Central slip injuries occur when the middle joint of the finger is unable to straighten or looks bent. If a central slip injury is not managed well at the time of injury or it is not functioning well your finger can develop into a deformity called a boutonniere. 


The extensor tendon on the back of the finger is a complex and delicate structure. The tendon mechanism divides into two lateral bands and a central slip. These structures then work together to assist with straightening the finger.

Central slip injuries are commonly caused by a sudden or forced bending of the PIP joint by a knock, fall, ball or punching force. However, it can also be caused by a cut to the top of the finger and is known as an open injury. Disruptions to the central slip can result in a boutonniere deformity – when the DIP (top joint) becomes hyperextended, and PIP (middle joint) is bent and prevents the finger from straightening. It may take some time for the deformity to occur; however, if it is present for some time the bend will become fixed, and it will become more difficult to manage and correct. 


Central slip injuries are caused by the middle joint of the finger (proximal interphalangeal joint) being forcefully bent forwards or being impacted directly. This can commonly occur when you have a deep laceration to the back of your finger (open injury), punching something, getting hit by a ball or if it is knocked forcefully.

Although most central slip injuries and disruptions are caused by trauma, it can commonly occur in people with rheumatoid arthritis without trauma too. 

Signs & Symptoms

  • Inability to straighten finger
  • Loss of extension at PIP and hyperextension at DIP – this may not occur straight away and may gradually occur 10-14 days after the initial injury
  • Reduced grip strength or inability to grasp
  • Swelling and pain over middle joint of finger 


Central slip injuries need to be appropriately managed to avoid further complications and deformities. These injuries need to be splinted with the joint held in extension to allow for proper healing of the tendon for six weeks.

Once the tendon is healed, the joint may become stiff and need to be moved and stretched. A hand therapist will be able to assess your level of mobility and provide exercises to restore movement and strength.

Melbourne Hand Therapy Can Help You

At Melbourne Hand Therapy we treat central slip injuries with the splinting, strengthening and stretching. Our treatment is tailored to your individual needs and is dependent on the type of injury, age of injury, presentation and severity. It is important that you get your central slip injury treated right away to avoid any further complications or deformities.

Book in today to see one of our highly skilled therapists if you are experiencing any of the symptoms above. 


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