Attritional Flexor Tendon Rupture due to a Scaphoid Non Union Imitating an Anterior Interosseous Nerve Syndrome: A Case Report

1985 ◽  
Vol 10 (1) ◽  
pp. 62-64 ◽  
Author(s):  
M. MÁHRING ◽  
CAMPBELL SEMPLE ◽  
I. C. M. GRAY
Keyword(s):  
Index Finger ◽  
Scaphoid Fracture ◽  
Acute Onset ◽  
X Rays ◽  
Loss Of Function ◽  
Flexor Pollicis Longus ◽  
Non Union ◽  
Anterior Interosseous Nerve ◽  
Flexor Tendon Rupture ◽  
Anterior Interosseous Nerve Syndrome

A case is presented of acute loss of function of flexor pollicis longus and profundus tendon to the index finger. Although the aetiology was obscure, the acute onset suggested a mechanical cause rather than a nerve compression disorder such as anterior interosseous nerve palsy. X-rays showed an ununited scaphoid fracture related to an injury many years previously. Surgical exploration revealed attritional rupture of flexor pollicis longus and partial division of profundus tendon to index finger by a spicule of ununited scaphoid which had eroded through the volar capsule. Removal of the spicule and tenodesis of flexor pollicis longus gave a good long term result.

Anterior interosseous nerve compression after supracondylar fracture of the humerus: a metaanalysis

1999 ◽  
Vol 90 (6) ◽  
pp. 1053-1056 ◽  
Author(s):  
Alexander Joist ◽  
Uwe Joosten ◽  
Dirk Wetterkamp ◽  
Michael Neuber ◽  
Axel Probst ◽  
...  
Keyword(s):  
Index Finger ◽  
Interphalangeal Joint ◽  
Nerve Compression ◽  
Flexor Digitorum Profundus ◽  
Pronator Quadratus ◽  
Motor Branch ◽  
Content Type ◽  
Anterior Interosseous Nerve ◽  
Anterior Interosseous Nerve Syndrome ◽  
Fine Print

Object. The authors conducted a metaanalysis of reports of anterior interosseous nerve syndrome, a rare nerve compression neuropathy that affects only the motor branch of the median nerve. This syndrome is characterized by paralysis of the flexor pollicis longus, the flexor digitorum profundus to the index finger, and the pronator quadratus, with weakness on flexion of the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger without sensory loss.Methods. The authors reviewed reports of 34 cases of anterior interosseous nerve syndrome combined with supracondylar fractures of the humerus in children. They have added a new case identified in a 7-year-old boy in whom a diagnosis was made from the clinical findings and whose treatment and outcome are analyzed. The ages of patients reported in the literature ranged from 4 to 10 years. Ten patients (29%) were treated with closed reduction and application of a cast, whereas 25 patients (71%) were treated with open reduction and fixation of the fracture.Conclusions. All patients regained full flexion and strength after 4 to 17 weeks. The fractures that were surgically treated showed no entrapment of the anterior interosseous nerve.

scholarly journals The Clinical Scaphoid Fracture: Early Computed Tomography as a Practical Approach

2008 ◽  
Vol 90 (6) ◽  
pp. 488-491 ◽  
Author(s):  
Q Nguyen ◽  
S Chaudhry ◽  
R Sloan ◽  
I Bhoora ◽  
C Willard
Keyword(s):  
Ct Scan ◽  
General Hospital ◽  
Scaphoid Fracture ◽  
False Negative ◽  
False Negative Rate ◽  
District General Hospital ◽  
X Rays ◽  
Fracture Clinic ◽  
Non Union ◽  
Scaphoid Fractures

INTRODUCTION Up to 40% of scaphoid fractures are missed at initial presentation as clinical examination and plain radiographs are poor at identifying scaphoid fractures immediately after the injury. Avoiding a delay in diagnosis is essential to prevent the risk of non-union and early wrist arthritis. We demonstrate the use of CT scanning for the early confirmation of a scaphoid fracture. PATIENTS AND METHODS We conducted a retrospective, chronological review of patients who attended an upper limb fracture clinic from January 2001 to October 2003 in a small district general hospital. We performed a CT scan on all ‘clinical scaphoid’ patients who had negative plain X-ray films. RESULTS Overall, 70% of patients had a CT scan within 1 week of injury and not from date of accident and emergency attendance; 83% of patients had a CT scan within 2 weeks of injury. Of 118 patients identified, 32% had positive findings and 22% of ‘clinical scaphoid’ patients had scaphoid fractures. The proportion of positive findings for an acute scaphoid fracture was 68%. Additional pathologies identified on CT were capitate, triquetral and radial fractures. CONCLUSIONS Our audit shows that it is practical to perform CT on suspicious scaphoid fractures in a small district general hospital. We identified an extremely high false-negative rate for plain X-rays and demonstrate that the appropriate use of CT at initial fracture clinic attendance with ‘clinical scaphoid’ leads to an earlier diagnosis and reduces the need for prolonged immobilisation and repeated clinical review.

scholarly journals The prevalence and anatomical characteristics of the accessory head of the flexor pollicis longus muscle: a meta-analysis

PeerJ ◽  
2015 ◽  
Vol 3 ◽  
pp. e1255 ◽  
Author(s):  
Joyeeta Roy ◽  
Brandon M. Henry ◽  
Przemysław A. Pękala ◽  
Jens Vikse ◽  
Piravin Kumar Ramakrishnan ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Flexor Pollicis Longus ◽  
Anatomical Variant ◽  
Anatomical Characteristics ◽  
Pooled Prevalence ◽  
Longus Muscle ◽  
Anterior Interosseous Nerve ◽  
Language Restriction ◽  
Anterior Interosseous Nerve Syndrome ◽  
The Right

Background and Objectives.The accessory head of the flexor pollicis longus muscle (AHFPL), also known as the Gantzer’s muscle, was first described in 1813. The prevalence rates of an AHFPL significantly vary between studies, and no consensus has been reached on the numerous variations reported in its origin, innervation, and relationships to the Anterior Interosseous Nerve (AIN) and the Median Nerve (MN). The aim of our study was to determine the true prevalence of AHFPL and to study its associated anatomical characteristics.Methods.A search of the major electronic databases PubMed, EMBASE, Scopus, ScienceDirect, and Web of Science was performed to identify all articles reporting data on the prevalence of AHPFL in the population. No date or language restriction was set. Additionally, an extensive search of the references of all relevant articles was performed. Data on the prevalence of the AHFPL in upper limbs and its anatomical characteristics and relationships including origin, insertion, innervation, and position was extracted and pooled into a meta-analysis using MetaXL version 2.0.Results.A total of 24 cadaveric studies (n= 2,358 upper limb) were included in the meta-analysis. The pooled prevalence of an AHFPL was 44.2% (95% CI [0.347–0.540]). An AHFPL was found more commonly in men than in women (41.1% vs. 24.1%), and was slightly more prevalent on the right side than on the left side (52.8% vs. 45.2%). The most common origin of the AHFPL was from the medial epicondyle of the humerus with a pooled prevalence of 43.6% (95% CI [0.166–0.521]). In most cases, the AHFPL inserted into the flexor pollicis longus muscle (94.6%, 95% CI [0.731–1.0]) and was innervated by the AIN (97.3%, 95% CI [0.924–0.993]).Conclusion.The AHFPL should be considered as more a part of normal anatomy than an anatomical variant. The variability in its anatomical characteristics, and its potential to cause compression of the AIN and MN, must be taken into account by physicians to avoid iatrogenic injury during decompression procedures and to aid in the diagnosis and treatment of Anterior Interosseous Nerve Syndrome.

scholarly journals Bilateral anterior interosseous nerve syndrome with 6-year interval

2018 ◽  
Vol 6 ◽  
pp. 2050313X1877741
Author(s):  
Thomas Tyszkiewicz ◽  
Isam Atroshi
Keyword(s):  
Complete Recovery ◽  
Interphalangeal Joint ◽  
Wrist Arthroscopy ◽  
Flexor Pollicis Longus ◽  
Active Flexion ◽  
Anterior Interosseous Nerve ◽  
History Of ◽  
Anterior Interosseous Nerve Syndrome ◽  
Flexor Pollicis Longus Tendon ◽  
The Right

Flexor pollicis longus paralysis related to idiopathic anterior interosseous nerve syndrome is well known, but few reports exist on bilateral disease. A 24-year-old man with no personal or family history of neurological disease developed isolated total loss of active flexion of the right thumb’s interphalangeal joint after undergoing a wrist arthroscopy. Surgical exploration 5 weeks after onset showed flexor pollicis longus tendon to be intact; anterior interosseous nerve decompression was done with no abnormalities found. Because of persistent paralysis, electromyography was performed showing findings consistent with anterior interosseous nerve syndrome. After 7 months without recovery, the patient underwent tendon transfer. After 6 years, the patient presented with left-sided isolated flexor pollicis longus paralysis and electromyography indicated anterior interosseous nerve syndrome. Examination 9 months after onset showed persistent complete flexor pollicis longus paralysis but by 15 months spontaneous complete recovery had occurred. Anterior interosseous nerve syndrome can occur bilaterally and is likely to resolve completely without intervention but recovery may take longer than a year.

Rupture of the Flexor Pollicis Longus Tendon Resulting from the Non-Union of a Scaphoid Fracture

1988 ◽  
Vol 13 (1) ◽  
pp. 80-82
Author(s):  
A. B. CROSS
Keyword(s):  
Similar Case ◽  
Scaphoid Fracture ◽  
Interphalangeal Joint ◽  
Flexor Pollicis Longus ◽  
Proximal Pole ◽  
Non Union ◽  
Longus Tendon ◽  
Good Movement ◽  
Flexor Pollicis Longus Tendon

A case is described in which a patient presented with a rupture of the flexor pollicis longus tendon resulting from an ununited scaphoid fracture. No similar case appears to have been reported in the literature. This was not an attrition rupture and the mechanism is explained. The proximal pole of the scaphoid was removed and the tendon repaired. The patient regained good movement at the interphalangeal joint of the thumb.

ANTERIOR INTEROSSEOUS NERVE SYNDROME

Hand Surgery ◽  
1998 ◽  
Vol 03 (01) ◽  
pp. 57-62 ◽  
Author(s):  
Gary L. Arishita ◽  
Tsu-Min Tsai
Keyword(s):  
Conservative Treatment ◽  
Upper Extremity ◽  
Surgical Decompression ◽  
Flexor Digitorum Profundus ◽  
Flexor Pollicis Longus ◽  
Pronator Quadratus ◽  
Steroid Injections ◽  
Anterior Interosseous Nerve ◽  
Anterior Interosseous Nerve Syndrome ◽  
Flexor Digitorum

The anterior interosseous nerve syndrome was first described in 1948. It comprises less than 1% of all upper extremity nerve palsies. Patients have a characteristic pinch deformity, with paralysis or weakness of the muscles innervated by the anterior interosseous nerve, flexor pollicis longus, radial portion of the flexor digitorum profundus, and pronator quadratus. Electromyograms are positive in most patients presenting with motor complaints. Treatment is related to the specific etiology. Conservative treatment includes avoidance of strenuous forearm work, immobilization, steroid injections, and anti-inflammatory medications. If the presentation suggests nerve compression, and the EMG reveals evidence of axonal interruption, then surgical decompression should be performed. We present a series of six patients seen over a 7-year period. Improvement was noted in all the patients postoperatively.

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