What is the recommended treatment for a central slip (extensor tendon) injury?

From the Guidelines

The recommended treatment for a central slip injury typically involves splinting the finger in a specific position called the Stack splint, which holds the proximal interphalangeal (PIP) joint in full extension while allowing the distal interphalangeal (DIP) joint to move freely. This approach is supported by the fact that MRI is ideal for evaluating tendon injuries and helping with surgical planning, as reported by 1. The treatment should be maintained continuously for 6-8 weeks to allow proper healing of the tendon. Following the initial immobilization period, a gradual rehabilitation program should be implemented, including protected motion exercises and strengthening activities under the guidance of a hand therapist. For acute injuries with significant pain and swelling, over-the-counter pain medications such as acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours) may be used for symptom management, along with ice application for 15-20 minutes several times daily. Key considerations in the treatment of central slip injuries include:

• The importance of proper immobilization to prevent boutonnière deformity, characterized by PIP joint flexion and DIP joint hyperextension
• The role of MRI in evaluating the extent of tendon injury and guiding surgical planning, as noted in 1
• The need for a gradual rehabilitation program to restore finger function and strength
• The use of pain management strategies, such as medication and ice application, to control symptoms and promote healing. It is also important to note that radiographs are used to detect fracture fragments, as large fragments may require open reduction and internal fixation, as mentioned in 1. However, the primary focus of treatment for a central slip injury should be on restoring tendon function and preventing long-term deformity, rather than solely on addressing any associated fractures.

From the Research

Treatment Options for Central Slip Injuries

• Surgical repair is a common treatment approach for central slip injuries, with studies showing excellent or good recovery outcomes 2, 3
• A combination of immobilization and controlled mobilization is an effective rehabilitation regime for surgically repaired open central slip injuries 2
• Early active short arc motion following central slip repair can produce improved range of motion with shorter treatment time compared to static immobilization 3
• Reconstruction techniques, such as using a slip of flexor digitorum superficialis tendon, have been described for correction of boutonniere deformities resulting from central slip injuries 4

Rehabilitation Regimes

• Immobilization within a cylinder splint for 3 weeks, followed by controlled mobilization within a Capener coil splint for 3 weeks, has been shown to be an effective rehabilitation regime 2
• Early active short arc motion can be used to restore motion and improve range of motion after central slip repair 3

Limitations of Current Evidence

• The evidence base regarding treatment of central slip injury is limited, and the roles of different treatment strategies for open as well as closed injuries are not well-supported by evidence 5