Title : case 411 |
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Age / Sex : 21 / M
Chief complaint: finger pain after trauma
Courtesy: Hye Jin Ryu, Seoul national university hospital
Diagnosis: Sagittal band tear DiscussionFindings: Absence of radial sagittal band at MCP joint level. Fluid-equivalent signal intensity at the radial sagittal band tear site. - with mild ulnar subluxation of 3rd extensor tendon - with surrounding soft tissue edema Differential Diagnosis: MCP joint collateral ligament injury EDC tendon rupture Trigger finger Junctura tendinum disruption Congenital sagittal band deficiency MCP joint arthritis Diagnosis: Sagittal band tear Discussion: • Sagittal band (SB) rupture leads to dislocation of the extensor tendon • also known as "boxer's knuckle" • Epidemiology • demographics • more common in pugilists • index and middle finger in professionals • ring and little finger in amateurs • location • the middle finger is most commonly involved • index 14% • middle 48% • ring 7% • little 31% • the radial SB is more commonly involved • radial:ulnar = 9:1 • Mechanisms • traumatic • forceful resisted flexion or extension • direct blow to MCP joint • atraumatic • inflammatory (e.g. rheumatoid arthritis) • spontaneously during routine activities • Associated conditions • MCP joint collateral ligament injuries MRI • indications • to establish diagnosis of SB disruption (radial or ulnar SB) • may show underlying etiology e.g. synovitis in rheumatoid arthritis • views • axial images at the level of the long MCP • with MCP joint flexed for maximum EDC tendon displacement • findings • poor definition, focal discontinuity and focal thickening in acute injury • subluxation of extensor tendon in ulnar direction due radial SB defect • dislocation of extensor tendon into ulnar intermetacarpal gully radial SB defect References: Functional anatomy of the thumb sagittal band J Hand Surg Am. 2008 Jul-Aug;33(6):879-84. The sagittal band: anatomic and biomechanical study J Hand Surg Am. 2000 Nov;25(6):1107-13. |
Correct Answer | |
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Name | Institution |
이름:소속병원 | |
Total Applicants: 24 | |
Correct answers:24 | |
전성희:중앙보훈병원 | |
이은주:리더스병원 | |
이혜란:석병원 | |
박지원:대구 참튼튼병원 | |
최마리아:예병원 | |
김지현:하이병원 | |
최현진:인하대병원 | |
LE TRONG BINH:인하대병원 | |
신윤상:인하대병원 | |
이택기:인하대병원 | |
김유진:인하대병원 | |
우아름:인하대병원 | |
신재환:서울 백병원 | |
윤민아:고대 구로병원 | |
이선영:대림 성모병원 | |
김현수:병무청 | |
윤유성:삼기보건지소 | |
이지현:병무청 | |
손상욱:단국대병원 | |
이수현:충북대병원 | |
김하연:인하대병원 | |
김지민:순천향대 천안병원 | |
김정례:단국대병원 | |
조신영:웰튼 병원 |
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