- See:
Flexor Pollicis Longus:
- Discussion:
- rupture of the
flexor pollicis longus tendon is common in RA;
-
etiology:
- rupture of
FPL occrus as result of attrition over scaphoid (osteophyte), which had eroded through volar wrist capsule;
- arises from carpal irregularities, volar synovitis, or volar carpal tunnel subluxation at the carpal tunnel;
-
diff dx:
-
anterior interosseous nerve;
-
trigger thumb
- IP joint arthritis;
- Exam:
- carefully note
anterior interosseous nerve function (r/o compression);
-
carpal tunnel symptoms may result from proximally displaced tendon edge which has been known to be doubled over itself at entrance of carpal tunnel;
- patients typically have passive but not active flexion of thumb at IP joint (otherwise consider
trigger thumb);
- if pt has a good IP joint, then the loss is apparent;
- if there is destruction of the IP joint then the tendon rupture causes little functional loss;
- Radiographs:
- assess amount of joint destruction of IP, MP, and CMC joints;
-
carpal tunnel view
- Treatment:
-
FPL Advancement and Pull Thru:
- either terminal joint stability or restoration of active motion must be provided;
- volar aspect of wrist must be explored, to look for a bony spicule that has disrupted
FPL, since such a spicule might also affect the tendons of the index finger;
- treatment options include FPL advacement and pull thru, bridge grafts, FDS tendon transfer, or arthrodesis of PIP joint & synovectomy;
- if spicule of bone is present, and both ends of the tendons can be identified, then consider a bridge graft;
- use
palmaris longus or
FCR;
- Post Op:
- the thumb and wrist are immobilized for three wks, before active motion is begun;
Laceration of the Flexor Pollicis Longus Tendon: Delayed Repair by Advancement, Free Graft or Direct Suture. A clincial and experimental study.
J.R. Urbaniak MD and J.L. Goldner MD JBJS vol 55-A, 1973. p 1123-1148.
Flexor superficialis tendon transfers to the thumb: An alternative to the free tendon graft for treatment of chronic injuries within the digital sheath.
J Hand Surg Am 1983;8:876-881.
