Rupture of the Flexor Pollicis Longus Tendon after 30 Years due to Migration of a Retained Foreign Body

Abstract

Delayed rupture of a flexor tendon in the hand due to the presence of a retained foreign body is rare. We present the case of a late flexor pollicis longus rupture 30 years after traumatic implantation of a glass fragment. The foreign body had migrated distally a distance of 4.5 cm from the site of the original injury and eroded into the flexor tendon sheath. Thumb function was restored with a flexor digitorum superficialis tendon transfer from the ring finger with excellent results.

Proximal migration of retained pencil lead along a flexor tendon in the hand

“…Retained foreign bodies can be inert, or can result in both acute and chronic complications, including infection, nerve apraxia or injury, nail deformity, fracture, inclusion cyst, tendonitis, tenosynovitis, adhesion, and migration of the foreign body. [2,5] Foreign bodies may move to adjacent tissues, but rarely wander far. Migrations into major blood vessels, and abdominal, thoracic, and cranial cavities, have been reported.…”

“…Infection is the most common complication, and foreign body migration is possible. [2,5] Foreign body migration has been reported from the abdominal cavity to the intracranial space and major blood vessels. [6,7,8,9,10]…”

Foreign Body Migration Along a Tendon Sheath in the Lower Extremity

“…Our review of the literature identified mostly cases of migrating foreign bodies in the periphery of the upper extremity [10][11][12] . Stoǐko et al 10 , in a Russian surgical article in 1983, described a small metal piece migrating 36 cm along a forearm tendon sheath, as seen on serial radiographs, in a forty-year-old mechanic.…”

“…Stoǐko et al 10 , in a Russian surgical article in 1983, described a small metal piece migrating 36 cm along a forearm tendon sheath, as seen on serial radiographs, in a forty-year-old mechanic. Yang et al 11 described a small piece of glass migrating 4.5 cm through a hand over a period of thirty years; it finally eroded into, and ruptured, the flexor pollicis longus tendon. This migration was not believed to be primarily along the tendon sheath, but rather was thought to have extended into the sheath shortly before rupturing the flexor pollicis longus.…”

“…More commonly, a penetrating foreign body in the foot, particularly a wooden object, can lead to cellulitis, osteomyelitis, or an apparent ''pseudotumor.'' [4][5][6][7][8][9] However, foreign bodies in the foot do not appear to migrate far, in contrast to those in the upper extremity, which can migrate along some distance [10][11][12] . We report a case of a toothpick penetrating a child's foot and migrating a sufficient distance to be undetectable with conventional imaging techniques.…”