0:00

Um, this is a 50-year-old woman with a finger laceration,

0:06

and the laceration was dorsal, and I think Dr.

0:10

Chung talked about this, but it's a nice example.

0:15

So, again, if I know I have a laceration, dorsally

0:18

and I, you know, I've got a, a busy day ahead of me.

0:20

I like to put up these sequences

0:22

that are gonna show the pathology.

0:24

And so for flexors

0:25

and extensors, it's gonna be the sagittal.

0:28

Uh, so I'll begin there.

0:29

When I'm in the wrist of the TFC, it's gonna be the coronal.

0:33

So I've got, um, three sequences, two water weighted,

0:38

one fat weighted, and let's go to the region

0:41

of the middle finger, I believe, and the extensor mechanism.

0:45

And here we've got the, the central slip right here,

0:49

which has torn off

0:50

and avol a little bit proximally without a piece,

0:54

without a piece of bone.

0:55

You can see some more of the, the, the distal

0:59

terminal anatomy and,

1:00

and that, that finger anatomy can be a little daunting.

1:03

You know, I have, I think I can kind of recreate a,

1:06

a diagram here for you.

1:08

If you, if you look at the lateral aspects

1:11

of the extensor kind of coming together

1:13

to form the conjoint,

1:14

and then you've got the central slip coming up the middle,

1:18

then these two join a little more distally

1:21

to form the terminal tendon.

1:23

And you have something that's transversely oriented right

1:26

here that I think Christine briefly showed,

1:28

called the triangular ligament

1:30

or the triangular portion of the tendon.

1:32

So it's not quite as daunting as it looks. I know Dr.

1:35

Chung makes, makes it look easy,

1:37

but you just have to know where these things insert this one

1:40

inserts right along the proximal base, uh,

1:43

uh, of the middle failing.

1:45

So that's where you're gonna make your inspection.

1:47

And there is your very strong and powerful.

1:49

It takes a lot of force to disrupt that, that Palmer plate.

1:54

Uh, Christine, any comments on this one?

1:56

No, that's a beautiful example.

1:59

And then you also see, if I flip it upside down,

2:02

you've got this, this big hole.

2:04

It's like a hole in the d**e.

2:05

You're missing a piece of very important anatomy.

2:08

And for those of you that are just learning,

2:10

one helpful thing to do is look at what you know,

2:14

look at the adjacent fingers,

2:15

and that'll help you get oriented, uh, to the anatomy

2:19

of the pathologic finger.