Sagittal Band Injury Basics

Sagittal band injuries can make a knuckle tendon drift, flare up, and hurt more the more you “work it.” I break down what the sagittal band does, how repairs are protected, and simple cold techniques that can lower inflammation fast while you heal. 
• what the sagittal band is and why it keeps the extensor tendon centered 
• common causes of sagittal band rupture including spontaneous tears and trauma 
• a real surgical case with glass in the joint and what the joint capsule does 
• early post-op rehab expectations even with sutures still in place 
• the splinting progression from forearm-based protection to relative motion orthosis 
• cold running water for 10 to 20 seconds until deeply cold 
• ice cube and paper-cup ice methods with minimal pressure 
• why frequent motion and self-massage can increase inflammation 
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CarlPetito.com, check it out. 

Transcript

Welcome And The Big Problem

SPEAKER_00 0:00

Welcome back to the Hand to Shoulder Solution where pain meets its match. I'm your host, Carl Petito. I'm an occupational therapist and a board certified hand therapist specializing in the rehabilitation of orthopedic conditions that affect the fingertips through the shoulder. A lot of people have been writing in about their sagittal band injuries, and you know I didn't expect that because I don't see a lot of

What A Sagittal Band Does

SPEAKER_00 0:22

them. I might see, well, maybe two or three a month come into the clinic. And there's spontaneous rupture of the sagittal band, which is a ligament that keeps this tendon centered on the back of the knuckle. And I have other videos explaining it in more detail. And it so there's spontaneous rupture, and then there's also trauma, everything from fist fights to car accidents to trip and fault and hand going through a window. And uh I really want to stress that it's important, it's crucial to be seen by your healthcare provider to get an accurate, clear diagnosis and get a very uh accurate, tailored, appropriate home program for you so that you can get well in minimal time. I would like to ask you to like and subscribe to the channel. Uh I've been told that there's a lot of good content that has been helping out a lot of people, and that really pleases me. I'm happy that this is getting out and people are seeing it. And thank you for sharing this on social media with anyone who might uh uh benefit from such information.

Glass Injury And Joint Repair

SPEAKER_00 1:30

So the sagittal band, I have a case right now that I'm working with, and this woman had glass buried into her joint, and it was deep inside the joint. So the surgeon had to remove the foreign body, had to repair the joint capsule. The joint capsule, if you put it put in simplest terms, if you bring the two bones together and you wrap those bones in plastic wrap, that's the capsule. So the capsule really helps stabilize the joint, and that was torn because a piece of glass was shoved in there. So that was sewn back together. Well, now above the capsule is the tendon, which the tendon connects these bones to the muscle in the forearm. So when the muscle in the forearm contracts, extensor digitorum conus EDC muscle contracts and pulls the fingers out straight. And this tendon, you can see it popping up on me. That lives underneath the sagittal band. The job of the sagittal band is to keep that tendon centered on the knuckle so when you close your fist, it doesn't pop off or roll off into this trough right here. And everything when it pops off, rolls off into the trough, it starts to hurt after a while. So the sagittal band in this case was repaired by the surgeon and it's paper thin, it's very delicate.

Splinting And Weaning Plan

SPEAKER_00 2:48

So what my job was about four or five days after surgery is I made a um a splint. It was her uh long finger. So I made a splint on the forearm that went up here, and it has a trough, and it keeps the finger and the neighboring finger fully straight so that there's no stress on that sagittal band so it can heal. Then the next step is we allow the IP joints or the small joints of the fingers to be free, and then eventually we turn it into a hand-based splint, and we start weaning the person out of the splint and eventually into a relative motion orthosis, which I demonstrate in another video, that's sort of like a ring splint that keeps the finger up compared to the other one. So it's a progressive weaning from external stabilization.

Cold Running Water For Pain

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Now, people have been writing in, boy, it's painful, it's inflamed, you know, what do I do? So this this person who is five to seven days post-operative, I already have her putting her hand under cold running water only until deeply cold, 10 to 20 seconds. So, right when that's deeply cold, it's done. And if the water's, you know, perhaps she has well water and it's extra cold. Maybe it only takes her five seconds to feel deeply cold inside of her tissues. Studies have shown that that is more effective than an ice back for 10 minutes, it envelops a whole area, it penetrates deeper, and what does cold do? Cold shrinks. So it's literally shrinking down the inflammation and reducing the pain. A lot of patients will say, My goodness, my sutures are still on. I can't start any therapy. Well, we have to. We we routinely do that. They come into my office, I remove the post-operative dressings, educate the patient on proper wound care, which we'll talk about in another video, and educate the patient to a home exercise program, fabricate the custom splint, and educate the patients on when and how to use the splint, how to do the wound care, and how to reduce their pain.

Ice Cube And Paper Cup Tricks

SPEAKER_00 4:55

So another nice technique, aside from the cold running water, is an ice cube directly on the skin. So the patient would. I'm sorry, I don't have an ice cube with me. By the way, I looked all over for ice, I don't have any ice. So I so if you hold an ice cube and you just barely touch touch the ice cube onto the skin, you don't want any pressure. Ice cube is hard as a rock, you wouldn't want to rub a rock on it, right? So you just barely touch the skin because the goal is only to get it cold. Right when it gets deeply cold, you can do the that hole back of the hand and back here. And right when it gets deeply cold, you're done. Same thing, and then either throw the ice cube in the sink or just keep it wrapped with a little cloth or something and put it right back in the freezer. Another nice trick is to use a paper, um little uh paper cup, disposable cup, and fill it three-quarters of the way with water, stick it in the freezer, and then hold the bottom of the cup after it's frozen, peel off the top, so now you have uh a handle on the cup and you have the bare piece of ice. And next time I'll bring ice, okay? Um, and then you can just put that on your skin, and then when you're done, just stick it back in the freezer. So those are some really nice techniques.

What Not To Do While Healing

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A couple of things not to do because you can do all of this stuff, right, but still have terrible pain if you if a person insists on continuously exercising and moving, and it's just it feels tight because it's it's swollen, you just had an injury, or it's swollen, you just had surgery, and people want to try to keep it loose and keep it moving, and that it just adds up and it adds up and it builds and it increases the inflammation and irritation. Another thing is let's say the surgery, in this case, the patient I'm talking about, the surgery was here, and they have a a sutured wound from here down to about here, and you know what, everything gets stiff, the wrist is a little stiff, maybe the wrist is sore, and you know what, they just want to make that wrist better, so they're they're massaging their wrist, and boy, the fingertips hurt. So you know, kind of doing that, fidgeting, it's a hand that's right there. It's easy for the other hand to come in here and get all mischievous and start rubbing and then massaging, and it feels good at the time while you're doing it, but then the after effect is now increased inflammation. So I'm here to tell you, just leave it alone. Stop, stop the frequent habitual range of motion, stop the self-massage, do some ice or cold running water. It's gonna reduce the inflammation and pain. You're gonna feel a lot better. Hey, you're going through it, you have to go through it, might as well go through it with minimal discomfort, right? Just that'll allow you to feel better.

Thanks And Where To Learn More

SPEAKER_00 7:30

So, thank you for liking and subscribing and sharing this with other people. This is the hand to shoulder solution, where we are the solution to your pain. CarlPetito.com, check it out.