Left Volar Thumb Wound with Transection of Flexor Pollicis Longus Tendon

Jhade Woodall, MD

History:

25 year  old woman who presents two weeks after cutting her left volar thumb with a knife. She is unable to flex the IP joint of her thumb. She is right-handed and has a negative medical history.

 

Findings:

Over the radial side of the left thumb there is a healing 12 mm transverse skin laceration. The patient is unable to flex the IP joint. thumb extension is normal and so is opposition and abduction. Sensation and circulation to the distal thumb are normal.

Fig. 1. Healing wound in left thumb from knife laceration 2 weeks earlier.

Fig.2. Shows no IP flexion in left thumb.

 

Diagnosis:

Left thumb laceration with transection of flexor pollicis longus tendon just distal to the MP joint. The tendon has probably retracted toward the wrist. There are no other injuries.

 

Differential Diagnoses:

There might be partial laceration to a digital nerve as well as to a digital artery. 

Workup Required:

No additional work up beyond a CBC requested by anesthesia.

Plan:

Repair of left flexor pollicis longus tendon under axillary block anesthesia. She would likely need an incision/exploration of the wrist for retrieval of the retracted tendon. Postoperative splinting for two weeks followed by hand therapy to regain motion.

Expertise Needed:

Hand Surgeon, Plastic or Orthopedic.

Treatment:

The patient was taken to the OR and under axillary block anesthesia the tendon was retrieved at the level of the carpal tunnel. It was threaded through the tendon sheath to the level of the laceration and repaired with a modified Kessler repair with epitendinous suture.

Fig.3. Flexor pollicis longus tendon retrieved in the carpal tunnel.

Fig.4. Shows the repaired tendon.

Follow Up:

At three months she had regained full IP flexion as well as well opposition and abduction.

Fig.5. Shows IP flexion of left thumb.

Fig. 6. Shows opposition of left thumb.

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References

Hand (N Y) . 2022 Mar;17(2):285-292. doi: 10.1177/1558944720930294. Epub 2020 Jul 1. Zone II Flexor Pollicis Longus Repair: Thumb Flexion and Complications Luca L Bruin 1, Jonathan Lans 1, Kyle R Eberlin 1, Neal C Chen 1 Affiliations expand PMID: 32609006
J Hand Surg Eur Vol . 2022 Jan;47(1):31-39. doi: 10.1177/17531934211053757. Epub 2021 Nov 5. Flexor tendon repair: recent changes and current methods Jin Bo Tang 1, Donald Lalonde 2, Leila Harhaus 3, Ahmed Fathy Sadek 4, Koji Moriya 5, Zhang Jun Pan 6 Affiliations expand PMID: 34738496
J Hand Surg Br . 1998 Oct;23(5):649-54. doi: 10.1016/s0266-7681(98)80020-x. "Venting" or partial lateral release of the A2 and A4 pulleys after repair of zone 2 flexor tendon injuries I Kwai Ben 1, D Elliot Affiliations expand PMID: 9821612
https://www.ncbi.nlm.nih.gov › articles › PMC8984735
https://journals.sagepub.com › doi
https://pubmed.ncbi.nlm.nih.gov › 9821612

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