Wednesday, August 31, 2016

Central slip injury

AliEM - By Ting D and Baylis J -  July 25th, 2016
"In a previous post, we discussed the approach to identifying, treating, and managing extensor tendon injuries of the hand. In it, we advocate for a high index of suspicion for extensor tendon injuries whenever a patient suffers a laceration to the dorsal aspect of the hand. However, lacerations over the PIP joint deserve special mention. In this article, we focus on the diagnosis of a specific type of extensor tendon laceration: the central slip injury...
The modified Elson’s test. A) Uninjured fingers show a symmetric inability to straighten the distal interphalangeal joint when the middle interphalangeal joints are flush against each other. B) In a central slip injury, the distal interphalangeal joint is pathologically straightened, which is seen in the left hand in this example. (Illustration by David Ting)
  • Missed central slip injuries can lead to a Boutonnière deformity and patient morbidity.
  • Lacerations over the PIP joint demand testing for a central slip injury.
  • A combination of the Elson’s and modified Elson’s tests evaluate the central slip.
  • Central slip injuries should be splinted in extension and referred to a hand surgeon in 1 week for repair."