Sagittal Band Tear
What is a Sagittal Band Tear?
In order to truly understand what a Sagittal Band Tear is, a basic knowledge of hand anatomy is helpful. The hand bones (metacarpals) articulate with the finger bones (phalanges) at the metacarpophalangeal joint (MCP). The extensor tendons are thick fibrous structures that connect the muscles in the forearm along the back of the hand to the phalanges to produce movement in the fingers. Specifically they allow the fingers to straighten or extend. The sagittal bands are ribbon-like ligaments that encircles the MCP joints to stabilize and centralize the extensor tendons during motion. Injury to the hand can result in partial or complete rupture of a sagittal band. Sagittal Band Tears are commonly referred to as “Boxer’s Knuckle” since this type of injury is common to the sport.
What causes Sagittal Band Tear?
Sagittal Band Tears often results from trauma to the knuckle, whether it be a single blow or multiple blows over time as is usually the case with professional martial artists and boxers. While much more uncommon, this injury can also occur in people with no history of trauma to the hand and in older individuals suffering from arthritis. Any activity that requires repetitive extension of the finger may lead to Sagittal Band Tears. The middle fingers are most commonly affected, followed by the little fingers.
What are the symptoms of Sagittal Band Tear?
The symptoms of Boxer’s knuckle vary with the severity of the injury. In traumatic cases, patients frequently report a popping or snapping sensation along with immediate pain and edema to the knuckle. It may be difficult or impossible to fully extend the finger. When making a fist the defect can be seen and felt as the extensor tendon slides to one side of the knuckle.
How is Sagittal Band Tear diagnosed?
As with most injuries, diagnosis begins with a review of history and onset of symptoms. The physician will examine and manipulate the hand assessing the appearance and range of motion, as well as, the quality and degree of pain. X-rays will be used to rule out the possibility of fracture. MRI or CT scans can confirm diagnosis by visualizing the soft tissues in the hand and identifying if rupture has occurred.
How is Sagittal Band Tear treated?
Conservative treatment may be indicated in acute cases of Sagittal Band Rupture where trauma is not the cause, when there is minimal pain or loss of function and within one week of onset. The affected finger will be immobilized in an extension splint for 4-6 weeks. Additionally, your doctor will recommend pain and swelling management with ice and over-the-counter medications like ibuprofen, aspirin, or naproxen. Unfortunately, most acute and chronic case of Sagittal Band Tear will require surgery.
Surgery may consist of either a direct repair of the sagittal band or an extensor centralization procedure when sagittal band repair is not possible. Post operatively a splint is placed for about 6 weeks to ensure proper healing and recovery. Hand therapy is then used to restore full function, strength and dexterity. Full recovery varies from patient to patient but can be expected in 5 to 6 months.
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