Sagittal Band Rupture

HPI: Young male presents after feeling a pop in his finger after he dropped a case of bottled water causing his middle finger to get caught in the wrapping.  

PE:  Ulnar deviation of affected digit and a popping sensation and pain when flexing his fingers.

Imaging:

• Hand x-rays
  
• Ultrasound: Subluxation of EDC on MCP flexion
  
• MRI to clarify diagnosis if unclear on physical exam
  

Anatomy:

• Sagittal band is the primary stabilizer of the extensor tendon at the MCP and is a fascial tube that surrounds the metacarpal head and extensor tendon.

Treatment Options:

• Non-operative: extension splint for 4-6 weeks
  
• Operative: chronic injuries, professional athletes

Pearls:

• Most common in pugilists (cool word for boxers!)
  
• Middle finger most common

Dispo:

• Can follow up with ortho as outpatient