Isolated Closed Rupture of the Middle Finger Flexor Digitorum Superficialis Tendon in a Climber
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.005 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".