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Case Study

Important points:
1-Extensor tendon subluxation or dislocation can trigger other tendons dislocation or subluxation,
2-The head of metacarpal bones will migrate dorsally==> flexion deformity,
3-Ulnar dislocation of the extensor tendon==> adduction at MCP J==> ULNAR DEVIATION,
4-Lack of MCPJ Extension ==> over-activity of interensic muscles of hand==> hyper-extension of PIP joints==> swan neck deformity,
5- Abnormal Biomechanics==> deformity despite control of RhA activity by medicines,
6-When you do MSK US assessment of RhA patient, don't forget to do dynamic scan,
7- Abnormal biomechanics due to inflammatory attenuation of ligaments==> red flag of future damage.

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Case Study

  1. 1. *Female *26years * Rheumatoid Arthritis (RF-/ACPA+) *TTT; Oral steroids (5mg/d), Leflunomide (20mg/d),
  2. 2. Pain at Left 3rd MCP J + audible snap with extension after maximal flexion of fingers
  3. 3. Ultrasound study
  4. 4. Static scan
  5. 5. R = Radial U = Ulnar LT = Left = Extensor tendon = ?
  6. 6. Dynamic scan
  7. 7. Diagnosis
  8. 8. Snapping extensor tendon of Left middle finger due to attenuation of the radial sagittal band at 3rd MCPJ (Type ।।। closed injury) }
  9. 9. Discussion
  10. 10. Anatomy
  11. 11. sono-Anatomy
  12. 12. Normal versus attenuation
  13. 13. Attenuation versus Tear
  14. 14. Epidemiology
  15. 15. *Middle Finger *Sagittal Band - Radial : ulnar = 9 : 1
  16. 16. Mechanism of injury
  17. 17. Rayan and Murray Classification of Closed Sagittal Band Injury
  18. 18. Complications
  19. 19. TTT
  20. 20. Control of RhA activity (10 mg steroids + MTX 12.5mg/week + hydroxychloroquine 200mg twice daily) + dynamic MCP extension assist splint
  21. 21.  surgical repair.
  22. 22. May the Force be with you"

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