Intramuscular Tenotomy of Flexor Digitorum Superficialis in the Distal Forearm after Surgical Excision of Dupuytren’s Disease

Author(s): Barr V, Bhatia R, Hawkins P, Savage R

Source: J Hand Surg 28B:37-39, 2003.

Summary:

The authors describe 5 cases of Dupuytren’s disease where persistent flexion of the involved finger proximal interphalangeal (PIP) joint after fasciectomy was partially attributed to contracture of the flexor digitorum superficialis muscle.  These patients were treated by release of the PIP joint, joint manipulation, and intramuscular tenotomy of the respective flexor digitorum superficialis muscle slip in the distal forearm.  Observing for a tenodesis affect with passive wrist flexion and extension made the determination as to whether the muscle was contributing to the PIP joint flexion deformity.

There is divergence of opinion about whether it is correct to surgically release a contracted PIP joint after excision of Dupuytren’s cords and nodules.  In the rare circumstance where the flexor digitorum muscle is contributing to a PIP joint flexion contracture, a selective tenotomy may be appropriate to consider.  Dividing the tendon at the intramuscular level in the distal forearm maintains continuity of the muscle-tendon unit.  It is unclear if this is any different than distal tenotomy with respect to long-term function with an intact profundus tendon.

 


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J Hand Surg