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The patient bends the PIP 90° over the edge of a table and extends the middle phalanx against resistance.A patient with intact lateral bands will maintain the ability to extend the digit (albeit, weakened).Įlson’s test is the most well known test to diagnose an injury to the central slip before complications occur. PITFALL! Simply testing extension at the PIP can miss a central slip injury.
#Extensor tendon compartments skin
Furthermore, a detailed exploration may require extension of the skin wound, which not all providers are prepared to do. Without intimate knowledge of hand anatomy, a tendon injury can easily be missed by visual inspection alone. PITFALL! The extensor tendons are thin and tend to retract out of the field of view when severed.
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It pays to be aware of a few diagnostic pitfalls: Furthermore, it is a condition that is very tough for a hand surgeon to reverse once it occurs. This typically takes weeks to occur, but if you miss the injury to the central slip on presentation, you are putting the patient at risk. This leads to an odd appearance of the finger known as the Boutenniere deformity. If the central slip is avulsed, the lateral bands will be freed, and may migrate volarly to actually become flexors of the finger. The common extensor divides at the PIP into a central slip and two lateral bands. Adapted from “Extensor Tendon Repair in the Emergency Department,” by Calabro JJ, Hoidal CR, and Susini LM. The extensor tendon of the digit is not just a simple single tendon–it’s actually a complex network of 12 extrinsic extensor tendons that originate in the proximal forearm and pass across the wrist in 6 separate compartments beneath the extensor retinaculum. Read on to learn more about the relevant anatomy, pitfalls in the diagnosis, and for an explanation of the test and a simple modification in further detail. This video describes Elson’s test, used for early detection of PIP central slip extensor tendon laceration.