Fractures and dislocations: Elson test for central slip injury: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Fractures and dislocations: Elson test for central slip injury

Sample item

After a blow to the dorsum of a flexed middle finger, the PIP joint is swollen and tender dorsally. With the PIP joint flexed to 90 degrees over a table edge, the patient tries to extend it against resistance. Which finding indicates a ruptured central slip?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Weak PIP extension with the DIP joint becoming rigidly extended

In the Elson test, with the central slip ruptured the PIP extension force is lost and the extensor effort is transmitted through the lateral bands to the DIP joint, which becomes rigid. Untreated injuries progress to a boutonniere deformity, and an acute injury is splinted in extension.

Option by option

  • A. Strong PIP extension with a floppy DIP joint

    A floppy DIP with strong PIP extension is the normal response, because the lateral bands are slack.

  • B. Hyperextension of the MCP joint on resisted extension

    MCP hyperextension on resisted extension is not part of this test.

  • C. Weak PIP extension with the DIP joint becoming rigidly extended (correct)

    Correct. A ruptured central slip gives weak PIP extension with rigid DIP extension via the lateral bands.

  • D. Inability to flex the DIP joint

    Inability to flex the DIP suggests a profundus avulsion, not a central slip lesion.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is C, Weak PIP extension with the DIP joint becoming rigidly extended. In the Elson test, with the central slip ruptured the PIP extension force is lost and the extensor effort is transmitted through the lateral bands to the DIP joint, which becomes rigid.

Why is "Strong PIP extension with a floppy DIP joint" not the answer?

A floppy DIP with strong PIP extension is the normal response, because the lateral bands are slack.

Why is "Hyperextension of the MCP joint on resisted extension" not the answer?

MCP hyperextension on resisted extension is not part of this test.

Why is "Inability to flex the DIP joint" not the answer?

Inability to flex the DIP suggests a profundus avulsion, not a central slip lesion.

What concept does this question test?

It tests Fractures and dislocations: Elson test for central slip injury in Orthopaedics. Untreated injuries progress to a boutonniere deformity, and an acute injury is splinted in extension.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Fractures and dislocations: Elson test for central slip injury?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.