gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Multiple flexor tendon rupture in a 34-year old patient with rheumatoid arthritis

Meeting Abstract

  • presenting/speaker Francesca Teodonno - Hospital Universitario Infanta Elena, Valdemoro, Spain
  • Juan Carlos Márquez Ambite - Hospital Universitario Infanta Elena, Valdemoro, Spain
  • Marta Olmeda Lozano - Hospital Universitario Infanta Elena, Valdemoro, Spain
  • Daniel López Dorado - Hospital Universitario Infanta Elena, Valdemoro, Spain
  • Hugo Garlito Díaz - Hospital Universitario Infanta Elena, Valdemoro, Spain
  • Raquel Serrano Serrano - Hospital Universitario Infanta Elena, Valdemoro, Spain
  • Rocio Mascaraque Ortiz - Hospital Universitario Infanta Elena, Valdemoro, Spain
  • Cristóbal Suárez Rueda - Hospital Universitario Infanta Elena, Valdemoro, Spain

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-383

doi: 10.3205/19ifssh0230, urn:nbn:de:0183-19ifssh02301

Veröffentlicht: 6. Februar 2020

© 2020 Teodonno et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives/Interrogation: Flexor tendon ruptures in patients with rheumatoid arthritis are an uncommon condition caused by attrition on osseus spurs or by direct invasion of the tendon by hypertrophic tenosynovium. The most common localization of this condition is the carpal tunnel. The flexor pollicis longus and profundus to the index finger are most commonly affected.

Methods: We present the case of a 34-year old patient with seropositive rheumatoid arthritis that suddenly presents hand pain with no prior traumatic event.

The physical examination showed a limited flexion of flexor digitorum superficialis and profundis of all the fingers of the dominant hand as for the fifth. Extension of all fingers was preserved.

An MRI and an ecography were performed showing important synovial proliferation and distension concerning the common synovial sheath of the flexor pollicis longus and flexor tendons at the level of the carpal tunnel and metacarpal region of the hand, as well as partial rupture of flexor digitorum profundis and probable rupture of the flexor digitorum superficialis of 2nd, 3rd and 4th fingers.

A surgical treatment is then performed: A volar approach over the carpal tunnel showed a partial rupture and proliferative tenosynovitis of the flexor digitorum profundis and superficialis of the second, third and fourth finger and of the flexor pollicis longus in flexor zones III, IV and V, as well as an important adhesion of the median nerve.

Consequently, the surgery consisted in an exoneurolysis of the median nerve, identifying both motor and sensitive branches and a reconstruction of the flexor tendons using an autograft of the palmaris longus for the flexor pollicis longus and the radial hemi flexor carpi radialis tendon for the flexor digitorum profundis and superficialis of the second, third and fourth finger. The tenosynovial tissue was excised and sent for histological examination.

The patient was immobilized with a forearm splint in flexion including all fingers.

After two weeks the surgery wounds were in good state with no signs of infection, and the splint was changed to allow phase I of early protected mobilization.

At four-weeks post-operative the splint was changed to advance in the protected mobilization. The analysis of the tissue showed various rheumatoid nodules (nodulosis) and presence of synovitis.

Results and Conclusions: Patients with flexor tendon ruptures present an high disease activity. Prevention of tendon ruptures by early tenosynovectomy is advised, due to poor prognosis.