Atraumatic extensor tendon subluxation at the level of the metacarpophalangeal (MCP) joint is uncommon in patients who do not have rheumatoid disease. The authors described the cases of 3 elderly women with spontaneous subluxation of the extensor tendons. In each case, the extensor tendon was surgically treated by division of the ulnar sagittal band, relocation and stabilized by reefing the radial extensor hood. Rehabilitation involved dynamic extension splint use for 6 weeks. At a mean of 2.5 years after surgery, there were no recurrences of tendon subluxation and all patients had a “functional pain-free range of MCP joint flexion.”
The authors hypothesized that spontaneous extensor tendon subluxation in the elderly results from tissue atrophy, allowing for stretching of the radial sagittal bands during MCP joint flexion. A tight ulnar junctura tendinum may also contribute to the pathogenesis. They emphasize the need to regain full passive MCP joint extension before considering extensor tendon relocation surgery. Other surgical techniques for extensor tendon subluxation at this level have been described (McCoy and Winsky, PRS, 1969; Kilgore et al, The Hand, 1975; Eisenbaum, PRS, 1987; Carroll et al, JHS Am, 1987). This diagnosis must be considered in the elderly “triggering,” as it can be confused with stenosing tenosynovitis as both manifest as digital popping during flexion.
Elderly, Triggering, Extensor, Tendon, Subluxation, Sagittal Band, Ulnar
Related Links