Closed rupture of the flexor digitorum profundus tendon of the little finger caused by calcification of the triangular-fibrocartilage

Are Flexor Tendon Ruptures Ever Spontaneous? - A Literature Review on Closed Flexor Tendon Ruptures of the Little Finger

Background: When closed ruptures of flexor tendons of fingers occur, there is often an identifiable pathology, which should be addressed in the same surgical setting as the tendon repair. The concept of “spontaneous” tendon rupture, occurring in the absence of identified pathology, however, has also been reported in a significant number of papers. This controversy has prompted us to do a review of the existing literature.

Methods: We did a review of cases of closed ruptures of the flexor digitorum profundus (FDP) of the little finger in existing literature. Fifty-three publications were retrieved by searching “FDP tendon rupture” and “little finger” using PubMed database. We analyzed data such as the zone of rupture noted intra-operatively; and any precipitating factors, pathology or trauma. We also conducted a review on papers which discussed the concept of “spontaneous rupture”.

Results: Fifty-three publications were retrieved. There were 8 cases of ruptures in Zone I; 2 in Zone II; 30 in Zone III; 59 in Zone IV and 5 in Zone V. Majority of cases were associated with an element of trauma of varying severity, or pathology. A precipitating cause was not documented in 12 cases. Amongst all 36 cases of ruptures labelled as “spontaneous”, only 1 case was truly “spontaneous” without any associated trauma or pathology.

Conclusions: Most reports labeled as spontaneous rupture occurred in Zone III, where tendon ruptures are rare. There are documented pathological causes or evidence of trauma to most of these cases. We conclude these ruptures may have been mislabeled as spontaneous ruptures. Bearing in mind the propensity for tendon excursion, we suspect the lack of documentation of exploration in proximal zones contributed to this mislabeling. Understanding this concept of non-spontaneity to most tendon ruptures and the common sites of rupture or pathology is crucial for a surgeon to make strategic incisions and minimize future recurrence.

Attritional rupture of the flexor tendons to the small finger caused by osteophyte of the ulnar head: case report

We present a rare case of attritional rupture of the flexor tendons to the small finger caused by an osteophyte of the volar aspect of the ulnar head.

[Primary flexor tendon ruptures of the little finger within the carpal tunnel. Proposed classification based on six clinical cases and review of the literature]

Six cases of primary flexor tendon rupture of the little finger within the carpal tunnel are presented. All of them were attritional ruptures caused by a rough hook of the hamate. These ruptures are rare. They have their place among the flexor tendon ruptures of the wrist and the palm. Ultrasound may by helpful to determine the level of rupture. The surgical treatment consists of excision of the hook of the hamate and tendon repair.

Pisotriquetral instability causing an unusual flexor tendon rupture

We present a case of a closed rupture of the flexor digitorum profundus tendon of the small finger. It is our hypothesis that because of pisotriquetral instability as a result of a lesion of the pisotriquetral ligaments the flexor digitorum profundus tendon was entrapped repeatedly between the pisiform and triquetrum. This resulted in an attritional lesion of the tendon. The pisotriquetral joint showed no bone abnormalities.