Closed rupture of the flexor tendons of the thumb
and index due to severe scaphotrapezoidal arthritis
Luc De Smet
Received: 20 March 2007 / Accepted: 4 August 2008 / Published online: 9 September 2008
Abstract We report a case of severe scaphotrapezoidal
osteoarthritis with closed rupture of multiple flexor tendons.
The thumb was treated with a tenodesis with the remaining
flexor and the deep flexor of the index was reconstructed
with a short cable graft, harvested from the superficial flexor.
Keywords Flexor tendon
Closed ruptures of flexor tendons in non-rheumatoid
patients are very rare; it can be seen after malunion of
Colles’ fractures [1, 2], fractures of the hook of the hamate
[3, 4] and other rare wrist conditions [3–5, 8–13]. We report
a new case with multiple flexor tendon ruptures due to
severe scaphotrapezoidal (STT) osteoarthritis.
A 52-year-old woman, in good general health, consulted
with the impossibility of actively flexing the thumb and
index fingers. The symptoms appeared a few weeks before
the visit: firstly, she noted an hyperextension of the thumb
in the interphalangeal joint and no active flexion; some
days later, due to a sudden movement, she could not flex
the index finger as well. Sensation was not disturbed. She
had a forearm fracture in 1960 but no other trauma since
then. There were no joint or other general diseases.
Physical examination revealed hyperextension of the
interphalangeal joint of the thumb and a spontaneous
extended position of the index (Fig. 1). Passive motion was
normal. Deep palpation of the distal forearm was painful.
There were no signs of rheumatoid arthritis. The radiographs
showed a marked dorsal intercalated segment instability
configuration of the carpus, with widening of the scapholu-
nate gap and a scapholunate angle of 85°. The scaphotrape-
zoidal joint was severely arthritic (Fig. 2). Ultrasound
examination demonstrated severe synovitis of the flexor
tendons. On exploration, we found a closed rupture of the
flexor pollicis longus, both flexors of the index finger and
fraying of the deep flexor to the middle finger (Fig. 3). The
synovium was very thick. The distal pole of the scaphoid
protruded into the carpal tunnel. The synovium was resected.
The superficial flexor of the index was used to bridge the 10-
cm defect in the deep flexor to the index. A tenodesis of the
interphalangeal joint of the thumb was also performed. The
STT joint was reduced and fused with two powered staples.
The staples and the STT were covered with a local flap of
synovial tissue. Rehabilitation with a dynamic splint was
started 1 week after the operation. At 3 months postopera-
tively, she obtained 80° active flexion in the proximal
interphalangeal joint of the index.
The mechanism of flexor tendon ruptures in rheumatoid
arthritis can be due to the prolonged synovitis compromis-
Eur J Plast Surg (2009) 32:109–111
L. De Smet
Hand Unit, Department of Orthopaedic Surgery,
University Hospital Pellenberg, University of Leuven,
L. De Smet (*)
Department of Orthopaedic Surgery, U.Z. Pellenberg,
3212 Lubbeek (Pellenberg), Belgium