How is flexor tendon rupture in rheumatoid arthritis (RA) treated?

Updated: Jan 11, 2019
  • Author: Michael Neumeister, MD, FRCSC, FACS; Chief Editor: Joseph A Molnar, MD, PhD, FACS  more...
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Answer

Answer

Treatment of flexor tendon rupture varies with the degree of functional disability. Rupture of the FDP may not require repair if the DIP joint remains stable, despite compromised active flexion. The treatment of a rupture of the FDP tendon is also complicated because, through restoration of the FDP tendon, the FDS tendon or PIP joint may become compromised, resulting in a stiff and functionless finger. The treatment of most FDP ruptures is best served with a tendon or arthrodesis at the DIP joint. FDS tendon rupture alone usually does not require repair, because the functional loss is minimal. Rupture of both the FDP and FDS tendons does require surgical intervention, because the functional loss is obvious.

In the wrist and palm, the ruptured tendon can be sutured to an adjacent tendon, but within the fibro-osseous canal in the finger, this is not an option. Primary repair is seldom an option because of the significant restriction of the tendon within the canal. Also, tendon grafts have traditionally yielded poor results. [2] Staged tendon reconstruction can usually be effective, but this technique is also fraught with poor results. [2] A last-resort treatment for older patients with severe disease may be fusion of the PIP and DIP joints in a functional position.


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