The examination was notable for no independent function of the FDS tendon. The left long finger had a flexion contracture of 55 degrees, with PIP joint range of motion limited to 60 to 100 degrees of flexion. Examination revealed progressive worsening of the flexion contracture with bowstringing of the left long finger on resisted PIP joint flexion. Six months later, the patient sought a second opinion after gradual worsening of his symptoms. He was treated conservatively with a dynamic splint and physical therapy. X-rays were unremarkable for osseous or soft tissue abnormality. His examination was notable for flexion contracture of the left long finger at the PIP joint. 8, 9Ī 58-year-old right-hand-dominant male who worked as a diesel mechanic presented to the hand clinic with 1 month of pain and decreased range of motion in his left long finger after the finger was hyperextended when he lifted a heavy brick stepping-stone. To our knowledge, this report presents only the third case describing the combined injury of a closed traumatic FDS avulsion with flexor tendon pulley ruptures. 7Ĭompounding the rarity of such pulley injuries are associated avulsions of the flexor digitorum superficialis (FDS) tendon. The pulleys function to keep the flexor tendons close to the bone, allowing a translational force to be directed by the flexor muscle-tendon unit and resulting in rotational movement of the phalanges. The A2 pulley is located on the proximal half of the proximal phalanx, the A3 pulley arises from the volar plate of the proximal interphalangeal (PIP) joint, and the A4 pulley is located at the midportion of the middle phalanx. The finger flexor pulley system of the second to fifth fingers is composed of 5 annular (A1-A5) and 3 cruciate (C1-C3) pulleys. 5 Multiple combined pulley ruptures are rare and require surgical reconstruction to prevent functional deficits. 1- 4 Most of these injuries occur as isolated single-pulley ruptures of either the annular (A) or cruciate (C) pulleys. Keywords:Ĭlosed flexor tendon pulley ruptures are especially frequent among rock climbers but can also happen through daily activity. The desired outcome was achieved through A2 and A4 pulley reconstruction using an autologous palmaris longus tendon graft with FDS tendon excision and proximal interphalangeal joint capsulotomy.Ĭonclusion: Multiple pulley rupture is not commonly combined with FDS avulsion, and treatment of this injury requires careful surgical planning based on pulley biomechanics to maximize postoperative function. This uniquely associated pathology was treated with a complex surgical reconstruction that corrected flexion contracture and tendon bowstringing in the left long finger. Pulley rupture combined with avulsion of the flexor digitorum superficialis (FDS) tendon is an even more uncommon occurrence.Ĭase Report: We describe a closed traumatic annular 2 (A2) through annular 4 (A4) pulley rupture with avulsion of the FDS tendon. Background: Multiple closed spontaneous pulley ruptures are rare injuries and require surgical reconstruction to prevent functional deficits.
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