Abstract
Subcutaneous tendon ruptures in patients with rheumatoid arthritis almost always affect the extensor tendon, and flexor tendon rupture is infrequent. We experienced a rare case of multi-flexor tendon rupture in a 71-year-old female patient with rheumatoid arthritis, who presented with inability to flex her left middle finger, ring finger and little finger. She had been receiving treatment for rheumatoid arthritis for 17 years, and had been unable to flex the DIP joint of the left middle finger for many years. However, the inability to flex the DIP joint and PIP joint of the left ring finger and little finger had developed 2 weeks before presentation. Surgical exploration revealed FDP(III, IV, V) and the FDS (IV, V) rupture at the center of the palm. No bone spur was found within the carpal canal, and we considered that the tendon ruptures had been caused by direct invasion of the tendon by tenosynovitis. We sutured the FDP(V) to the FDP(IV), and the end of the FDP(IV) to the FDS. Tenodesis of the FDP(III) and arthrodesis of the DIP joint of the middle finger were then performed. The patient started ROM exercise with tape fixation of the middle finger, ring finger and little finger as soon as possible after the operation.
In this condition, it is important to perform suturing to a strong tendon, and to start exercise as soon as possible in order to prevent articular contracture.
