Abstract
Ulnar subluxation of the extensor digitorum communis tendon at the MCP joint occurs infrequently in the nonrheumatoid patient and is secondary to one of four reported etiologies: traumatic, spontaneous, congenital, or epileptic. If symptomatic, patients may present with pain, swelling, a sensation of the tendon "snapping", "catching", "locking", or the inability to fully extend the MCP joint. Conservative and operative interventions have been recommended as treatment options. In the acute traumatic dislocation (less than ten days post injury), satisfactory results may be obtained with simple splinting with the MCP joint in extension. Patients who have failed conservative management or have a more chronic or degenerative dislocation may require surgical correction. The successful surgical repair must meet two requirements: (1) the tendon must be accurately aligned over the MCP joint to diminish the forces causing the dislocation to occur, and (2) the repair must be able to withstand the ulnar forces incurred during flexion of the joint. Realignment of the extensor tendon and direct repair of the radial sagittal band may be sufficient in acute traumatic, congenital, or spontaneous cases if the tissue is sufficient. In chronic dislocations or in cases with atrophic or degenerative tissue, reconstruction with augmentation of the radial restraints to the extensor hood is advised.
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- Bin Iftikhar T., Hallmann B. W., Kaminski R. S., Ray A. K. Spontaneous rupture of the extensor mechanism causing ulnar dislocation of the long extensor tendon of the long finger. Two case reports. J Bone Joint Surg Am. 1984 Sep;66(7):1108–1109. [PubMed] [Google Scholar]
- Fitzgerald R. R. HABITUAL DISLOCATION OF THE DIGITAL EXTENSOR TENDONS. Ann Surg. 1939 Jul;110(1):81–83. doi: 10.1097/00000658-193907000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Harvey F. J., Hume K. F. Spontaneous recurrent ulnar dislocation of the long extensor tendons of the fingers. J Hand Surg Am. 1980 Sep;5(5):492–494. doi: 10.1016/s0363-5023(80)80082-7. [DOI] [PubMed] [Google Scholar]
- Ishizuki M. Traumatic and spontaneous dislocation of extensor tendon of the long finger. J Hand Surg Am. 1990 Nov;15(6):967–972. doi: 10.1016/0363-5023(90)90025-m. [DOI] [PubMed] [Google Scholar]
- MICHON J., VICHARD P. [Lateral luxations of the extensor tendons with regard to the metacarpophalangeal articulation]. Rev Med Nancy. 1961 Jun;86:595–601. [PubMed] [Google Scholar]
- McCoy F. J., Winsky A. J. Lumbrical loop operation for luxation of the extensor tendons of the hand. Plast Reconstr Surg. 1969 Aug;44(2):142–146. [PubMed] [Google Scholar]
- Morohashi M., Sasahara S., Hasegawa M., Ibaragi K. [Experiences with and evaluation of idiopathic dislocation of the finger extensor muscles]. Seikei Geka. 1967 Mar;18(4):354–356. [PubMed] [Google Scholar]
- Ostrowski D. M. Traumatic dislocation of the long finger extensor tendon at the metacarpophalangeal joint. A case report and literature review. Orthopedics. 1989 Apr;12(4):581–583. doi: 10.3928/0147-7447-19890401-13. [DOI] [PubMed] [Google Scholar]
- Ritts G. D., Wood M. B., Engber W. D. Nonoperative treatment of traumatic dislocations of the extensor digitorum tendons in patients without rheumatoid disorders. J Hand Surg Am. 1985 Sep;10(5):714–716. doi: 10.1016/s0363-5023(85)80215-x. [DOI] [PubMed] [Google Scholar]
- Smith R. J. Balance and kinetics of the fingers under normal and pathological conditions. Clin Orthop Relat Res. 1974 Oct;(104):92–111. doi: 10.1097/00003086-197410000-00010. [DOI] [PubMed] [Google Scholar]
- Straus F. H. LUXATION OF EXTENSOR TENDONS IN THE HAND. Ann Surg. 1940 Jan;111(1):135–140. doi: 10.1097/00000658-194001000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
- TUBIANA R., VALENTIN P. THE ANATOMY OF THE EXTENSOR APPARATUS OF THE FINGERS. Surg Clin North Am. 1964 Aug;44:897–906. [PubMed] [Google Scholar]