In this article, we will discuss extensor tendon dislocation of the ring finger in a female therapist.
As a profession that uses manual techniques to work on muscles and joints, therapists sometimes suffer from finger injuries.
The location of the injury may vary depending on the type of technique, but I think the mother finger is the most common.
When I first started working in an osteopathic clinic, I sometimes had trouble sleeping because my thumb hurt so much.It's not the technique that causes the pain, but in the case I'm going to show you, the extensor tendon of the ring finger was dislocated.
Extensor tendon dislocation?
Extensor tendon dislocation is believed to be caused by congenital, tissue degeneration, trauma, or spontaneous sagittal band tears.
The most common of these dislocations are caused by tissue degeneration and usually occur in patients with rheumatoid arthritis.
Cases
A 43-year-old female shiatsu therapist
20 years of work experience
She came to the clinic complaining of sudden snapping of the MCP joint in her left ring finger (her non-dominant hand) and pain in the back of the MCP joint.
The patient told us that she did not have any predisposing conditions for sagittal band laxity in the past, including trauma.
Two weeks later, the patient developed a crackling pain in the right ring finger.
On physical examination, the extensor tendons on the dorsal side of the MCP joints of both ring fingers were dislocated in certain hand positions.
When the MCP joint of the ring finger was actively extended, the extensor tendon decreased in snap.
However, when the MCP joints of both the middle and ring fingers were flexed together, the ring finger extensor tendon did not dislocate.
X-rays did not show any deformity of the MCP joints.
The patient did not respond to non-surgical treatment, such as MCP joint extension bracing, because he was unable to continue working with the brace.
Four weeks after the initial consultation, the extensor tendons of both ring fingers were reconstructed with wrist blocks.
A longitudinally curved skin incision on the dorsal aspect of the MCP joint of the ring finger revealed a severely attenuated radial sagittal band and bilaterally dislocated extensor tendons.
The tendon junction of the extensor hallucis longus between the metacarpal and ring fingers was folds and the ulnar sagittal band was partially released to increase the range of motion of the non-dislocated extensor hallucis longus throughout the full range of motion of the MCP joint intraoperatively.
The active range of motion of the fingers was also tested.
Postoperatively, a hand dressing with a forearm-based palmar plaster splint was applied to the MCP joint in the extended position to prevent inadvertent passive flexion of the MCP joint.
Active flexion and extension exercises were performed 1 to 6 weeks postoperatively.
At 6 weeks postoperatively, the splint was removed and all MCP joint motion was allowed.
The patient resumed her work as a therapist without any dislocations or M-snaps.
All finger movements were performed without restriction in either hand, and 26 months after surgery, the patient reported no dislocation of the extensor tendons, no snapping sounds in either hand, and no pain while working.
Kamiya M, Sasaki G, Ikuta K, Miyamoto H, Kimura M, Kawano H. Extensor Tendon Dislocation at the Metacarpophalangeal Joint of Both Ring Fingers Caused by a Specific Hand Posture in a Shiatsu Therapist. Case Rep Orthop. 2020;2020:6842986. Published 2020 Sep 22. doi:10.1155/2020/6842986
Conclusion
In this case, surgical treatment was performed because conservative treatment was not possible due to the nature of the work, but conservative treatment may be indicated for acute injuries.
However, if the subluxation is not corrected, surgical treatment may be necessary, as in this case.
Although it is believed that the subluxation was caused by the strain of the therapist's unique hand shape, care does not necessarily prevent dislocation of the extensor tendon.However, care does not necessarily prevent extensor tendon dislocation. If it does prevent it, it is better to improve form so as not to keep applying unwanted traction to each extensor tendon.
