Isolated Closed Rupture of the Middle Finger Flexor Digitorum Superficialis Tendon in a Climber
Notice bibliographique
Résumé
A 23-yr-old left-handed man without any preexisting medical condition was seen at the outpatient ultrasound clinic for a right middle finger injury while rock climbing, which occurred 10 mos ago: during a climbing maneuver involving significant grip force, he felt a snap followed by an immediate sharp pain on the volar side of his right third middle finger at the level of the palm. He ceased all activity for 2 wks and was then able to gradually resume climbing. At the 10-month postinjury visit, he presented with mild pain, stiffness, and a restriction of his middle finger range of motion (ROM) of the proximal interphalangeal (PIP) joint. On physical examination, there was an active and passive limitation of range of motion in flexion and extension of the third PIP joint with local pain on the volar side of the third right metacarpophalangeal joint without a palpable nodularity. There was full range of motion of the metacarpophalangeal and distal interphalangeal joints. Neurovascular examination was unremarkable. Ultrasound examination (Samsung RS80A US machine, linear L4-18B probe) revealed a zone II complete rupture and retraction of third right flexor digitorum superficialis (FDS) tendon causing a fusiform tissue mass at the level of the metacarpophalangeal joint associated with a local inflammatory reaction (Fig. 1 and Supplementary Video 1, Supplemental Digital Content 1, https://links.lww.com/PHM/B906).FIGURE 1: Ultrasound findings of the finger flexor system volar and slightly proximal to third right metacarpophalangeal joint. Fusiform tissue mass (red arrows) corresponding to a retracted FDS tendon with associated with slight tenosynovitis surrounding the FDP tendon (asterisks) of 3.4 mm in short-axis (A, C, D) and 21 mm in long-axis (B). The FDP tendon is intact with a slightly thickened appearance (B). Slight color Doppler activity is seen in the chronically torn and retracted FDS tendon (C). A transverse axis comparative (left/right) image of the flexor tendons at the level of the distal third metacarpal highlights the difference in caliber of remaining normal tendon (D).Magnetic resonance imaging examination confirmed the diagnosis of complete isolated third FDS tendon rupture (Fig. 2). The patient was referred to hand surgery for an opinion.FIGURE 2: Magnetic resonance imaging showing sagittal T1 (A), sagittal T2 fat-saturated (B), and transverse T2 fat-saturated (C) images of the right third finger. Complete rupture of the FDS with retraction causing a tendon nodule (white arrows) at the distal end of the third metacarpal. The radial FDS slip is a little less retracted than the ulnar slip (C). Mild tenosynovitis surrounds the FDP tendon (asterisks) at the level of the first phalanx where its appearance is slightly thickened but remains intact. The flexor tendon pulley system is intact (A, B). Dashed line = cross-sectional slice for the transverse image in C.Rock climbing is gaining in popularity internationally, and hand flexor tendon injuries are frequent in rock climbers.1 However, complete closed isolated FDS ruptures remain rare and are poorly documented in the literature.2 Biomechanical risk factors in climbers include atypical grip techniques imposing high loads on the FDS tendon like the “hook” and “nail” techniques.3 Recently, Schweizer and Bayer2 described a radial-sided FDS tendon slip rupture in three athletes (2 climbers and 1 judoka), one of which was diagnosed by ultrasound. Likewise, Caso et al.3 reported a left middle finger isolated FDS rupture in a climber, probably related to the hook grip technique, confirmed by ultrasound and magnetic resonance imaging. To our knowledge, this report is first to present ultrasound findings of a complete closed FDS tendon rupture. Ultrasound examination facilitates its diagnostic approach and could assist future clinicians to recognize this seldom entity.
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Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,005 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».