Closed rupture of the flexor digitorum profundus tendon within the carpal tunnel

Closed rupture of the flexor digitorum profundus tendon within the carpal tunnel

CLOSED RUPTURE OF THE FLEXOR DIGITORUM PROFUNDUS TENDON WITHIN THE CARPAL TUNNEL K. NAKAMICHI and S. TACHLBANA From the Department of Orthopaedic Su...

400KB Sizes 9 Downloads 141 Views

CLOSED RUPTURE OF THE FLEXOR DIGITORUM PROFUNDUS TENDON WITHIN THE CARPAL TUNNEL K. NAKAMICHI

and S. TACHLBANA

From the Department of Orthopaedic Surgery, Toranomon Hospital, Minato-ku, Tokyo, Japan

We report a case of a closed rupture within the carpal tunnel of the flexor digitorum profundus tendon of the little finger. There was no underlying pathology.

Journal of Hand Surgery (British and European Volume, 1994) 19B: 197-198 Closed ruptures of the flexor tendons in the hand without underlying pathology are uncommon. Reported cases are dominated by ruptures in the palm (distal to the carpal tunnel), and at the tendon insertion (Boyes et al, 1960; Kumar and James, 1985; Langa and Posner, 1986; Imbriglia and Goldstein, 1987; Wray and Parlin, 1989; Walker and Lesavoy, 1990; de Roos and Zeeman, 1991; Takami et al, 1993), but those within the carpal tunnel are even more rare. We describe such a case. CASE REPOIRT

A 52-year-old man was seen because of inability to flex the distal phalanx of the right little finger. 3 days before, he noticed a snap and a slight pain in the right wrist when he tried to lift a steel pipe weighing approximately 40 kg from thie floor by abruptly hooking it with the tips of the ring and little fingers only. The fingers and wrist were slightly flexed. He gave no history of injury or significant past medical history. His job involved desk work. He was unable to actively flex his right little finger at the DIP joint, but had a normal passive range of motion. There was no area of tenderness or subcutaneous bleeding to suggest the site of the rupture. Radiographs demonstrated no abnormalities, and laboratory te:sts for rheumatoid arthritis, gout and infection were normal. 1 week after the injury, the wrist was explored where he had felt a snap, and the FDP tendon of the little finger was found to be ruptured within the distal portion of the carpal tunnel (Fig 1), at approximately the level of the hook of the hamate. The stumps were blunt, and slightly frayed. There was no deformity or spur formation within the tunnel. End-to-end repair was performed using a modified Kessler suture of 4/O nylon after resecting the ffrayed ends. Histological examination of the stump and1 synovium showed no specific pathology. After immobilization for 3 weeks, his hand was mobilized. 4 months after operation, he regained a normal active range of motion.

Fig 1

Operative photograph. The distal and proximal stumps of the tendon of FDP of little finger are indicated by the upper and lower forceps respectively. Arrowheads = Incised transverse carpal ligament. Top arrowhead = Distal border of ligament. The ulnar side is to the left.

responsible. At the level of the hook of the hamate the tendon of FDP of the little finger changes its direction, and it could be vulnerable to compression against the bony wall of the tunnel when tension is applied. A sudden increase in tension might have caused acute mechanical failure at this level. The area where a snap had been felt was indicative of the site of the rupture also in our case, as was described by Kumar and James ( 1985).

DISCUSSION A similar case was reported in the series by Imbriglia and Goldstein (1987), but the case was not described in detail. The cause of the rupture in our case was not clear, but the unusual means of lifting the pipe seemed 197

198

THE JOURNAL

References BOYES, J. I-I., WILSON, tures in the forearm n. 1;17_/;nl; 7.

u_I,

J. N. and SMITH, J. W. (1960). Flexor-tendon and hand. Journal of Bone and Joint Surgery,

rup42A:

Y-r”.

DE ROOS, W. K. and ZEEMAN, R. J. (1991). A flexor tendon rupture in the palm of the hand. Journal of Hand Sur-0-7, “’ x1 &C’J, ‘LA. I”__ 7. ,,,-,;5.Lc IMBRIGLIA, J. E. and GOLDSTEIN, S. 2 4. (1987). Intratendinous ruptures of the flexor digitorum profundus tendon of the small finger. Journal of Hand Surgery, 12A: 6: 985-991. KUMAR, S. and JAMES, R. (1985). Closed rupture of flexor profundus tendon in the palm. Journal of Hand Surgery, 10B: 2: 193-194. LANGA, V. and POSNER, M. A. (1986). Unusual rupture of a flexor profundus tendon. Journal of Hand Surgery, IlA: 2: 227-229. TAKAMI, H., TAKAHASHI, S. and ANDO, M. (1993). Rupture of the flexor

OF HAND

SURGERY

VOL. 19B No. 2 APRIL

1994

di&orum profundus tendon in the palm caused by repeated, chronic direct t&ma. Journal of Hand Surgery, i8A: 1: 65-67: _ WALKER, L. G. and LESAVOY, M. A. (1990). Traumatic rupture of the profundus tendon proximal to the lumbrical origin. Journal of Hand Surgery, 15A: 3: 484-486. WRAY, R. C. and PARLIN, L. S. (1989). Spontaneous flexor tendon rupture in the palm. Annals of Plastic Surgery, 23: 4: 352-353.

Accepted: 23 September 1993 K. Nakamichi, MD, The Department of Orthopaedic Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan. 0 1994 The British Society for Surgery of the Hand