Sagittal band injury and treatment
Sagittal Band Ruptures
I have worked in hand surgery for 15 years and I often see sagittal band
disruptions of the extensor tendons. The sagittal bands encircle the
metacarpophalangeal (MCP) joint stabilizing the extensor tendon during
MCP flexion so it moves in a straight line over the digit.
Sagittal band rupture is commonly seen in rheumatoid patients and
patients that suffer some type of resistance to extension to the hand or
digit. Patients who are boxers are also quite prone to this injury. There
is a sagittal band on each side of the MCP’s. The radial sagittal band is
most commonly ruptured. When this injury occurs it can be quite
disabling to the patient and they will make an appointment to be seen.
Ms. D is a 40 year old professional concert pianist who was walking on a
glacier when she slip and fell on her outstretched left hand. She stated
that she hyperextended her left index finger. She experienced swelling
around the 2nd MCP, along with a snapping sensation of her extensor
tendon. She also noticed that she was unable to fully extend her index
finger. The injury affected her piano playing and was disabling. On
examination she had swelling, and tenderness around the MCP. With
active motion she had a extensor lag and with flexion the extensor
tendon subluxed ulnarly with a snap when it crossed over the MCP. She
was very point tender to the radial side of the MCP. Her x-rays were
negative for fracture. She was diagnosed with a 2nd MCP radial sagittal
band rupture. After explaining the diagnoses to her she elected to move
forward with surgery.
Sagittal band ruptures can be treated conservatively or surgical. If the
patient would like to try conservative treatment first it will involve
splinting and occupational therapy for six to ten weeks. If their
symptoms persist in spite of conservative treatment, they can move
forward with surgery. Ms. D chose surgery because she had a concert
on the east coast in the next four months. Her surgery consisted of
reconstruction of the sagittal band and occupational therapy. She was
splinted for six weeks post surgery and than begin progressive ROM.
She is back playing the piano and doing fine.