inserted in 3 locations about the metacarpophalangeal joint (MPJ): through the extensor tendon and across the MPJ, adjacent to the extensor tendon insertion site and across the MPJ, and through the sagittal band and into the base of the proximal phalanx (P1). The load on the tendons was reapplied, and angles of PIP joint flexion were recorded for each of the 3 conditions. Results: The mean angle of PIP joint flexion prior to K-wire insertion was 87°, and the mean load applied was 241 g. The angles of flexion were 53° when the K-wire was placed through the extensor tendon, 70° when the K-wire was placed adjacent to the tendon, and 75° when the K-wire was placed into the base of P1 by going through the sagittal band, midway between the volar plate and the extensor tendon. Conclusions: K-wires placed remote from the extensor tendon create less of an immediate tether to PIP joint flexion than those placed through or adjacent to the extensor tendon.

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The Excursions of the Long Extensor Tendons of the Hand

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681_86_90019-7 ◽

1986 ◽

Vol 11 (1) ◽

pp. 77-80

Author(s):

D. ELLIOT ◽

D. A. McGROUTHER

Keyword(s):

Extensor Tendon ◽

Cadaveric Study ◽

Joint Motion ◽

Mathematical Relationship ◽

Extensor Tendons ◽

The Mean ◽

Clinical Problems ◽

Tendon Excursion

In a cadaveric study in seven hands, the mathematical relationship between extensor tendon excursion and joint motion (wrist, m.p., p.i.p. and d.i.p.) has been investigated. This has been found to be linear at all joints, allowing the mean tendon excursions corresponding to ten degrees of joint motion to be calculated for each of the above joints for all five rays of the hand. A table of these excursion values is presented as a reference for calculation of clinical problems.

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Extensor Tendon Dislocation at the Metacarpophalangeal Joint of Both Ring Fingers Caused by a Specific Hand Posture in a Shiatsu Therapist

Case Reports in Orthopedics ◽

10.1155/2020/6842986 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Mariko Kamiya ◽

Gen Sasaki ◽

Kensuke Ikuta ◽

Hideaki Miyamoto ◽

Michio Kimura ◽

...

Keyword(s):

Range Of Motion ◽

Ring Finger ◽

Extensor Tendon ◽

Middle Finger ◽

Metacarpophalangeal Joint ◽

Hand Posture ◽

Extensor Digitorum Communis ◽

Surgical Exploration ◽

Tendon Excursion ◽

Juncturae Tendinum

A 43-year-old female shiatsu therapist complained of sudden snapping of the metacarpophalangeal joints (MCPjs) of both ring fingers during a specific hand posture. The extensor tendon of the ring finger was dislocated ulnarly when the MCPj of the ring finger was flexed and deviated ulnarly and the MCPj of the middle finger was extended. Surgical exploration revealed an attenuated radial sagittal band. We plicated the juncturae tendinum of the extensor digitorum communis between the middle and ring fingers and released the ulnar sagittal band partially to centralise the extensor tendon excursion. Twenty-six months postoperatively, the patient regained full active and passive range of motion of all fingers without extensor tendon dislocation or snapping in either hand during work.

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Intramedullary Splinting or Conservative Treatment for Displaced Fractures of the Little Finger Metacarpal Neck? a Prospective Study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193410377845 ◽

2010 ◽

Vol 35 (9) ◽

pp. 725-729 ◽

Cited By ~ 40

Author(s):

B. Strub ◽

S. Schindele ◽

J. Sonderegger ◽

J. Sproedt ◽

A. Von Campe ◽

...

Keyword(s):

Patient Satisfaction ◽

Conservative Treatment ◽

Grip Strength ◽

Metacarpophalangeal Joint ◽

Treated Group ◽

Neck Fracture ◽

Functional Advantage ◽

A Prospective Study ◽

Flexion And Extension ◽

Little Finger

Forty patients with a 30 ° to 70° palmar displacement of a little finger metacarpal neck fracture were treated either with closed reduction and intramedullary splinting, or conservatively without reduction. Functional mobilization was started after 1 week in both groups. A radiological and clinical assessment of flexion and extension of the small finger metacarpophalangeal joint was done at 2 and 6 weeks, and at 3, 6 and 12 months. In addition patient satisfaction and grip strength were recorded at 12 months. No statistically significant differences in range of motion and grip strength were found between the two groups. Patient satisfaction and the appearance were superior in the surgically treated group. We conclude that intramedullary splinting for displaced fractures of the little finger metacarpal neck offers an aesthetic, but not a functional advantage.

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Treatment of Soft Tissue Injuries to the Dorsum of the Metacarpophalangeal Joint (Boxer’s Knuckle)

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2001.0656 ◽

2002 ◽

Vol 27 (1) ◽

pp. 90-95 ◽

Cited By ~ 28

Author(s):

K. ARAI ◽

S. TOH ◽

K. NAKAHARA ◽

S. NISHIKAWA ◽

S. HARATA

Keyword(s):

Soft Tissue ◽

Conservative Treatment ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Extensor Tendon ◽

Soft Tissue Injuries ◽

Metacarpophalangeal Joint ◽

Joint Capsule ◽

Successful Outcome ◽

Surgical Closure

We retrospectively reviewed the surgical treatment for 16 cases of traumatic soft tissue injury to the metacarpophalangeal joint (Boxer’s knuckle). A history of trauma was present in all cases and there was an associated extensor tendon dislocation in seven cases. Eight cases were initially treated conservatively, but their symptoms persisted. Intraoperative findings included rupture of the extensor hood or joint capsule in all cases. Surgical closure of the rupture of the joint capsule resulted in a successful outcome in all cases. We consider that conservative treatment of this injury may not be effective when the joint capsule of the metacarpophalangeal joint is ruptured. We recommend arthrography of the metacarpophalangeal joint to assist in the decision as to whether to proceed with surgical or conservative treatment.

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A Case Report of Complex Dislocation of the Metacarpophalangeal Joint of the Little Finger

Orthopedics & Traumatology ◽

10.5035/nishiseisai.38.277 ◽

1989 ◽

Vol 38 (1) ◽

pp. 277-280

Author(s):

Tatsuya Ogata ◽

Kosuke Hyakutake ◽

Hiroshi Inoue ◽

Masashi Sagara ◽

Shyoji Nakao ◽

...

Keyword(s):

Case Report ◽

Metacarpophalangeal Joint ◽

Little Finger

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The Dorsal Triangular Fibrocartilage of the Metacarpophalangeal Joint: A Cadaveric Study

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2015.03.019 ◽

2015 ◽

Vol 40 (7) ◽

pp. 1410-1415 ◽

Cited By ~ 6

Author(s):

David J. Hunter-Smith ◽

Philip G. Slattery ◽

Alexandra Rizzitelli ◽

Sarah R. Hunter-Smith ◽

Sian Fairbank ◽

...

Keyword(s):

Metacarpophalangeal Joint ◽

Cadaveric Study ◽

Triangular Fibrocartilage

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The Incidence and Pattern of Hand Fractures in Children

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681_86_90259-7 ◽

1986 ◽

Vol 11 (2) ◽

pp. 198-200

Author(s):

P. H. WORLOCK ◽

M. J. STOWER

Keyword(s):

Proximal Phalanx ◽

Metacarpophalangeal Joint ◽

Common Site ◽

Vulnerable Area ◽

Fracture Patterns ◽

Fractures In Children ◽

Hand Fractures ◽

Epiphyseal Injuries ◽

Little Finger

The incidence and pattern of hand fractures occurring in children living in Nottingham has been reviewed. The hand is the second commonest site of fracture in children. The incidence is low in infants, but rises steeply after the age of eight, especially in boys. The most common site is the proximal phalanx. The little finger/fifth metacarpal is the most vulnerable area, especially around the metacarpophalangeal joint. Greenstick fractures. are more common in metacarpals, while epiphyseal injuries predominate in the phalanges. Over 45% of fractures occurred either at sport or in a fight. Aetiological factors are discussed in relation to the fracture patterns described.

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ROTATORY SUBLUXATION OF THE METACARPOPHALANGEAL INDEX FINGER JOINT: A CASE REPORT

Hand Surgery ◽

10.1142/s0218810413720064 ◽

2013 ◽

Vol 18 (01) ◽

pp. 103-105 ◽

Cited By ~ 1

Author(s):

Ken Teo ◽

Anthony Berger

Keyword(s):

Case Report ◽

Index Finger ◽

Extensor Tendon ◽

Metacarpophalangeal Joint ◽

Clinical Suspicion ◽

Collateral Ligament ◽

Open Injury ◽

Complete Tear ◽

Rotatory Subluxation ◽

High Level

We report a case of rotatory subluxation of the metacarpophalangeal joint (MCPJ) of the finger. A 40-year-old man sustained an open injury to his index finger following an explosive injury. Radiographs showed rotatory subluxation of the index finger MCPJ. The index finger extensor digitorium was found interposed in the MCPJ, with a complete tear of the radial collateral ligament. Treatment was by open reduction and repair of the collateral ligament and the extensor tendon. A high level of clinical suspicion is needed to diagnose this entity.

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