RA- FLEXOR TENDONS

Question 1

2 main flexor tendon conditions in RA

Answer 1

1. Tenosynovitis

2. Flexor tendon rupture

Question 2

2 main factors causing flexor tendon rupture in RA

Answer 2

1. Tenosynovitis
2. Tendon attrition over bony prominences
   - FPL = scaphoid spur at STT joint
   - EDM and EDC to LF and RF = prominent ulna head
   - EPL = Lister’s tubercle

Question 3

Mannerfelt syndrome

Answer 3

Rupture of FPL tendon due to tenosynovitis and attrition at STT joint by scaphoid spur

Question 4

3 main surgical options for FPL rupture in RA

Answer 4

1. Tendon reconstruction with PL tendon graft
2. Tendon transfer = RF FDS (note BR used with high median nerve palsy)
   - need to excise STT spurs causing attrition
3. IPJ arthrodesis with arthritis

Question 5

Management of FDS and FDP rupture in RA

Answer 5

1. FDS rupture = non-op as FDP intact
2. FDP rupture = DIPJ arthrodesis and tenosynovectomy of FDS to prevent rupture
3. FDS and FDP rupture = tendon reconstruction with PL tendon graft