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Othman MF, Mohd Raziff AQ, Narin Singh PSG, Abdullah S. Spontaneous Midsubstance Rupture of the Left Little Finger's Flexor Tendon in the Absence of Trauma. Cureus 2024; 16:e71164. [PMID: 39525188 PMCID: PMC11548940 DOI: 10.7759/cureus.71164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2024] [Indexed: 11/16/2024] Open
Abstract
Spontaneous midsubstance rupture of the flexor tendon without underlying pathology is rare. This case report describes a healthy 45-year-old man who experienced spontaneous midsubstance flexor tendon rupture at zone III. He presented with pain and disability in flexing his left little finger after carrying a plastic bag containing 20 kg and only sought medical treatment 10 days after the injury. Two-stage tendon reconstructive surgery was performed, involving the insertion of a nasogastric tube in the first stage followed by ipsilateral palmaris longus tendon grafting in the second stage. No underlying pathology was found to cause the tendon rupture. This report also describes the clinical diagnosis and treatment options for flexor tendon injuries, including primary tendon repair and two-stage tendon reconstructive surgery.
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Affiliation(s)
- Mohd Fareez Othman
- Hand and Microsurgery, Fakulti Perubatan, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | | | | | - Shalimar Abdullah
- Hand and Microsurgery, Fakulti Perubatan, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
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2
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Yano K, Kato T, Yokoi T, Kaneshiro Y, Kita T. Limited Flexion of the Middle Finger Due to a Degenerative Partial Flexor Tendon Rupture Mimicking a Soft Tissue Tumor. Cureus 2024; 16:e64534. [PMID: 39144903 PMCID: PMC11321951 DOI: 10.7759/cureus.64534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2024] [Indexed: 08/16/2024] Open
Abstract
Atraumatic subcutaneous rupture of the finger flexor tendon of the hand and forearm is rare. Most sites of closed and subcutaneous ruptures of the finger flexor tendon are the tendon-bone insertion and musculotendinous junction, and an intratendinous lesion is unusual. We report the case of a 76-year-old female who presented to our department with a one-month history of a soft tissue mass and limited flexion of the left middle finger without trauma. Preoperative magnetic resonance imaging revealed a soft tissue mass that caused limited finger flexion. Intraoperative findings showed an intratendinous rupture of the flexor digitorum profundus tendon at the middle phalanx; the lesion was resected to obtain smooth grinding of the tendon. One year postoperatively, the soft tissue mass and limited flexion of the finger resolved without recurrence.
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Affiliation(s)
- Koichi Yano
- Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai City, JPN
| | - Tomoya Kato
- Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai City, JPN
| | - Takuya Yokoi
- Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai City, JPN
| | | | - Teruo Kita
- Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai City, JPN
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Kwon TY, Lee YK. Multiple flexor tendon ruptures due to osteochondroma of the hamate: A case report. World J Clin Cases 2023; 11:3038-3044. [PMID: 37215430 PMCID: PMC10198070 DOI: 10.12998/wjcc.v11.i13.3038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/19/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Closed rupture of the little and ring finger flexor tendons caused by the hamate is mostly associated with a fracture or nonunion of the hamate hook. Only one case of a closed rupture of the finger flexor tendon caused by osteochondroma in the hamate has been reported. Here, we present a case study to highlight the possibility of hamate osteochondroma as a rare cause of finger closed flexor tendon rupture based on our clinical experience and literature review.
CASE SUMMARY A 48-year-old man who had been a rice-field farmer for 7–8 h a day for the past 30 years visited our clinic due to the loss of right little finger and ring finger flexion involving both the proximal and distal interphalangeal joints. The patient was diagnosed with a complete rupture of the ring and little finger flexors because of the hamate and was pathologically diagnosed with an osteochondroma. Exploratory surgery was performed, and a complete rupture of the ring and little finger flexors due to an osteophyte-like lesion of the hamate was observed, which was pathologically diagnosed as an osteochondroma.
CONCLUSION One should consider that osteochondroma in the hamate may be the cause of closed tendon ruptures.
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Affiliation(s)
- Tae Young Kwon
- Department of Orthopedics, Jeonbuk National University Hospital, Jeonju-si 54907, South Korea
| | - Young-Keun Lee
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54896, South Korea
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Krishna SV, Umesh S, Hs C. Closed Traumatic Zone 2 Flexor Tendon Injury of the Long Finger - A Case Report. J Hand Surg Asian Pac Vol 2023; 28:113-116. [PMID: 36803334 DOI: 10.1142/s2424835523720013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Closed rupture of the flexor digitorum profundus (FDP) tendon causes loss of flexion at the distal interphalangeal joint. Following trauma, these are known to present as avulsion fractures (Jersey finger) commonly in ring fingers. Traumatic tendon ruptures at the other flexor zones are seldom noted and are often missed. In this report, we present a rare case of closed traumatic tendon rupture of the long finger FDP at zone 2. Though it was missed initially, was confirmed with Magnetic Resonance Imaging and underwent successful reconstruction using an ipsilateral palmaris longus graft. Level of Evidence: Level V (Therapeutic).
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Affiliation(s)
- Sathya Vamsi Krishna
- Department of Hand Surgery, Sanjay Gandhi Institute of Orthopaedics and Trauma, Bangalore, Karnataka, India
| | - Shreyas Umesh
- Department of Orthopaedics Surgery, Sanjay Gandhi Institute of Orthopaedics and Trauma, Bangalore, Karnataka, India
| | - Chandrashekar Hs
- Department of Orthopaedics Surgery, Sanjay Gandhi Institute of Orthopaedics and Trauma, Bangalore, Karnataka, India
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Karagergou E, Chalidis B, Sachinis NP, Givissis P. A Low Virulence Infective Tenosynovitis Triggered by a Neisseria Species. J Hand Surg Asian Pac Vol 2022; 27:1043-1047. [PMID: 36606351 DOI: 10.1142/s2424835522720523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A persistent infective tenosynovitis, caused by a non-pathogenic Neisseria species and involving the little finger and the thumb of a middle-aged woman, forming a horseshoe-type infection is presented. An extensive volar approach was utilised for excision of the granulomatous synovium and drainage of turbid fluid. Neisseria spp was isolated by tissue microbiology and targeted antibiotic therapy for 6 weeks was required to eradicate infection. The presence of low virulence microorganisms which might act as true pathogens should always be considered as a causative factor leading to persistent infections that require open surgical debridement and washout. Level of Evidence: Level V (Therapeutic).
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Affiliation(s)
- Eleni Karagergou
- Department of Burns, Plastic Surgery and Hand Surgery, Georgios Papanikolaou Hospital, Thessaloniki, Greece
| | - Byron Chalidis
- First Department of Orthopedics, School of Medicine, Aristotle University of Thessaloniki, Georgios Papanikolaou Hospital, Thessaloniki, Greece
| | - Nikolaos Platon Sachinis
- First Department of Orthopedics, School of Medicine, Aristotle University of Thessaloniki, Georgios Papanikolaou Hospital, Thessaloniki, Greece
| | - Panagiotis Givissis
- First Department of Orthopedics, School of Medicine, Aristotle University of Thessaloniki, Georgios Papanikolaou Hospital, Thessaloniki, Greece
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Zukawa M, Osada R, Hirokawa T, Suzuki K, Makino H, Kawaguchi Y. Usefulness of Wide-Awake Local Anesthesia No Tourniquet Surgery to Decide on Tendon Transfer Versus Grafting in Chronic Flexor Tendon Rupture. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:408-413. [PMID: 36420458 PMCID: PMC9678645 DOI: 10.1016/j.jhsg.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/04/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE We investigated the clinical outcomes of flexor tendon reconstruction for chronic rupture of the flexor tendon based on an evaluation of the voluntary active contraction distance (ACD) of the ruptured musculotendinous unit and changes in intraoperative total active motion (TAM) that could only be observed during wide-awake local anesthesia no tourniquet (WALANT) surgery. METHODS Reconstructions of 19 tendons of the flexor pollicis longus (FPL) and 18 tendons of the flexor digitorum profundus (FDP) were performed during WALANT surgery to evaluate the ACD of the ruptured musculotendinous unit and TAM observed during the surgery. Tendon grafting or tendon transfer was selected during the surgery based on ACD. TAM, pinch strength, and grip power were evaluated before the surgery, during the surgery, and at final follow-up, and they were surveyed based on Quick Disabilities of the Arm, Shoulder, and Hand (q-DASH) scores. The final outcomes of tendon grafting and tendon transfer were compared. RESULTS In FPL tendon reconstruction, tendon grafting was performed in 10 patients with a total PDD and ACD value greater than 30 mm, and tendon transfer was performed in 9 patients with the value less than 30 mm. In FDP tendon reconstruction, tendon grafting was performed in 8 patients and tendon repair in 2 patients with a total PDD and ACD value greater than 40 mm, and tendon transfer was performed in 8 patients with the value less than 40 mm. The TAM value, q-DASH score, pinch power, and grip strength were improved in all patients. In both the tendon reconstructions, intraoperative TAM was significantly increased compared with preoperative TAM but significantly decreased at final follow-up. No significant differences were identified in final follow-up TAM and the q-DASH scores between tendon transfer and tendon grafting. CONCLUSIONS The great advantage of WALANT surgery is that surgeons can evaluate the ruptured musculotendinous unit and measure TAM during the surgery. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
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Affiliation(s)
- Mineyuki Zukawa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Ryusuke Osada
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Tatsurou Hirokawa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Kayo Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Hiroto Makino
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
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Kuroda T, Moriya K, Tsubokawa N, Maki Y, Inagaki K, Yoshizu T. Comparison of bridge graft and end-to-side transfer for treatment of closed rupture of the flexor tendons in the little finger. J Hand Surg Eur Vol 2022; 47:520-526. [PMID: 35086366 DOI: 10.1177/17531934211073751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to compare the outcomes of bridge tendon grafts and end-to-side tendon transfers for treating closed ruptures of the flexor tendons in Zones 3 to 5 of the little finger. We selected the surgical procedure based on the passive distraction amplitude of the proximal part of the ruptured flexor tendon. Eleven patients comprised the bridge tendon graft group and ten patients comprised the end-to-side tendon transfer group. We found no significant between-group differences in the total active motion, percentage of total active motion, functional assessment by the Strickland and Glogovac criteria and grip strength compared with the unaffected hand. We believe that choosing the surgical procedure after determining the passive distraction amplitude of the ruptured tendon can be useful in clinical practice.Level of evidence: III.
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Affiliation(s)
- Takuma Kuroda
- Niigata Hand Surgery Foundation, Niigata, Japan.,Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Koji Moriya
- Niigata Hand Surgery Foundation, Niigata, Japan
| | | | - Yutaka Maki
- Niigata Hand Surgery Foundation, Niigata, Japan
| | - Katsunori Inagaki
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
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Leow SKH, Knight R. Digital flexor tendon rupture due to gout: a case report and literature review. AUSTRALASIAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.34239/ajops.v5n1.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
N/A - Case Report
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9
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Closed extensor tendon rupture caused by Kienböck disease: a case report. Arch Plast Surg 2022; 49:76-79. [PMID: 35086314 PMCID: PMC8795655 DOI: 10.5999/aps.2021.01522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022] Open
Abstract
Kienböck disease, a rare disease that can cause chronic pain and motor dysfunction, occurs due to avascular necrosis of the lunate bone, which leads to dislocation of the carpal bone. Among various other etiologies, Kienböck disease can cause closed tendon rupture of the finger. In this report, we introduce a case of total rupture of the second extensor digitorum communis and the extensor indicis proprius tendons caused by undiagnosed Kienböck disease in an elderly female patient.
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10
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Spontaneous Midsubstance Rupture of the Flexor Digitorum Profundus Tendon of the Long Finger. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:306-310. [PMID: 36157300 PMCID: PMC9492793 DOI: 10.1016/j.jhsg.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/01/2021] [Indexed: 11/22/2022] Open
Abstract
Closed flexor tendon injuries can often result from trauma that causes sudden forceful extension of an actively flexed digit. These closed tendon injuries commonly occur as avulsions in flexor zone I. Spontaneous midsubstance flexor tendon ruptures are rare, especially in the absence of an underlying pathology. Diagnosing such injuries accurately is challenging and critical. We present a case of a zone III spontaneous flexor tendon rupture of the long finger after forceful eccentric loading. Surgical exploration was performed, and the level of the rupture was identified during surgery. A side-to-side tendon repair technique was performed using a palmaris longus tendon graft. No underlying pathology to explain the rupture was found in this case. This report emphasizes the importance of considering spontaneous midsubstance ruptures, identifying the level of ruptures, and preoperative planning for such cases. It reviews the possible causes and treatment of spontaneous flexor tendon rupture.
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11
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Hatori Y, Tajika T, Kuboi T, Saida R, Chikuda H. Closed rupture of a flexor profundus tendon to the little finger caused by asymptomatic pisotriquetral osteoarthritis: A case required differentiation from the tendon rupture due to hamate bony irregularity by bone erosion. SAGE Open Med Case Rep 2022; 10:2050313X221104314. [PMID: 35747244 PMCID: PMC9210073 DOI: 10.1177/2050313x221104314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Abstract
Carpal joint osteoarthritis and the formation of bony irregularities of the carpal bone cause closed flexor tendon ruptures. This report describes a case of a flexor profundus tendon closed rupture of the little finger due to asymptomatic pisotriquetral osteoarthritis in a 73-year-old woman, which required differentiation from tendon rupture due to hamate bony irregularity due to bone erosion. Computed tomography showed cortical bone irregularities of the hamate and the narrowing of the pisotriquetral joint space, and a bony spur on the radial side of the pisiform. Intraoperative findings revealed the capsule of the pisotriquetral joint was torn on the radial side. Pisiform-hamate ligament disruption and the bony spur on the pisiform were found on this side. However, the flexor tendon floor on the hamate was intact. Surgical resection of the pisiform and a free tendon interposition graft for tendon rupture restored the good function of the little finger. Particular attention should be paid in making the diagnosis in cases with multiple possible triggers for closed flexor tendon rupture.
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Affiliation(s)
- Yuhei Hatori
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tsuyoshi Tajika
- Graduate School of Health Sciences, Gunma University, Maebashi, Gunma, Japan
| | - Takuro Kuboi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Ryuta Saida
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Tomori Y, Motoda N, Nanno M, Majima T. Intratendinous Ganglion in the Extensor Pollicis Longus: A Case Report and Review of Literature. J NIPPON MED SCH 2020; 88:500-505. [PMID: 32999177 DOI: 10.1272/jnms.jnms.2021_88-416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Ganglion cysts are common benign lesions in the hand and wrist. However, intratendinous ganglion cysts are fairly rare lesions. We present the case of a 73-year-old woman with an intratendinous ganglion cyst occurring in the extensor pollicis longus (EPL) tendon of her right hand. The subcutaneous mass moved according to the movement of the EPL tendon of her right thumb. Magnetic resonance imaging showed a space-occupying lesion in the EPL tendon. Biochemical and hematoimmunological examinations ruled out diabetes mellitus, rheumatoid arthritis and other connective tissue diseases. She complained of a motion pain during thumb extension, and she had desired surgery. Intraoperatively, an intratendinous cyst was identified within the tendon substance of the EPL, in which a part of the cyst was herniated into a slit in the tendon substance, just distal to the extensor retinaculum without remarkable proliferative synovial tissue. The EPL tendon was opened longitudinally, and a cystic lesion was enucleated. The pathological findings showed that the cyst wall consisted of fibrous tissue with degeneration, lacking epithelial lining. Postoperative recovery was uneventful. Six months after surgery, the patient had no residual pain and cyst recurrence. The rarity of intratendinous ganglion cysts makes diagnosis and treatment challenging. Since intratendinous ganglion cysts and associated synovitis frequently weaken the structure of the affected tendons, prompt diagnosis and surgical excision are necessary.
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Affiliation(s)
- Yuji Tomori
- Department of Orthopaedic Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Norio Motoda
- Department of Diagnostic Pathology, Nippon Medical School Musashi Kosugi Hospital
| | - Mitsuhiko Nanno
- Department of Orthopaedic Surgery, Nippon Medical School Hospital
| | - Tokifumi Majima
- Department of Orthopaedic Surgery, Nippon Medical School Hospital
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Spontaneous Flexor Tendon Rupture due to Primary Distal Radioulnar Joint Osteoarthritis. Case Rep Orthop 2019; 2019:7604897. [PMID: 31093400 PMCID: PMC6481123 DOI: 10.1155/2019/7604897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 03/21/2019] [Indexed: 11/24/2022] Open
Abstract
Spontaneous flexor tendon rupture is rare, occurring most commonly in the little finger or flexor pollicis longus. To the best of our knowledge, there have been no reports of spontaneous flexor tendon rupture due to primary distal radioulnar joint (DRUJ) osteoarthritis (OA). We present a case of spontaneous flexor tendon rupture in the index finger due to primary DRUJ OA in a 71-year-old female farmer. Surgical exploration confirmed that, at the wrist joint level, the flexor digitorum profundus of the index finger had undergone degeneration and complete rupture. The flexor digitorum superficialis of the index finger was elongated and thinned. A bony spur toward the volar side was covered with synovial fluid from a pinhole-sized perforation of the capsule. The combination of direct friction from the DRUJ spur and the matrix metalloproteinases in the synovial fluid from the perforation of the DRUJ capsule may have caused the spontaneous flexor tendon rupture. Palmar-side symptoms associated with DRUJ OA should be carefully examined because of the risk of spontaneous flexor tendon rupture.
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Lee JS, McGrouther DA. Are Flexor Tendon Ruptures Ever Spontaneous? - A Literature Review on Closed Flexor Tendon Ruptures of the Little Finger. J Hand Surg Asian Pac Vol 2019; 24:180-188. [DOI: 10.1142/s2424835519500243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: When closed ruptures of flexor tendons of fingers occur, there is often an identifiable pathology, which should be addressed in the same surgical setting as the tendon repair. The concept of “spontaneous” tendon rupture, occurring in the absence of identified pathology, however, has also been reported in a significant number of papers. This controversy has prompted us to do a review of the existing literature.Methods: We did a review of cases of closed ruptures of the flexor digitorum profundus (FDP) of the little finger in existing literature. Fifty-three publications were retrieved by searching “FDP tendon rupture” and “little finger” using PubMed database. We analyzed data such as the zone of rupture noted intra-operatively; and any precipitating factors, pathology or trauma. We also conducted a review on papers which discussed the concept of “spontaneous rupture”.Results: Fifty-three publications were retrieved. There were 8 cases of ruptures in Zone I; 2 in Zone II; 30 in Zone III; 59 in Zone IV and 5 in Zone V. Majority of cases were associated with an element of trauma of varying severity, or pathology. A precipitating cause was not documented in 12 cases. Amongst all 36 cases of ruptures labelled as “spontaneous”, only 1 case was truly “spontaneous” without any associated trauma or pathology.Conclusions: Most reports labeled as spontaneous rupture occurred in Zone III, where tendon ruptures are rare. There are documented pathological causes or evidence of trauma to most of these cases. We conclude these ruptures may have been mislabeled as spontaneous ruptures. Bearing in mind the propensity for tendon excursion, we suspect the lack of documentation of exploration in proximal zones contributed to this mislabeling. Understanding this concept of non-spontaneity to most tendon ruptures and the common sites of rupture or pathology is crucial for a surgeon to make strategic incisions and minimize future recurrence.
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Tolerton S, Nabarro M. Flexor Tendon Lacerations Secondary to Closed Proximal Phalangeal Fracture. J Hand Surg Asian Pac Vol 2019; 24:123-126. [PMID: 30760150 DOI: 10.1142/s2424835519720093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a case of complete laceration of both flexor tendons in the dominant ring finger of a young male caused by a closed volar fracture fragment of the proximal phalanx. Careful clinical examination, reasonable index of suspicion and ultrasound confirmation play a pivotal role in the diagnosis and surgical planning of this rare yet consequential injury. Good outcomes can be achieved from the surgical management and rehabilitation of both soft tissue and bony injuries when planning of surgical approaches and fixation techniques are facilitated by an accurate pre-operative diagnosis.
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Ohara M, Oda R, Toyama S, Katsuyama Y, Fujiwara H, Kubo T. Five-decade-delayed closed flexor tendon rupture due to Galeazzi dislocation fracture associated with Behçet syndrome: A case report. Int J Surg Case Rep 2018; 48:87-91. [PMID: 29913431 PMCID: PMC6005791 DOI: 10.1016/j.ijscr.2018.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/15/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Closed flexor tendon rupture after a malunited distal radius fracture is rare and usually becomes apparent early after the fracture. Most cases are accompanied by a severe distal radio-ulnar joint capsule injury, wherein bone protrusion (as a spur) directly stresses the tendons. We experienced a nonspecific flexor tendon rupture associated with an old fracture and the presence of collagen disease. PRESENTATION OF CASE A 63-year-old woman presented with delayed complete rupture of the flexor digitorum profundus (FDP) of the fifth digit. Her history included closed fracture on the left wrist at age 13 years. At 27 years, she was diagnosed with Behçet syndrome and commenced oral prednisolone 10 mg/day. At the current admission, physical examination revealed that she was incapable of fifth finger flexion after minor passive extension. The fifth digit FDP rupture appeared to be due to damage at the wrist-level fracture site. A tiny capsule rupture was seen on the volar side of the distal radio-ulnar joint. We resected ulnar head osteophytes protruding from the capsule hole and transferred tendon from the fifth FDP to the fourth FDP. CONCLUSION Reportedly, metalloproteases weaken tendon structure by acting as a collagenase in patients with Behçet syndrome. Also, vasculitis next to a tendon and steroid intake are considered to impede the tendon repair process. Hence, even minor trauma may lead to complete tendon rupture. Although an injury seems slight, we should take into account the possible history of bone and joint trauma.
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Affiliation(s)
- Masato Ohara
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan
| | - Ryo Oda
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan
| | - Shogo Toyama
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan.
| | - Yusei Katsuyama
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan
| | - Hiroyoshi Fujiwara
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan
| | - Toshikazu Kubo
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan
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Interposition Tendon Graft and Tension in the Repair of Closed Rupture of the Flexor Digitorum Profundus in Zone III or IV. Ann Plast Surg 2017; 80:238-241. [PMID: 29095192 DOI: 10.1097/sap.0000000000001240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the results of interposition tendon grafts using the ipsilateral palmaris longus tendon in 12 patients with closed flexor digitorum profundus tendon ruptures in zone III or IV of 14 digits between June 2006 and October 2015. Before surgery, 2 patients were diagnosed with closed tendon ruptures that occurred after nonunion of hamate hook fractures. The other 10 patients were diagnosed with spontaneous tendon ruptures of unknown cause. In 2 of the 10 patients with spontaneous tendon rupture, the cause of the rupture was not found. In the other 8 patients, there was rough surface with deficient overlying soft tissue on the radial side of the hamate hook. In all cases, the ruptured flexor digitorum profundus was reconstructed by applying overtension on the tendon graft, causing greater flexion than for the other normal digits. Hamate hook excision was also performed on 10 subjects with abnormalities. Postoperatively, the patients were followed for an average of 22.5 months (range, 12-64 months). At the final follow-up, the mean Disabilities of the Arm, Shoulder, and Hand questionnaire score was 5.7 (range, 3.3-8.3). There were excellent results in all 14 digits according to Strickland and Glogovac criteria. The mean total active motion was 167 degrees (range, 160-180 degrees). There were no surgical complications, including infection, adhesions, or tendon rerupture. There were excellent clinical results with the interposition tendon graft using palmaris longus for closed tendon rupture in zone III or IV of the hand. Applying overtension to the grafted tendon appears to be beneficial.
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18
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Koh IH, Kang HJ, Oh WT, Hong JJ, Choi YR. Correlation between change in muscle excursion and collagen content after tendon rupture and delayed repair. J Orthop Surg Res 2017; 12:15. [PMID: 28115019 PMCID: PMC5260042 DOI: 10.1186/s13018-017-0518-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 01/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objectives of the present study were to compare changes in muscle excursion, total collagen, and collagen subtypes after tenotomy over time and after delayed tendon repair. METHODS Tenotomy on the extensor digitorum tendon of the right second toes of 48 New Zealand White rabbits was performed; toes on the left leg were used as controls. Passive muscle excursion, total collagen content, and type I, III, and IV collagen contents were measured at 1, 2, 4, and 6 weeks after tenotomy. Next, passive muscle excursion and total collagen content were measured at 8 weeks after delayed tendon repair at 1, 2, 4, and 6 weeks after a tenotomy. RESULTS Passive muscle excursion decreased sequentially over time after tenotomy. Meanwhile, total collagen increased over time. These changes were significant after 4 weeks of injury. Type I collagen significantly increased, type III collagen significantly decreased, and type IV collagen had no significant change over time. Passive muscle excursion was negatively correlated with total collagen and type I collagen after tenotomy at each time point after tenotomy (p < 0.05). After tendon repair, increases in total collagen content after tenotomy were not reversed, despite early repairs at 1 and 2 weeks after tenotomy. CONCLUSIONS Increases in type I collagen were found to be associated with decreased excursion after tendon rupture. The increase in collagen that was observed after tenotomy was not reversed by repair within 8 weeks.
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Affiliation(s)
- Il-Hyun Koh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Ho-Jung Kang
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Won-Taek Oh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Jung-Jun Hong
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Yun-Rak Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
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Joyce CW, Woods JFC, Murphy S, Bollard S, Kelly JL, Carroll SM, O'Shaughnessy M. A Five-Year Review of Tag Rugby Hand Injuries. Injury 2016; 47:2266-2268. [PMID: 27553391 DOI: 10.1016/j.injury.2016.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 08/03/2016] [Accepted: 08/05/2016] [Indexed: 02/02/2023]
Abstract
Tag rugby is one of the fastest growing sports in Ireland. It is a soft-contact team game that is loosely based on the rugby league format except players try to remove Velcro tags from their opponents' shorts rather than engage in a typical rugby tackle. The purpose of this study was to examine all tag rugby associated hand injuries over a five-year period in three large tertiary referral hospitals in Ireland. Using the patient corresponding system, 228 patients with hand injury related tag rugby injuries were observed from 2010 to 2015. There were 138 males and 90 females in the study and over 40% of patients required surgery. Most of the patients were young professionals with an average age of 30. Twenty-five patients worked in the financial services whilst there were 23 teachers. Fractures accounted for 124 of the 228 injuries and mallet injuries accounted for 53. Eighty percent of all injuries occurred during the tackle. The mean number of days missed from work was 9.1±13.8 days. These injuries resulted in an average of seven hospital appointments per patient. Considering it is a soft-contact sport, it is surprising the number of hand injuries that we have observed. Although safety measures have been introduced to decrease the number of hand injuries in recent years, there is a need for further improvements. Better player education about seeking prompt medical attention once an injury occurs, coupled with longer shorts worn by players may improve measures for the sport.
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Affiliation(s)
- C W Joyce
- Department of Plastic Surgery and Hand Surgery, Cork University Hospital, Cork, Ireland.
| | - J F C Woods
- Department of Plastic Surgery and Hand Surgery, University Hospital Galway, Ireland
| | - S Murphy
- Department of Plastic Surgery and Hand Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - S Bollard
- Department of Plastic Surgery and Hand Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - J L Kelly
- Department of Plastic Surgery and Hand Surgery, University Hospital Galway, Ireland
| | - S M Carroll
- Department of Plastic Surgery and Hand Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - M O'Shaughnessy
- Department of Plastic Surgery and Hand Surgery, Cork University Hospital, Cork, Ireland
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Hosokawa T, Oda R, Toyama S, Taniguchi D, Tokunaga D, Fujiwara H, Kubo T. Spontaneous flexor tendon rupture due to an insufficiency fracture of the hamate hook in a patient with systemic lupus erythematosus: A case report. Int J Surg Case Rep 2016; 27:63-65. [PMID: 27552031 PMCID: PMC4995535 DOI: 10.1016/j.ijscr.2016.06.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Spontaneous flexor tendon rupture is usually caused by trauma, systemic diseases, or carpal bone and joint disorders. Here we report a case of spontaneous flexor tendon rupture occurring in a systemic lupus erythematosus (SLE) patient following nonunion of the hamate hook after an insufficiency fracture, and which was also associated with tendon degeneration caused by SLE. CASE PRESENTATION A 57-year-old woman was diagnosed with SLE 22 years ago and being treated with oral prednisolone. She became unable to flex her left little finger without any history of trauma or sporting activity. CT showed nonunion of the hamate hook. MRI showed rupture of the flexor digitorum profundus tendon of the little finger. We performed tendon transfer and excision of the hamate hook. She recovered active flexion of the little finger at 4 months postoperatively with full satisfaction. DISCUSSION There was no history of trauma that could have caused nonunion of the hamate hook. We considered that the insufficiency fracture of the hamate hook occurred as a result of osteoporosis caused by SLE and long-term steroid use. Nonunion of the hamate hook caused mechanical attrition of the tendons, and in combination with the tendon degeneration caused by SLE, further resulted in rupture of the flexor tendon. CONCLUSION When we encounter a case of spontaneous flexor tendon rupture in a patient with systemic disease such as SLE or long-term steroid use, attention should be paid to the state of the carpal bones and joints as they sometimes accompany unexpected causes.
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Affiliation(s)
- Toshihiro Hosokawa
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Ryo Oda
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Shogo Toyama
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Daigo Taniguchi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Daisaku Tokunaga
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Hiroyoshi Fujiwara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
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Acute Traumatic Musculotendinous Avulsion of the Flexor Pollicis Longus Tendon Treated with Primary Flexor Digitorum Superficialis Transfer: A Novel Technique of Management. Case Rep Orthop 2016; 2016:2106203. [PMID: 27019757 PMCID: PMC4785255 DOI: 10.1155/2016/2106203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/06/2016] [Indexed: 11/19/2022] Open
Abstract
Traumatic musculotendinous junction avulsions are rare injuries except in avulsion amputations. They pose a significant challenge to the treating surgeon. We present a 24-year-old male who sustained an open musculotendinous avulsion of the flexor pollicis longus tendon. He was treated with primary tendon transfer using the flexor digitorum superficialis of ring finger, in flexor zone 3. The functional result at 10 months following surgery was excellent.
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Funahashi T, Suzuki T, Iwamoto T, Shizu K, Matsumura N, Ochi K, Ikari K, Sato K, Nakamura M, Matsumoto M, Momohara S, Suzuki K, Yamada H. Subcutaneous flexor tendon rupture in patients with rheumatoid arthritis. Mod Rheumatol 2016; 26:869-872. [PMID: 26873301 DOI: 10.3109/14397595.2016.1153444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We examined the clinical features and functional outcomes of surgically repaired subcutaneous flexor tendon ruptures in patients with rheumatoid arthritis (RA). METHODS This retrospective study included 41 fingers of 24 RA patients who underwent surgical treatment for flexor tendon ruptures. Evaluations performed at the time of presentation following rupture were C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and disease activity score in 28 joints (DAS28)-ESR, as well as Larsen grading for carpal bone destruction. The ruptured tendon and postoperative active range of motion (ROM) of digits were also examined. RESULTS The mean CRP was 2.4 mg/dl, ESR was 52 mm/h, and the DAS28-ESR was 4.5. Carpal bone destruction according to Larsen grade IV-V was observed in 18/24 patients. Affected digits were most commonly the thumb (12) and the ring and little fingers (9 each). Tendon ruptures were most common in the carpal tunnel in zone IV. The mean postoperative finger ROM (flexion/extension) was 38°/2° for the interphalangeal (IP) joint of the thumb and 23°/-2° for the distal interphalangeal joint of the other four fingers. CONCLUSIONS Patients with flexor tendon ruptures present with high disease activity and advanced bone destruction. It is important to reduce the risk of progressive bone destruction and subsequent tendon rupture via tight control of disease activity.
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Affiliation(s)
- Takuya Funahashi
- a Department of Orthopaedic Surgery , Fujita Health University , Toyoake , Aichi , Japan
| | - Taku Suzuki
- a Department of Orthopaedic Surgery , Fujita Health University , Toyoake , Aichi , Japan.,b Department of Orthopaedic Surgery , Keio University School of Medicine , Tokyo , Japan , and.,c Department of Orthopaedic Surgery , Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan
| | - Takuji Iwamoto
- b Department of Orthopaedic Surgery , Keio University School of Medicine , Tokyo , Japan , and.,c Department of Orthopaedic Surgery , Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan
| | - Kanae Shizu
- a Department of Orthopaedic Surgery , Fujita Health University , Toyoake , Aichi , Japan
| | - Noboru Matsumura
- b Department of Orthopaedic Surgery , Keio University School of Medicine , Tokyo , Japan , and
| | - Kensuke Ochi
- b Department of Orthopaedic Surgery , Keio University School of Medicine , Tokyo , Japan , and.,c Department of Orthopaedic Surgery , Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan
| | - Katsunori Ikari
- c Department of Orthopaedic Surgery , Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan
| | - Kazuki Sato
- b Department of Orthopaedic Surgery , Keio University School of Medicine , Tokyo , Japan , and
| | - Masaya Nakamura
- b Department of Orthopaedic Surgery , Keio University School of Medicine , Tokyo , Japan , and
| | - Morio Matsumoto
- b Department of Orthopaedic Surgery , Keio University School of Medicine , Tokyo , Japan , and
| | - Shigeki Momohara
- c Department of Orthopaedic Surgery , Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan
| | - Katsuji Suzuki
- a Department of Orthopaedic Surgery , Fujita Health University , Toyoake , Aichi , Japan
| | - Harumoto Yamada
- a Department of Orthopaedic Surgery , Fujita Health University , Toyoake , Aichi , Japan
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Sayegh ET, Strauch RJ. Flexor digitorum profundus laceration in association with closed middle phalangeal fracture: case report. J Hand Surg Am 2015; 40:956-7. [PMID: 25817749 DOI: 10.1016/j.jhsa.2015.01.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 02/02/2023]
Abstract
We report a patient with a flexor digitorum profundus laceration caused by the volarly displaced proximal fragment of a middle phalangeal fracture. Awareness of this association may allow timely recognition and appropriate treatment.
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Affiliation(s)
- Eli T Sayegh
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
| | - Robert J Strauch
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY.
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Abstract
Spontaneous flexor intratendinous ruptures are rare and incompletely understood. They occur within the substance of the tendon, and in the absence of underlying pathological processes or direct trauma. We present an unusual case of spontaneous flexor digitorum profundus tendon rupture in the palm.
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Affiliation(s)
- Anant Piyush Patel
- Department of Plastic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kai Yuen Wong
- Department of Plastic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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