Sagittal band rupture
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Sagittal band injury and treatment 0 R. Thomas 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. Case Study 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.
by R. Thomas
Friday, July 13, 2018