I Cannot Provide Medical Images
I am unable to generate, display, or provide actual clinical photographs or radiographic images of injuries. However, I can describe what you would typically see in a hyperextension injury to the PIP joint with chronic sequelae.
Clinical Appearance of Chronic PIP Hyperextension Injury
In a patient with chronic pain and stiffness over 12 months following PIP hyperextension injury, you would typically observe visible deformity, swelling, and functional limitations that distinguish this from an acute injury.
Physical Examination Findings
Hyperextension deformity: The affected finger may demonstrate a persistent hyperextension posture at the PIP joint, creating a swan-neck appearance in some cases 1, 2
Flexion contracture: Paradoxically, chronic cases may develop a flexion contracture rather than hyperextension, particularly when associated with avulsion fractures 3
Visible swelling: Persistent periarticular swelling around the PIP joint, though typically less pronounced than in acute injuries 4
Bruising: Generally absent in chronic cases (>12 months), as ecchymosis resolves within weeks of initial injury 5
Functional impairment: Difficulty initiating finger flexion, reduced grip strength, and visible hesitation when attempting to make a fist 2
Radiographic Appearance
Standard anteroposterior and lateral radiographs would show specific findings that correlate with the chronic nature of the injury 6, 7:
Avulsion fractures: Small bony fragments at the volar base of the middle phalanx where the volar plate inserts, present in approximately 40% of hyperextension injuries 4
Joint space changes: Possible narrowing or early degenerative changes after 12 months of chronic instability 1
Malalignment: Persistent hyperextension or flexion deformity visible on lateral views 6
Volar subluxation: In severe cases, the middle phalanx may show subtle volar displacement relative to the proximal phalanx 3
Advanced Imaging Characteristics
MRI without IV contrast would be the ideal modality to visualize the soft tissue pathology in this chronic injury 6, 8:
Volar plate pathology: Thickened, scarred, or attenuated volar plate with possible retraction from its insertion site 1
Collateral ligament status: Assessment of lateral stability and any associated ligamentous injury 6
Tendon integrity: Evaluation of flexor and extensor tendon function and any adhesions 2
Joint capsule changes: Chronic synovitis or capsular thickening 1
Clinical Pitfalls
Do not assume normal radiographs exclude significant injury: Purely tendinous volar plate disruptions may have normal radiographs but still cause chronic disability 7, 4
The "triad sign" (pain on extreme flexion and extension) has no diagnostic or prognostic value in these injuries 4
Radiographic stress views do not reliably identify chronic instability and are not recommended 4
Documentation Recommendations
For proper clinical documentation and treatment planning, obtain:
Three-view radiographs of the affected finger (AP, lateral, and oblique) to assess for fractures and alignment 6, 5
MRI without IV contrast if surgical intervention is being considered, as it provides superior visualization of volar plate integrity, tendon quality, and degree of retraction 6, 7
Comparison views of the contralateral uninjured finger may help identify subtle deformities 6