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Extensor Tendon Injury, Wrist and Fingers
Carol L. Andrews, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Definitions

          • Mallet finger (drop finger): Inability to extend distal interphalangeal (DIP) joint due to terminal extensor tendon avulsion
          • Boxer knuckle: Extensor hood sagittal band tear at metacarpophalangeal (MCP) joint with subluxation/dislocation of common extensor tendon; results from direct blow while joint flexed and finger ulnarly deviated
          • Fight bite: Opponent's tooth breaks skin over MCP joint with injury to dorsal capsule, extensor tendon ± metacarpal (MC) head
          • de Quervain tenosynovitis (washerwoman's sprain, mother's wrist): 1st extensor compartment [extensor pollicis brevis (EPB) and abductor pollicis longus (APL)] tenosynovitis
          • Intersection syndrome: Radial wrist extensor tenosynovitis at intersection of 1st and 2nd extensor compartment tendons
          • Distal intersection syndrome: Tenosynovitis as 3rd extensor compartment tendon crosses over 2nd compartment tendons
          • Boutonnière deformity: Proximal interphalangeal (PIP) joint flexion with DIP joint extension due to extensor tendon central slip injury at or near insertion on middle phalanx, ± avulsion fracture of dorsal base of middle phalanx
          • Swan-neck deformity: PIP joint extension with DIP joint flexion; results from volar plate injury at PIP or extensor tendon injury at DIP
          • Duckbill deformity (hitchhiker thumb): Thumb interphalangeal (IP) joint hyperextension and MCP flexion; commonly seen in rheumatoid arthritis (RA); may also develop after tendon injury, from stretching of volar plate and attachment of extensor tendon on distal phalanx (similar to swan-neck deformity)

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Imaging Recommendations

                    PATHOLOGY

                    • Relevant Anatomy

                      • Mechanisms of Injury

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  Selected References

                                  1. Dezfuli B et al: Accuracy of High-Resolution Ultrasonography in the Detection of Extensor Tendon Lacerations. Ann Plast Surg. ePub, 2015
                                  2. Gupta P et al: High-resolution 3-T MRI of the fingers: review of anatomy and common tendon and ligament injuries. AJR Am J Roentgenol. 204(3):W314-23, 2015
                                  3. Lourie GM et al: Extensor pollicis longus ruptures in distal radius fractures: clinical and cadaveric studies with a new therapeutic intervention. Am J Orthop (Belle Mead NJ). 44(4):183-7, 2015
                                  4. Shewring DJ et al: The management of clenched fist 'fight bite' injuries of the hand. J Hand Surg Eur Vol. 40(8):819-24, 2015
                                  5. Valdes K et al: Conservative treatment of mallet finger: A systematic review. J Hand Ther. 28(3):237-45; quiz 246, 2015
                                  6. Ansede G et al: Extensor pollicis longus tendon rupture following avulsion fracture of the third metacarpal. Skeletal Radiol. 38(1):81-4, 2009
                                  7. Lee RP et al: Extended MRI findings of intersection syndrome. Skeletal Radiol. 38(2):157-63, 2009
                                  8. Shin AY et al: Ulnar-sided wrist pain: diagnosis and treatment. Instr Course Lect. 54:115-28, 2005
                                  9. Costa CR et al: MRI features of intersection syndrome of the forearm. AJR Am J Roentgenol. 181(5):1245-9, 2003
                                  10. Lopez-Ben R et al: Boxer knuckle (injury of the extensor hood with extensor tendon subluxation): diagnosis with dynamic US--report of three cases. Radiology. 228(3):642-6, 2003
                                  11. Clavero JA et al: MR imaging of ligament and tendon injuries of the fingers. Radiographics. 22(2):237-56, 2002
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Clinical Issues

                                        TERMINOLOGY

                                        • Definitions

                                          • Mallet finger (drop finger): Inability to extend distal interphalangeal (DIP) joint due to terminal extensor tendon avulsion
                                          • Boxer knuckle: Extensor hood sagittal band tear at metacarpophalangeal (MCP) joint with subluxation/dislocation of common extensor tendon; results from direct blow while joint flexed and finger ulnarly deviated
                                          • Fight bite: Opponent's tooth breaks skin over MCP joint with injury to dorsal capsule, extensor tendon ± metacarpal (MC) head
                                          • de Quervain tenosynovitis (washerwoman's sprain, mother's wrist): 1st extensor compartment [extensor pollicis brevis (EPB) and abductor pollicis longus (APL)] tenosynovitis
                                          • Intersection syndrome: Radial wrist extensor tenosynovitis at intersection of 1st and 2nd extensor compartment tendons
                                          • Distal intersection syndrome: Tenosynovitis as 3rd extensor compartment tendon crosses over 2nd compartment tendons
                                          • Boutonnière deformity: Proximal interphalangeal (PIP) joint flexion with DIP joint extension due to extensor tendon central slip injury at or near insertion on middle phalanx, ± avulsion fracture of dorsal base of middle phalanx
                                          • Swan-neck deformity: PIP joint extension with DIP joint flexion; results from volar plate injury at PIP or extensor tendon injury at DIP
                                          • Duckbill deformity (hitchhiker thumb): Thumb interphalangeal (IP) joint hyperextension and MCP flexion; commonly seen in rheumatoid arthritis (RA); may also develop after tendon injury, from stretching of volar plate and attachment of extensor tendon on distal phalanx (similar to swan-neck deformity)

                                        IMAGING

                                        • General Features

                                          • Radiographic Findings

                                            • CT Findings

                                              • MR Findings

                                                • Ultrasonographic Findings

                                                  • Imaging Recommendations

                                                    PATHOLOGY

                                                    • Relevant Anatomy

                                                      • Mechanisms of Injury

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Demographics

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Consider

                                                                  Selected References

                                                                  1. Dezfuli B et al: Accuracy of High-Resolution Ultrasonography in the Detection of Extensor Tendon Lacerations. Ann Plast Surg. ePub, 2015
                                                                  2. Gupta P et al: High-resolution 3-T MRI of the fingers: review of anatomy and common tendon and ligament injuries. AJR Am J Roentgenol. 204(3):W314-23, 2015
                                                                  3. Lourie GM et al: Extensor pollicis longus ruptures in distal radius fractures: clinical and cadaveric studies with a new therapeutic intervention. Am J Orthop (Belle Mead NJ). 44(4):183-7, 2015
                                                                  4. Shewring DJ et al: The management of clenched fist 'fight bite' injuries of the hand. J Hand Surg Eur Vol. 40(8):819-24, 2015
                                                                  5. Valdes K et al: Conservative treatment of mallet finger: A systematic review. J Hand Ther. 28(3):237-45; quiz 246, 2015
                                                                  6. Ansede G et al: Extensor pollicis longus tendon rupture following avulsion fracture of the third metacarpal. Skeletal Radiol. 38(1):81-4, 2009
                                                                  7. Lee RP et al: Extended MRI findings of intersection syndrome. Skeletal Radiol. 38(2):157-63, 2009
                                                                  8. Shin AY et al: Ulnar-sided wrist pain: diagnosis and treatment. Instr Course Lect. 54:115-28, 2005
                                                                  9. Costa CR et al: MRI features of intersection syndrome of the forearm. AJR Am J Roentgenol. 181(5):1245-9, 2003
                                                                  10. Lopez-Ben R et al: Boxer knuckle (injury of the extensor hood with extensor tendon subluxation): diagnosis with dynamic US--report of three cases. Radiology. 228(3):642-6, 2003
                                                                  11. Clavero JA et al: MR imaging of ligament and tendon injuries of the fingers. Radiographics. 22(2):237-56, 2002