Sagittal band, boutonniere, and pulley injuries in the athlete
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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.
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.
KeywordsSagittal 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.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.Wheeldon FT. Recurrent dislocation of extensor tendons in the hand. J Bone Joint Surg Br. 1954;36B:612–7.Google Scholar
- 3.Boyes J. Bunnell’s surgery of the hand. 4th ed. Boyes J, editor. Philadelphia: Lippincott; 1984.Google Scholar
- 6.• Catalano LW, Gupta S, Ragland R, Glickel SZ, Johnson C, Barron OA. Closed treatment of nonrheumatoid extensor tendon dislocations at the metacarpophalangeal joint. J Hand Surg. 2006. 242–5. Retrospective series illustrating the results of non-operative treatment of acute sagittal band injuries for patients without rheumatoid arthritis. Google Scholar
- 18.Green D, Wolfe S. In: Green D, Wolfe S, editors. Green’s operative hand surgery. 6th ed. Philadelphia: Elsevier/Churchill Livingstone; 2011.Google Scholar
- 20.Rothwell AG. The pseudo-boutonniere deformity. NZ Med J. 1979;89:51–4.Google Scholar
- 26.Grundberg AB. Anatomic repair of boutonniere deformity. Clin Orthop Relat Res. 1980;153:226–9.Google Scholar
- 41.Hauger O, Chung CB, Lektrakul N, Botte MJ, Trudell D, Boutin RD, et al. Pulley system in the fingers: normal anatomy and simulated lesions in cadavers at MR imaging, CT, and US with and without contrast material distention of the tendon sheath. Radiology. 2000;217:201–12.CrossRefPubMedGoogle Scholar
- 44.• Bouyer M, Forli A, Semere A, Chedal Bornu BJ, Corcella D, Moutet F. Recovery of rock climbing performance after surgical reconstruction of finger pulleys. J Hand Surg Eur. 2016;41(4):406–12. Recent article presenting results of pulley rupture reconstruction with extensor retinaculum graft. Correction of bowstringing was associated with return to level of preinjury performance CrossRefGoogle Scholar