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Geschlossene Streckhaubenverletzungen am Grundgelenk der Langfinger

Acute closed lesions of the extensor hood of the metacarpophalangeal joint

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Zusammenfassung

Geschlossene Streckhaubenverletzungen am Grundgelenk der Langfinger gehören zu den seltenen Verletzungen. In unserem Krankengut fanden sich in den vergangenen zehn Jahren sechs Patienten mit einer derartigen Verletzung, die operativ versorgt wurden. In fünf Fällen war der dorsoradiale, in einem Fall der dorsoulnare Anteil der Streckerhaube betroffen. Der Riß verläuft längs oder schräg durch die transvers angeordneten Fasern der Streckerhaube. Hinsichtlich des Unfallmechanismus werden direkte tangentiale Krafteinwirkungen auf die Streckerhaube sowie forcierte Ulnarabduktion im gebeugten Grundgelenk der Langfinger beschrieben. Die Diagnose wird regelhaft durch die ruckartige Luxation der Strecksehne nach der Ulnarseite bei zunehmender Beugung im Grundgelenk gestellt, gelegentlich tritt eine Ulnarabweichung des Fingers auf. Fehldiagnosen der uns überwiesenen Fälle lauteten: „schnellender Finger“ und „rezidivierende Grundgelenkluxation“; einmal hieß die präoperative Diagnose wegen fixierter Luxation „Strecksehnenriß“, da ein permanentes Streckdefizit von 30° bestehen blieb. Die Therapie ist immer operativ mit Naht und vierwöchiger Ruhigstellung des Grundgelenks in Streckstellung, da eine konservative Behandlung den Riß nicht zur Ausheilung bringen kann.

Abstract

Closed traumatic lesions of the extensor tendon hood of a longfinger at the metacarpophalangeal joint are rare. Surgical treatment was done in 6 cases during the last 10 years in our department; in 5 cases the dorsoradial part, in one case the dorsoulnar part of the hood was injured. The tear extended longitudinal or diagonal through the transvers fibers of the hood. Respecting the accident mechanism there have been reported tangential forces at the extensor tendon hood and forced ulnar deviation in the bended metacarpophalangeal joint. A jerky dislocation of the extensor tendon to the ulnar side of the metacarpophalangeal head during increased bending of the metacarpophalangeal joint, sometimes with ulnar abduction of the longfinger, leads usually to the diagnosis. Misdiagnoses of cases sent to our department were: „trigger finger“ and „recurrent dislocation of the metacarpophalangeal joint“. Once the presurgical diagnosis was „rupture of the extensor tendon“ because of a permanent extension deficit in 30 degree position of the metacarpophalangeal joint. Treatment is always surgical with suture of the hood and immobilization of the metacarpophalangeal joint in extension position for 4 weeks. Conservative treatment can not heal up a tear of the extensor tendon hood.

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Literatur

  1. Araki S, Ohtani T, Tanaka T. Acute dislocation of the extensor digitorum communis tendon at the metacarpophalangeal joint. J Bone Joint Surg [Am] 1987;69:616–9.

    CAS  Google Scholar 

  2. Bittoun J, Saint-Jalmes H, Querleux BG, et al. In vivo high-resolution MR imaging of the skin in a whole-body system at 1.5 T. Radiology 1990;176:457–60.

    PubMed  CAS  Google Scholar 

  3. Boyes JH. Bunnell’s surgery of the hand, 4th edn. Philadelphia, Pa: Lippincott 1964:343–6, 470–1.

    Google Scholar 

  4. Bracey DJ, Jeffreys TE. Habitual extensor tendon dislocation. Hand 1979;11:284–94.

    Article  PubMed  CAS  Google Scholar 

  5. Burton IB. Extensor tendons: late reconstruction. In: Green DP, ed. Operative hand surgery, 2nd edn. Vol 3. New York, NY: Ch. Livingstone, 1988:2073–116.

    Google Scholar 

  6. Curchod E. Traumatische Sehnenluxation eines Fingerstreckers. Beitr Klin Chir 1916;102:743.

    Google Scholar 

  7. Curtis RM. Joints of the hand. In: Flynn JE, ed. Hand surgery. Baltimore: Williams & Wilkins, 1966.

    Google Scholar 

  8. Drapé JL, Dubert T, Silbermann O, Thelen P, Thivet A, Benacerraf R. Acute trauma of the extensor hood of the metacarpophalangeal joint: MR imaging evaluation. Radiology 1994;192:469–76.

    PubMed  Google Scholar 

  9. Eaton RG. The extensor mechanism of the fingers. Bull Hosp Joint Dis 1969;30:39–47.

    PubMed  CAS  Google Scholar 

  10. Elson RA. Dislocation of the extensor tendons of the hand. J Bone Joint Surg [Br] 1967;49:324–6.

    CAS  Google Scholar 

  11. Erickson SJ, Prost RW, Timins ME. „Magic angle“ effect: background physics and clinical relevance. Radiology 1993;188:23–5.

    PubMed  CAS  Google Scholar 

  12. Foo TKF, Shellock FG, Hayes CE, Schenck JF, Slayman BE. High-resolution MR imaging of the wrist and eye with short TR, short TE, and partial-echo acquisition. Radiology 1992;183:277–81.

    PubMed  CAS  Google Scholar 

  13. Goodfellow JW, Weaver JPA. Locking of the metacarpophalangeal joint from a loose body. J Bone Joint Surg [Br] 1961;43:772–7.

    Google Scholar 

  14. Hakstian RW, Tubiana R. Ulnar deviation of the fingers: the role of joint structure and function. J Bone Joint Surg [Am] 1967;49:299–316.

    CAS  Google Scholar 

  15. Harvey FJ, Hume KF. Spontaneous recurrent ulnar dislocation of the long extensor tendons of the fingers. J Hand Surg [Am] 1980;5:492–4.

    CAS  Google Scholar 

  16. Kaplan EB. Anatomy, injuries and treatment of the extensor apparatus of the hand and the digits. Clin Orthop 1959;13:24–41

    Google Scholar 

  17. Kettelkamp DB, Flatt AE, Moulds R. Traumatic dislocation of the long-finger extensor tendon: a clinical, anatomical, and biomechanical study. J Bone Joint Surg 1971;53:229–40.

    PubMed  CAS  Google Scholar 

  18. Kilgore ES, Graham WP, Newmeyer WL, Brown LG. Correction of ulnar subluxation of the extensor communis. Hand 1975;7:272–4.

    Article  PubMed  CAS  Google Scholar 

  19. Legouest L. Discussion in Société Impériale de Chirurgie. Gazette Hop 1868;41:191.

    Google Scholar 

  20. Le Viet D, Ebelin M, Loy S. Luxation traumatique de l’appareil extenseur au dos de l’articulation métacarpo-phalangienne de l’auriculaire. Ann Chir Main Memb Super 1991;10:273–9.

    Article  PubMed  Google Scholar 

  21. Littler JW. The finger extensor mechanism. Surg Clin North Am 1967;47:415–32.

    PubMed  CAS  Google Scholar 

  22. Marsh H. Clinical lecture on displacements and injuries of muscles and tendons. BMJ 1896;2:181–6.

    Google Scholar 

  23. Mason ML. Rupture of tendons of the hand. Surg Gynecol Obstet 1930;50:611.

    Google Scholar 

  24. McCoy FJ, Winsky AJ. Lumbrical loop operation for luxation of the extensor tendons of the hand. Plast Reconstr Surg 1969;44:142–6.

    Article  PubMed  CAS  Google Scholar 

  25. Meriaux JL, Le Viet D, Ebelin M. Les blocages articulaires de la métacarpo-phalangienne des doigts: à propos de 2 cas. Rev Rhum 1984;51:233–6.

    PubMed  CAS  Google Scholar 

  26. Michon J, Vichard P. Luxations latérales des tendons extenseurs en regard de l’articulation métacarpophalangienne. Rev Med Est 1961;86:595–601.

    CAS  Google Scholar 

  27. Michon J. Lésions de l’appareil extenseur dans la région métacarpophalangienne. Ann Chir Plast 1962;7:209–13.

    PubMed  CAS  Google Scholar 

  28. Paget J. Clinical lectures and essays. White Plains, NY: Longman, 1875:86.

    Google Scholar 

  29. Razemon P. Luxation traumatique du tendon extenseur du médius. Ann Anat 1930;7:238.

    Google Scholar 

  30. Richard S, Querleux B, Bittoun J, et al. In vivo proton relaxation times analysis of the skin layers by magnetic resonance imaging. J Invest Dermatol 1991;97:120–5.

    Article  PubMed  CAS  Google Scholar 

  31. Ritts GD, Wood MB, Engber WD. Nonoperative treatment of traumatic dislocations of the extensor digitorum tendons in patients without rheumatoid disorders. J Hand Surg [Am] 1985;10:714–6.

    CAS  Google Scholar 

  32. Rubens DJ, Blebea JS, Totterman SMS, Hooper MM. Rheumatoid arthritis: evaluation of wrist extensor tendons with clinical examination versus MR imaging — preliminary report. Radiology 1993;187:831–8.

    PubMed  CAS  Google Scholar 

  33. Saldana MJ, McGuire RA. Chronic painful subluxation of the metacarpal phalangeal joint extensor tendons. J Hand Surg [Am] 1986;11:420–3.

    CAS  Google Scholar 

  34. Silfverskiöld N. Einige orthopädische Mitteilungen. Acta Chir Scand 1928;64:294–310.

    Google Scholar 

  35. Smith RJ, Kaplan EB. Rheumatoid deformities of the metacarpophalangeal joints of the fingers: a correlative study of anatomy and pathology. J Bone Joint Surg [Am] 1967;49:31–47.

    CAS  Google Scholar 

  36. Straus FH. Luxation of the extensor tendons in the hand. Ann Surg 1940;111:135–40.

    Article  PubMed  CAS  Google Scholar 

  37. Tubiana R, Valentin P. The anatomy of the extensor apparatus of the finger. Surg Clin North Am 1964;44:897–918.

    PubMed  CAS  Google Scholar 

  38. van Meirhaeghe J, Vercauteren M. Traumatic dislocation of the extensor tendons over the fifth metacarpophalangeal joint. J Hand Surg [Br] 1989;14:350–1.

    Article  Google Scholar 

  39. Wheeldon FT. Recurrent dislocation of extensor tendons in the hand. J Bone Joint Surg [Br] 1954;36:612–7.

    Google Scholar 

  40. Wilhelm A. Verletzungen der Strecksehnen. In: Nigst H, Buck-Gramcko D, Millesi H, eds. Handchirurgie. Stuttgart-New York: Thieme 1983:29–32.

    Google Scholar 

  41. Wise KS. The anatomy of the metacarpophalangeal joints with observations of the aetiology of ulnar drift. J Bone Joint Surg [Br] 1975;57:485–90.

    CAS  Google Scholar 

  42. Wong EC, Jesmanowicz A, Hyde JS. Highresolution, short echo time MR imaging of the fingers and wrist with a local gradient coil. Radiology 1991;181:393–7.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Chefarzt der Klinik für Unfall-, Wiederherstellungs- und Handchirurgie des Dr.-Herbert-Nieper-Krankenhauses, Harzkliniken, Kösliner Straße 12, D-38642, Goslar

    K. Ferlemann &  H. Zilch

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  1. K. Ferlemann
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  2. H. Zilch
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Ferlemann, K., Zilch, H. Geschlossene Streckhaubenverletzungen am Grundgelenk der Langfinger. Unfallchirurgie 23, 262–266 (1997). https://doi.org/10.1007/BF02628923

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  • DOI: https://doi.org/10.1007/BF02628923

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