1005 - Bellgard to Bellgard trauma resulting in sagittal band rupture

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

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Ray Espinosa, MD

Resident Physician
Mount Sinai Hospital
New York, New York, United States

Co-Author(s)

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Ian T. O'Connor, MD

Resident Physician
Icahn School of Medicine at Mount Sinai
NEW YORK, New York, United States
Mariam A. Zakhary, DO

Sports Medicine Fellowship Director
Mount Sinai
New York, New York, United States

Case Diagnosis: Rupture of the radial sagittal band in the right third metacarpophalangeal joint

Case Description: A 25 year old right handed epee fencer presented to the clinic due to hand pain following trauma to the right hand. Patient was training when they suffered a bellgard to bellgard trauma which resulted in immediate pain and swelling of the right hand. Patient reported snapping and subluxation of the middle finger. Did not report any locking of the finger in flexion. Pain was located over the 3rd metacarpophalangeal joint without radiation. Flexion of the 3rd digit, gripping of the bellgard, and extension of the third digit made the pain worse. Pain improved with rest, NSAIDs, ice and diclofenac gel. Patient denied any numbness, tingling or weakness of the hand. On exam, patient had swelling, ecchymosis, and an appreciable divot over the 3rd metacarpophalangeal joint. MRI showed a radial sagittal band rupture of the 3rd MCP with subluxation of extensor tendon. Patient was treated successfully with splinting.

Discussions: We present an interesting case of a ruptured radial sagittal band after hand trauma while fencing. An injury most often associated with boxers, this is a unique mechanism for rupture of the sagittal band. Treatment of sagittal band ruptures is often determined based on timing post injury. The patient was referred to Orthopedic Surgery, who recommended nonoperative management in this case. Given this grade II sagittal band injury diagnosed within 3-6 weeks from the time of injury, the patient underwent splinting which provided symptomatic relief. With time, patient was able to return to play without pain.

Conclusions: Though most commonly associated with boxing, sagittal band rupture should remain in the differential diagnosis for traumatic hand injuries.