Dr. Abdallah El-Sayed AllamMSc of Physical Medicine, Rheumatology and Rehabilitation .

Faculty of Medicine. Tanta University. EgyptMSK US fellowship. National Taiwan University Hospital. Taiwan

Case Presentation

*Female *26years

* Rheumatoid Arthritis (RF-/ACPA+)

*TTT; Oral steroids (5mg/d), Leflunomide

(20mg/d),

Pain at Left 3rd MCP J + audible snap with

extension after maximal flexion of fingers

Ultrasound study

Static scan

R U3rd MH

R U

3rd MH

R = Radial

U = Ulnar

LT = Left

=Extensor tendon

? =

Dynamic scan

Diagnosis

Snapping extensor tendon of Left middle finger due to attenuation of the radial sagittal band at 3rd MCPJ (Type ।।। closed injury) }

Discussion

Anatomy

sono-Anatomy

R U

3rd MH

Normal versus attenuation

R U3rd MH

R U

3rd MH

Attenuation versus Tear

R U3rd MH

Epidemiology

*Middle Finger

*Sagittal Band

- Radial : ulnar = 9 : 1

Mechanism of injury

Traumatic

Inflammatory

Rayan and Murray Classification of Closed

Sagittal Band Injury

Complications

TTT

Control of RhA activity(10 mg steroids + MTX

12.5mg/week + hydroxychloroquine 200mg twice

daily ) +dynamic MCP extension assist splint

surgical repair.

"May the Force be with you"

Thank you