Diferencia entre revisiones de «Boutonniere deformity»
(Created page with "==Background== *Extensor Zone III Injury over the PIP joint. *Most commonly central tendon is injured, causing FDS to be unopposed, thus causing flexion of PIP **Disruption o...") |
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==See Also== | ==See Also== | ||
[[Hand_and_finger_diagnoses]] | *[[Hand_and_finger_diagnoses]] | ||
[[Jammed_finger]] | *[[Jammed_finger]] | ||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
Tintinalli | *Tintinalli | ||
Rosen's | *Rosen's | ||
<references/> | <references/> | ||
Revisión del 05:33 15 abr 2016
Background
- Extensor Zone III Injury over the PIP joint.
- Most commonly central tendon is injured, causing FDS to be unopposed, thus causing flexion of PIP
- Disruption of central tendon causes lateral bands to be displaced volarly, causing them to act like flexors
- FDP still intact
Clinical Features
- History of trauma to digit and painful PIP.
- Forced flexion of actively extended finger
- Direct blow to PIP
- Jamming
- Laceration distal to PIP can injure central tendon
- On exam, will see hyperflexion of PIP w/ hyperextension of DIP and MP joints.
Differential Diagnosis
Rheumatoid Arthritis
Diagnosis
- Elson’s test: bend PIP 90 deg over edge of table, extend middle phalanx against resistance. Should have weak PIP extension and DIP goes rigid as lateral bands have to work.
- Positive test indicated rupture of central tnedon slip.
Management
- XR to assess for avulsion fracture of middle phalanx
- If open or with displaced avulsion fracture: operative repair
- Closed: splint in extension (Both DIP and PIP) for up to 6 weeks, refer to hand surgeon. NO flexion of DP permitted for duration of splinting, including during cleaning. Repair extensor tendon if injured.
Disposition
- Hand specialist follow up if closed injury
- Immediate consult if deformity is caused by open injury
See Also
External Links
References
- Tintinalli
- Rosen's