Closed Flexor Tendon Research Articles

Spontaneous Zone III Flexor Tendon Rupture of the Little Finger: A Case Report

Closed flexor tendon ruptures are uncommon, and most are avulsion ruptures from the tendon insertion. Such intratendinous ruptures are generally associated with an underlying pathological process such as inflammatory disease; purely spontaneous ruptures are very rare. A 66-year-old male patient presented with sudden loss of flexion in the left little finger distal interphalangeal joint (DIPJ) while rotating a steering wheel. Preoperative ultrasonography and magnetic resonance imaging (MRI) suggested a closed flexor digitorum profundus (FDP) injury in the substance of the tendon. Surgical exploration revealed a zone III rupture in the FDP tendon. After tenorrhaphy, early postoperative exercise using a dynamic splint was initiated. At 8 months’ follow-up, he had regained flexion of the DIPJ and was free of pain. We recommend that patients with suspected closed flexor tendon injuries promptly undergo preoperative imaging studies such as ultrasonography or MRI to determine the rupture site, facilitating preoperative planning and reducing surgical morbidity.

A Silent Closed Rupture of the Flexor Digitorum Profundus on the Index Finger: An Unsolved Mystery

We report the case of a patient who fully recovered from a closed flexor tendon rupture through a two-stage flexor tendon reconstruction using silicone rods, despite a considerable delay in treatment. A 17-year-old male patient visited our clinic with a sudden inability to flex his left index finger, although there were no signs of injury. Magnetic resonance imaging revealed an extensive rupture of the flexor digitorum profundus from the base of the distal phalanx to the proximal phalangeal joint of his left hand. After a two-stage tendon graft operation was performed, the patient regained full flexion of the index finger and was able to hold a fist without any limitations in range of motion. Complete rupture of tendons usually accompanies history of trauma or underlying tendon pathology. In our case, however, the tendon rupture occurred silently with no obvious underlying causes. It is important to recognize the signs to evaluate the underlying structures for appropriate management and treatment. Even with considerable delay, the patient may regain full function of the tendon.

Are Flexor Tendon Ruptures Ever Spontaneous? - A Literature Review on Closed Flexor Tendon Ruptures of the Little Finger.

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.

Closed disruption of a single flexor digitorum superficialis tendon slip: 3 cases

Two men and one woman (age 31, 36 and 45 years) felt a painful pop in the left middle, right middle and right index finger during sport-related activities (2 sport climbing and 1 judo). Clinical examination found a painful flexor tendon in zone 2 but no function deficit specific to the flexor digitorum superficialis (FDS) tendon. MRI and ultrasonography revealed a complete disruption of the radial FDS tendon slip only, which was found retracted between the A2 and A3 pulleys. All flexor tendon pulleys remained intact. Conservative and functional treatment resulted in unrestricted normal function and return to sport. Disruption of one FDS tendon slip is a differential diagnosis for a popping incident in the finger, which is typically associated with a closed flexor tendon pulley injury.

CLINICAL RESULTS OF 11 PATIENTS OPERATED FOR JERSEY FINGER A NEW RADIOLOGICAL FINDING

Objectives: The Jersey finger is a rare form of closed flexor tendon rupture. It is classified by modified Leddy-Packer classification and divided into five groups. There is no consensus on treatment. There is not much study on the finger of Jersey. Methods: Eleven patients who underwent surgical treatment for the last five years were evaluated retrospectively. VPS and ROM ratio values used for assessment of clinical outcomes. Results: The duration of surgery, the surgical method used, the type of injury did not affect the clinical outcome. Only side of injury had significantly difference (left’s outcomes better). In jersey finger patients with bone avulsion, had an x-ray image resembling a pin-hole. Conclusion: The Jersey finger is an FDP injury that is common in the sporting young male age, often related to the dominant hand, and often retracted to the A3 pulley. Both pullout or anchor repair methods give satisfactory results. In patients with bone avulsion, radiographs of the distal phalanx on the distal phalanx should show the appearance of a pinhole.make italic

Rupture du tendon fléchisseur long du pouce après une luxation de l’IP-case report

Closed flexor tendon ruptures due to trauma without external wound are rare. When the flexor tendon has excessive loading, failure occurs at the tendon insertion on the bone. Avulsion fracture occured more frequently than simple avulsion of the tendon himself. The inability to flex the IP joint is the major sign but the luxation of IP and swelling of the IP masked this signe. We have experienced one case of closed flexor tendon ruptures at zone I caused by forceful hyperextension mechanism against resistance. A 39-year-old man was victim of a fall with a forced hyperextension of the left thumb. He had gone to another hospital where he had performed an X-ray that showed a dislocation of the distal phalange of the thumb. Reduction was tempted followed by an immobilization. Our clinical examination begins with the removal of the temporary protection of the thumb and the finger appears inflated and ecchymotic. The patient has a total impossibility of active or passive flexion, with a small handheld anterior-radial invagination skin of DIP joint, as a suspected asymmetric incarceration. We decided to make an open reduction of the subluxation and we open the IP joint through a volar zigzag Bruner incision from the distal phalange to the MP joint. We found the external lateral ligament incarceration and also an avulsed volar plate and a complete avulsion of the flexor of the thumb. The second incision was made at the volar-radial aspect of the distal end of the forearm to find the FPL. The tendon was reinserted after the reinsertion of the volar plate with the anchors. We immobilized the patient's limb with a thermoplastic protection for 3weeks and controlled clinical evolution without finding any complications. Four months after surgery, this patient has 12°of active flexion, 40°of passive flexion, no pain. The interesting point is the association of closed irreducible luxation of the IP joint with a masked of the FPL. The swelling of the thumb after two days of a lack of the reduction and the losing of the active motion are not the consequence of an isolated luxation. The trap is to miss the diagnostic of the FPL's avulsion. If the patient is unable to make a flexion after the reduction of an IP luxation you have to think to an incarcerated collateral ligament or volar plate or worse an associated avulsion of the FPL.

Diagnosis of flexor tendon injuries of the hand

Open or closed flexor tendon injuries may be caused by a variety of circumstances. Loss of function based on flexor tendon injuries is quite often missed. Therefore, a precise knowledge of the anatomy, the biomechanical behaviour of tendons and the intrinsic hand muscles enables the clinician to examine flexor tendon injuries adequately. This article focuses on relevant clinical tests for flexor tendon injuries.

Closed rupture of flexor tendon by hyperextension mechanism in wrist level (zone V): a report of three cases

Closed flexor tendon ruptures due to trauma without external wound are rare. When the flexor tendon has excessive loading, failure occurs at the tendon insertion or its origin from the bone. It is likely to result in avulsion fracture rather than rupture of the proper portion of the tendon by forceful grasping with hyperextension. However, we have experienced three cases of closed flexor tendon ruptures at zone V, caused by forceful grasping or hyperextension mechanism against resistance. On physical examination, these patients could not flex interphalangeal joint of thumb or distal interphalangeal joint of the fifth finger. All patients underwent MRI or ultrasonography to find out the location of loss in continuity of the flexor tendons before the operation. After identifying the location, flexor tendon repair or tendon graft using palmaris longus were performed.

Spontaneous Rupture of a Flexor Digitorum Profundus Tendon at Two Levels in Zones II and III in a Child

Closed flexor tendon ruptures in the mid-substance rarely occur in healthy adults [25] and usually are subject to an underlying pathologic condition. Extrinsic causes for rupture are due to abnormalities of the carpus as fracture, tumor, or deforming arthritis, leading to fraying of the tendon against rough cortex or bone spikes and attritional tendon rupture [8, 12, 19, 30]. Intrinsic causes for rupture are intratendinous steroid injections or diminished tendon vascularity and nutrition, leading to intratendinous weakening of the tendon [1, 9, 18]. Most spontaneous flexor tendon ruptures without underlying pathology occur in zone III [4, 25]. We present a case of a traumatic closed flexor digitorum profundus (FDP) rupture at two levels in zones II and III of the ring finger in a 12-year-old boy. To date, traumatic closed mid-substance flexor tendon ruptures have not been reported in the pediatric population nor has a simultaneous rupture of a flexor tendon at two levels been described.

Sport climbing from a medical point of view

Rock climbing, sport climbing and bouldering are highly popular new sport disciplines. An increasing number of indoor climbing gyms throughout the country offer the possibility to perform the sport regularly independently from the weather. As a result a variety of new pathologies like the closed flexor tendon pulley rupture of the finger and syndromes caused by overuse mainly in the upper extremity have appeared and should be familiar to physicians and therapists working in the field of sports medicine. An overview of the most common and most specific climbing related injuries as well as their diagnosis and treatment options with a focus on the upper extremity are presented.

Bilateral spontaneous rupture of the flexor digitorum superficialis and the flexor digitorum profundus in a diabetic patient

Closed flexor tendon rupture is an unusual condition that has been described in association with distinct underlying disease processes. Several theories have been implicated in the pathogenesis, including labor-associated forceful usage, gender, and age. The effect of diabetes on the native tendon tissue is not yet fully understood; however, the metabolic perturbations of diabetes have been shown to result in detrimental changes to the musculoskeletal system. We report an unusual case of bilateral spontaneous rupture of the flexor digitorum superficialis and flexor digitorum profundus in a 58-year-old woman with Type 2 diabetes mellitus. The clinical course, radiographic findings, and the biomechanical factors and mechanisms through which diabetes may affect the native tendon are presented.

Injuries to the upper extremity in rock-climbers

Rock climbing and bouldering are highly popular upcoming sport disciplines. The majority of climbers perform their sport as a recreational activity in the indoor climbing gyms that can be found throughout the country. Different new pathologies like the closed flexor tendon pulley rupture of the finger and other syndromes caused by overuse appeared which should be known to physicians and therapists interested in sports medicine. The purpose of this article is to give an overview of the most common and most specific climbing injuries of the upper extremity as well as its diagnosis and treatment options.

The accuracy of ultrasound in evaluating closed flexor tendon ruptures

This paper examines the accuracy of ultrasound (US) in identifying closed flexor tendon ruptures and ruptures following recent flexor tendon repair. Between January 2001 and December 2006, 80 patients were investigated. Rates of accuracy between clinical examination and US findings were compared using the Wilcoxon signed ranks test. The chi square test was used to compare differences in sonographic accuracy according to the nature and zone of injury as well as time elapsed between injury and subsequent US. The accuracy of US was found to be significantly higher than clinical examination alone (95% vs. 79%, Z = 2.00, p = 0.03). Time between injury and US was the only variable to significantly affect diagnostic accuracy. US findings were 100% accurate when imaging was undertaken between 1 and 7 days following injury, 88% accurate when undertaken on the same day as injury and 85.7% accurate when performed after 1 week (X2 = 6.4, p = 0.04). This retrospective study supports the notion that US can have a valuable role in the management of suspected closed flexor tendon ruptures and ruptures of recent flexor tendon repairs.

Phaeohyphomycosis Infection Leading to Flexor Tendon Rupture: A Case Report

A rare previously unreported cause of flexor tendon rupture is described. A 66-year-old man presented with a fully extended left middle finger, accompanied by swelling and purulent drainage. Prior to presentation, he had received a steroid injection for left middle finger stenosing tenosynovitis and subsequently developed culture-proven phaeohyphomycosis fungal infection and secondary enterococcal bacterial infection, requiring pharmacotherapy and incision, drainage, and debridement for abscess formation. Clinical and magnetic resonance imaging findings were consistent with the diagnosis of closed flexor tendon rupture of the left middle finger. Antifungal and antibiotic therapy followed by two-stage flexor tendon reconstruction was performed. Six months postoperatively, full passive range of motion was achieved and the proximal interphalangeal and distal interphalangeal joints of the left middle finger actively flexed to 125 degrees and 90 degrees, respectively.

MULTIPLE CLOSED FLEXOR TENDON AVULSIONS FROM THEIR INSERTIONS BY A HIGH-ENERGY EXPLOSION

A case of multiple closed flexor tendon avulsions from their insertions as a result of the blast of a firework is presented and this pathology discussed.

CLOSED RUPTURE OF THE FLEXOR TENDONS OF THE LITTLE FINGER SECONDARY TO NON-UNION OF FRACTURES OF THE HOOK OF THE HAMATE

We report six patients with closed flexor tendon rupture affecting the little finger, occurring secondarily to non-union of the hook of the hamate bone. The ununited fragments were separated from the basal part of the hook by more than 1mm. The fragments were also rounded and showed marginal sclerosis. Non-union was located in the middle part of the hook in three patients, the tip in two, and the base in one. At operation, the fragments were removed in all patients. Five patients were treated by free tendon grafts using three palmaris and two plantaris grafts and one underwent tendon transfer. Postoperative total range of active motion of the little finger averaged 218 degrees (range 185-265 degrees ). All patients returned to their original employment. This series would suggest that flexor tendon rupture can occur after fracture of the hook of the hamate bone, even when the ununited fragment is small and/or rounded.

Closed rupture of the thumb flexor tendon pulleys

Closed flexor tendon pulley ruptures are relatively rare injuries. All previously reported cases have been in the long finger pulleys. To our knowledge, there has not been a case of closed thumb flexor tendon pulley rupture reported in the literature. This paper presents two cases of this pathology and discusses appropriate treatment of it.

CLOSED FLEXOR TENDON DISRUPTION IN ATHLETES

Closed tendon injuries of the hand and wrist are very common in the athletic population. Most of these injuries, especially those involving the extensor tendons, can be treated successfully with nonoperative management if seen acutely. Acute closed flexor tendon injuries, however, usually require operative intervention for the best result. Although evaluation and diagnosis of flexor tendon injuries are relatively straightforward, diagnosis is still commonly delayed secondary to both delayed presentation and missed diagnoses. If diagnosis is delayed, operative intervention becomes less optimal and the patient may have a permanent disability regardless of treatment. Generally, athletes are able to return to their pre-injury level of participation regardless of treatment. This is a product of both the finger involved--usually ring or little--and the extent of the disability. In many instances, the athlete may even continue participation during treatment with protective splinting.

THE ROLE OF MAGNETIC RESONANCE IMAGING IN LATE PRESENTATION OF ISOLATED INJURIES OF THE FLEXOR DIGITORUM PROFUNDUS TENDON IN THE FINGER

Four patients had magnetic resonance imaging (MRI) after a clinical diagnosis of a flexor digitorum profundus tendon rupture of the hand. The delay before presentation ranged from 1 to 5 weeks. Three patients had closed ruptures and one had a minor laceration which had healed. MRI showed proximal retraction of the profundus tendon to the palm in two patients and limited retraction in the other two. MRI provides important preoperative information for surgical decision-making and planning in patients who present late with closed flexor tendon injuries of the hand.