Abstract
Six patients (five male, one female) between 51 and 64 years of age sustained ruptures
of the right dominant flexor carpi radialis (FCR) tendon. Prior to rupture, within
the past 3 months to 1 year, each had received one or two corticosteroid injections
of the FCR tendon sheath for stenosing tenosynovitis. Three of six patients demonstrated
radiographic findings but none had clinical symptoms of osteoarthritis at the scaphoid-trapezium-trapezoid
joint. The pain and disability declared by these patients appeared out of proportion
to the relatively innocuous nature of a ruptured FCR tendon, with an average pre-operative
Disabilities of the Arm, Shoulder, and Hand (DASH) score of 32. In all patients there
was a palpable, tender mass of retracted, ruptured FCR tendon around 6 cm proximal
to the wrist crease as well as a palpable cord of pseudotendon formed within the residual
sheath. Pain along the course of the pseudotendon was consistently provoked by wrist
extension and gripping. The patients were initially treated non-surgically with stretching,
manual therapy, ultrasound, and oral medications for 2–4 months. None obtained sufficient
relief, and the patients requested more definitive care. The painful tethering of
the ruptured FCR was solved by complete excision of both pseudotendon and the retracted
tendon stump, resulting in complete relief of symptoms with an average post-operative
DASH score of 3. Pre-operative and post-operative DASH scores were analyzed with the
paired Student’s t-test, using a p-value of 0.05, and found to have a statistically significant difference.
Keywords
Flexor carpi radialis - Rupture - Pseudotendon - Tethering - Excision
