Trigger finger secondary to a neglected flexor tendon rupture

Abstract

Secondary trigger finger caused by trauma to the hand, especially associated with partial flexor tendon rupture, is not a common condition. Thus, the clinical manifestations of these patients are not well-known. The aim of this study is to present secondary trigger finger caused by a neglected partial flexor tendon rupture including discussion of the mechanism and treatment.We retrospectively reviewed the records of 6 patients with trigger finger caused by a neglected partial flexor tendon rupture who had been treated with exploration, debridement, and repairing of the ruptured tendon from August 2010 to May 2015. The average patient age was 41 years (range, 23-59). The time from injury to treatment averaged 4.7 months. The average follow-up period was 9 months (range, 4-18). Functional outcome was evaluated from a comparison between the Quick-disabilities of the arm, shoulder, and hand (DASH) score and the visual analogue scale (VAS) for pain, which were measured at the time of preoperation and final follow up.Four patients showed partial rupture of the flexor digitorum profundus (FDP) tendon and 3 showed partial rupture of the flexor digitorun superficialis (FDS) tendon. Both the FDP and FDS tendons were partially ruptured in 2 patients, and the remaining patient had a partial rupture of the flexor pollicis longus tendon. All patients regained full range of motion, and there has been no recurrence of triggering. The average VAS score decreased from 3.6 (range, 3-5) preoperatively to 0.3 (range, 0-1) at the final follow up. The average Quick-DASH score decreased from 33.6 preoperatively to 5.3 at the final follow up.When we encounter patients with puncture or laceration wounds in flexor zone 2, even when the injury appears to be simple, partial flexor tendon laceration must be taken into consideration and early exploration is recommended.

Figure 1

(A) Intraoperative view of showing that the lacerated portion of the FDS tendon has formed a flap (arrow) and caught the A1 pulley. (B) After the A1 pulley and synovial tissue were removed, this intraoperative view shows the complete rupture of FDS tendon ulnar slip (arrow). (C) The ruptured tendon was sutured after debridement. (D and E) Photographs obtained 7 months after operation show normal ROM in the small finger without triggering. FDS = flexor digitorum superficialis, ROM = range of motion.

Figure 2

(A) Preoperative photographs show limited ROM at the PIP and DIP joints in this patient's left long finger. (B) The Zigzag skin incision at the level of the A2 to A3 pulleys. (C) Intraoperative photographs show partial radial side laceration of the FDP tendon after excision of the C1 and A3 pulleys. (D) Sutured tendon after trimming. (E and F) At follow-up 16 months later, the patient had regained nearly normal ROM in his left long finger without triggering. DIP = distal interphalangeal, FDP = flexor digitorum profundus, PIP = proximal interphalangeal, ROM = range of motion.