Sagittal band, boutonniere, and pulley injuries in the athlete

  • Louis Christopher Grandizio
  • Joel Christian Klena
Hand and Wrist Sports Medicine (E Tolo and L Dwyer, section editors)
Part of the following topical collections:
  1. Topical Collection on Hand and Wrist Sports Medicine


Purpose of review

While hand injuries occur frequently in the athletic population, sagittal band ruptures, boutonniere deformities, and pulley ruptures are infrequently encountered. These injuries represent diagnostic challenges and can result in significant impairment. Early recognition with appropriate treatment is necessary to maximize recovery and minimize return to athletic competition. This review will focus on the underlying mechanism, pathophysiology of injury, diagnosis, and treatment of each of these injuries.

Recent findings

With respect to sagittal band ruptures, boutonniere deformities, and pulley ruptures, the recent literature has been limited in scope. For sagittal band injuries, current efforts have focused on alternative techniques for sagittal band reconstruction. Little progress has been made in recent years with respect to boutonniere injuries in the athletic population; prevention of fixed deformities remains the backbone of treatment. The exact contribution from individual and combined pulley injuries in the creation of bowstringing remains controversial. Recent anatomical studies have failed to definitively answer the question of what degree of rupture is necessary to create symptomatic bowstringing. Favorable outcomes, with respect to both preventing bowstringing and returning to full athletic participation, have been newly reported following pulley reconstruction in rock climbers.


Due to the infrequent nature of sagittal band ruptures, boutonniere deformities, and pulley ruptures, current treatment is mostly guided by historically established methods, limited case series, and case reports. Nonsurgical treatment remains the mainstay for most injuries and, if employed early, often precludes the need for surgery. Further anatomical and clinical research, including outcome studies, is necessary in guiding treatment algorithms.


Sagittal band Pulley injuries Boutonniere deformity Central slip disruption Extensor tendon injuries Athletic hand injuries 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Louis Christopher Grandizio
    • 1
  • Joel Christian Klena
    • 1
  1. 1.Division of Hand and Microsurgery, Department of Orthopaedics (52-12)Geisinger Medical CenterDanvilleUSA

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