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Question: Ortho

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You are seeing a 16 year old basketball player who presents with pain and swelling over his dorsal PIP joint, and inability to extend at the PIP joint. 

Which of the following injuries do you suspect?

pemsou5_wp • March 7, 2023

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  1. Kelly March 7, 2023 - 9:33 pm Reply

    B) Central slip injury
    Injuries to finger extensor tendon mechanisms commonly occur from a direct blow to the tip of the finger (e.g. jammed finger). In mallet finger, the extensor tendon is avulsed at the distal phalanx, resulting in tenderness over the DIP and an inability to extend at the DIP. Chronic mallet finger can result in a “swan neck deformity” with DIP hyperflexion and PIP hyperextension. The central slip crosses the PIP joint and attaches to the middle phalanx. Central slip injury results in difficulty extending at the PIP, and can cause a “boutonniere” deformity with flexion at the PIP and extension at the DIP (opposite of the swan neck deformity). Sagittal band injury, aka “boxer’s knuckles,” lead to the extensor tendon slipping back and forth over the MCP joint, causing a snapping sensation when flexing. Jersey finger is a flexor tendon injury, classically from grabbing the jersey of another player who then pulls away, leading to inability to flex at the DIP joint.

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