Central Slip Injuries of the Hand

Central slip injuries manifest when the middle finger joint cannot straighten or appears bent. If these injuries are not properly addressed initially or if they don't function well, they can lead to a deformity known as a boutonniere.

What is a central slip injury?

The extensor tendon at the back of the finger is intricate, comprised of two lateral bands and a central slip. These elements collaborate to facilitate finger straightening. Central slip injuries often occur due to sudden bending or direct impact on the PIP joint, caused by accidents like falls, impacts, or even cuts to the finger's top (open injuries). Disruption to the central slip can cause a boutonniere deformity, wherein the top joint hyperextends while the middle joint bends, hindering finger straightening. This deformity might develop gradually, becoming fixed and challenging to correct over time.


Causes of central slip injuries:

These injuries stem from forceful bending or direct impact on the middle finger joint (proximal interphalangeal joint), frequently resulting from deep cuts to the finger's back (open injuries), punching, ball impacts, or forceful knocks. While trauma commonly causes central slip injuries, they can also occur in individuals with rheumatoid arthritis without any evident trauma.


Signs & Symptoms of central slip injuries:

  • Inability to straighten the finger

  • Loss of extension at PIP and hyperextension at DIP, which might appear gradually after 10-14 days post-injury

  • Reduced grip strength or inability to grasp

  • Swelling and pain over the middle finger joint

Central Slip Splint - SIM Physiotherapy Frenchs Forest and Macquarie Park

Treatment of central slip injuries:

Effective management of central slip injuries is crucial to prevent complications and deformities. These injuries require splinting with the joint held in extension for about six weeks to ensure proper healing of the tendon. Once the tendon heals, the joint might become stiff and require movement and stretching. Hand therapists can evaluate mobility levels and provide exercises to restore movement and strength.

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