Pseudotendon Formation Causing Painful Tethering of Ruptured Flexor Carpi Radialis Tendons

Abstract

Six patients (five male, one female) between 51 and 64years of age sustained ruptures of the right dominant flexor carpi radialis (FCR) tendon. Prior to rupture, within the past 3months to 1year, each had received one or two corticosteroid injections of the FCR tendon sheath for stenosing tenosynovitis. Three of six patients demonstrated radiographic findings but none had clinical symptoms of osteoarthritis at the scaphoid-trapezium-trapezoid joint. The pain and disability declared by these patients appeared out of proportion to the relatively innocuous nature of a ruptured FCR tendon, with an average pre-operative Disabilities of the Arm, Shoulder, and Hand (DASH) score of 32. In all patients there was a palpable, tender mass of retracted, ruptured FCR tendon around 6cm proximal to the wrist crease as well as a palpable cord of pseudotendon formed within the residual sheath. Pain along the course of the pseudotendon was consistently provoked by wrist extension and gripping. The patients were initially treated non-surgically with stretching, manual therapy, ultrasound, and oral medications for 2-4months. None obtained sufficient relief, and the patients requested more definitive care. The painful tethering of the ruptured FCR was solved by complete excision of both pseudotendon and the retracted tendon stump, resulting in complete relief of symptoms with an average post-operative DASH score of 3. Pre-operative and post-operative DASH scores were analyzed with the paired Student's t-test, using a p-value of 0.05, and found to have a statistically significant difference.