Artikel
Treatment for PIP joint flexion contracture in stenosing tendovaginitis using resection of the flexor digitorum superficialis
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Autoren
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Jiro Namba
- Hoshigaoka Medical Center, Hirakata, Japan
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Michio Okamoto
- Yao Municipal Hospital, Yao, Japan
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Generally, PIP flexion contracture associated with finger stenosing tendovaginitis is resolved by incision of A1 pulley which is a major obstruction site. In spite of the favorable result of A1 pulley release, sometimes certain degree of contracture did not go away due to remaining sliding disorder at other sites except A1. We reviewed whether excision of total or half slip of the flexor digitorum superficialis (FDS) tendon was practicable for primary or revision cases with refractory flexion contracture.
Methods: We identified 12 fingers in 12 patients who underwent FDS resection. The average age was 76 years old (62-91). 2 fingers had one prior A1 pulley release and 1 had 2 previous surgeries. Diabetes were involved in 4. The long finger was affected in 11 and index finger in one. The intraoperative findings on tendons were recorded. Clinical outcome was reviewed including ROM, grip strength, Visual analogue score (VAS).
Results and Conclusions: The mean preoperative PIP contracture was 28 degrees. The ulnar half slip of the FDS was excised in 4, both slips in 8 fingers. Intraoperative full extension was achieved in 11 cases, and no other soft tissue release like capsule and volar plate was conducted. All FDS tendons had longitudinal internal lesions and enlargement. The postoperative PIP contracture was 7 degrees, full extension was achieved in 7 fingers at a mean of 18 months postoperative. No case of swanneck deformity was recognized. VAS was 14 points, and grip strength was 86% against contralateral side. Total active arc motion was 241 degrees. Between half slip and total resection, total arc was significantly different with 219 / 252 degrees, as opposed to insignificance among the other variables.
Resection of hemi or total slip of FDS is an effective method for treatment of residual PIP contracture. In consideration of total arc motion in our cases at final follow up, total resection might provide wider space for flexor digitorum profundus to glide than half slip.
