Summary: The authors retrospectively analyzed 21 patients with closed rupture of flexor tendons caused by carpal pathology. There were no cases of rheumatoid arthritis or infection. Rupture of the small finger flexor tendons occurred most commonly and was associated with a hook of hamate fracture non-union, a hamate projection, pisotriquetral arthritis, or Kienbock’s disease. Wrist arthrograms were found useful in locating the capsular defect in the carpal canal that corresponded to the intruding bone prominence. Treatments included intercalary tendon grafting (17) and tendon transfer (3): 1 patient underwent no surgical treatment. Follow-up assessments were completed in 16 cases at a minimum of 1 year. There were 5 fair, 10 good, and 1 excellent result according to the American Society for Surgery of the Hand Evaluation (Kleinert and Verdan, JHS Am, 1983).
In patients with attritional flexor tendon rupture caused by a bone spur, detection of the spur is important: sharp edges require debridement and the joint capsule/periosteum should be repaired to prevent tendon re-injury after repair. A wrist MR arthrogram may be useful for localizing the capsular defect and ruptured tendon ends. The superiority of one tendon repair/reconstruction technique over another for treatment of an attritional flexor tendon rupture cannot be determined from this study.
flexor tendons, carpal bone, joint disorders