(iii) Extensor tendon injuries

Therapeutic management of closed central slip injuries: Outcome of a service evaluation

“…These were included based on the published average extension deficits seen in conservative and surgically repaired CS injuries 14,16 and to allow the treating therapists to carefully progress rehabilitation to prevent long-term joint stiffness 19 or adhesions developing. 20,30,53,54 Exercise prescription out of the splint(s) were guided by patient presentation. For example, if the MCPJ developed a pattern of hyperextension in gross digital extension, then the MCPJ was blocked into flexion to an intrinsic positive position to ensure all extension force was directed through the PIPJ.…”

“…The CS lies just beneath the dermis on the dorsum of the hand at the PIPJ and is prone to both injury and subsequent adhesions due to the lack of a protective synovial sheath and a high tendon-to-bone surface ratio. 29,30 The CS is joined by fibres from the intrinsic lumbrical and interossei muscles to insert onto the base of the middle phalanx. 31,32 The gradual transition between tendon and bone at the insertion point, the enthesis and the shallow angle of attachment contributes to its strength 33 but also complicates its rehabilitation, either conservatively or surgically, in terms of stress tolerance and scarring.…”