Flexor tendon rupture in the rheumatoid wrist caused by bony spurs in the carpal tunnel

Abstract

Five cases of flexor tendon rupture in surgically treated rheumatoid wrists were studied. The tendon ruptures occurred in the thumb and index finger, and the ruptures site was in the carpal tunnel in all five cases. The main cause of rupture was the formation of bony irregularities in the form of bony spurs in the carpal bones, mainly in the scaphoid, or at the volar aspect of the distal radius, as a result of rheumatoid erosion. In all five cases, tendon reconstruction and bony spur excision were conducted, and good recovery of phalangeal function was achieved. To clarify the causes of the rupture of the flexor pollicis longus in rheumatoid hands, we used three-dimensional computed tomography on 19 rheumatoid wrists without tendon rupture to investigate the presence or absence of bony spurs in the volar aspect of the scaphoid. The results showed a correlation between the frequency of scaphoid spurs and progression of bone changes as checked by radiography.

Radiotriquetral arthrodesis for rheumatoid wrist with flexor tendon rupture: A case report

“…For rupture of the FDP tendon with an intact flexor digitorum sublimis tendon of the index finger, there are some surgical reconstruction methods, such as tendon transfer, tendon grafting, tenodesis, and arthrodesis of the DIP joint. 5,10,18,19 Postoperative ranges of motion of the fingers with flexor tendon rupture in RA treated by tendon reconstruction have been reported in previous studies. 5,10,19 Based on these reports, the results of tendon reconstruction were not satisfactory in terms of the ranges of motion of not only the DIP joint but also the PIP joint, which is supposed to be affected by tendon adhesion.…”

“…3,4 The most common site of flexor tendon rupture is the carpal tunnel, which is caused by infiltration of tenosynovitis to the tendon and attrition by the bony prominence of the wrist. 3,5,10 Procedures to prevent further rupture in the wrist joint are controversial, including resection of the bony prominence and covering with surrounding soft tissue or partial/total wrist arthrodesis. Although total wrist arthrodesis is a good treatment option for patients with a severely destructive joint to acquire a stable and painless joint, daily activities, such as personal hygiene, handling coins, and fastening buttons, become impaired because of the loss of range of motion.…”

Subcutaneous flexor tendon rupture in patients with rheumatoid arthritis

“…The most notable reports include those of Mannerfelt et al in 1969 (31 fingers in 25 hands) [1], Moore et al in 1987 (10 fingers in 9 hands) [2], and Ertel et al in 1988 (115 fingers in 45 hands) [3]. These publications are now over two decades old, and more recent reports on flexor tendon rupture are few in number [6,7]. Furthermore, a limited number of studies involving patients with RA and flexor tendon ruptures have referred to clinical laboratory data or radiographic evaluation.…”

“…We retrospectively reviewed their medical charts to evaluate the pathology associated with flexor tendon rupture, and the postsurgical functional outcomes and complications. Flexor tendon ruptures were diagnosed using the following clinical assessments: flexor digitorum superficialis (FDS) test; the flexor digitorum profundus (FDP) test [5,11]; the tenodesis effect, three-dimensional computed tomography (3DCT) [5,6,12], magnetic resonance imaging (MRI) [4,13], and via intraoperative findings. Surgery was indicated when tendon ruptures were observed in at least one finger at the time of the initial examination.…”

“…Subcutaneous tendon rupture can be considered an invasion of synovitis into the tendon or frictional wear of the tendon caused by mechanical stimulation of bone spurs [1][2][3][4][5][6][7]. The incidence of flexor tendon rupture is relatively low and it occurs at 10% the rate of extensor tendon ruptures [2,6].…”