Proximal interphalangeal joint (PIP) dislocation with avulsion tear of the volar plate

Case contributed by Dr Mohammad A. ElBeialy

Presentation

Painful little finger after trauma while playing football.

Patient Data

Age: 23 years
Gender: Male

Dorsal dislocation of the proximal interphalangeal joint of the little finger. No significant lateral displacement is noted. 

The volar plate of the proximal interphalangeal joint (PIP) of the right little finger appears grossly thickened and ill-defined with increased signal intensity with tear / avulsion of its proximal attachment, within the head of the proximal phalanx with associated flexion deformity of the proximal interphalangeal articulation giving the appearance of pseudo-boutonniere deformity.

Intact extensor tendon as well as extensor tendon central slip. The collateral ligaments of the proximal interphalangeal articulation appear grossly unremarkable with no evidence of rupture or sprain.

No definite MRI evidence of acute fracture or dislocation is noted. Intact metacarpophalangeal articulations as well as distal interphalangeal articulations. No significant joint effusion. Mild marrow edema of the distal metadiaphysis and head of the proximal phalanx of the little finger. No otherwise  gross marrow signal abnormality. No peri-tendinous soft tissues mass lesions are identified.

Annotated image.

Case Discussion

Type I lesion of the volar plate of the proximal interphalangeal joint of the right little finger with disruption of the proximal attachment of the volar plate as well as mild flexion deformity of the proximal interphalangeal articulation and pseudo boutonniere deformity.

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