A 26-year-old right-handed nurse presented with a ten day history of pain and swelling in her right little finger. She had noticed these symptoms when she woke up and also found that she could not bend the finger. There had been no recent trauma, but ten years previously she had sustained a closed fracture of that finger, and more recently a shopping bag had been snatched from her hand. There was no other relevant history.
Examination showed swelling and discoloration over the middle segment of the digit and inability to flex the finger at either interpbalangeal joint. A clinical diagnosis of rupture of both flexor tendons was made.
X-rays were normal and showed no evidence of an old fracture. At operation, she was found to have ruptured both profundus and superficialis tendons at the level of the proximal interphalangeal joint. There was dense scarring around the tendon ends and volar plate with no obvious cause for the rupture (Fig. 1). The volar plate had been damaged, but the proximal interphalangeal joint was stable. The flexor sheath, including the Az and A3 pulleys was destroyed.
Both tendons were mobilised proximally, but due to the scarfing, there was loss of length of the proximal part of the profundus tendon. Therefore, the proximal end of the superficialis tendon was sutured to the distal profundus tendon stump using a modified Kessler repair with a circumferential continuous peripheral monofilament suture. The proximal end of the profundus tendon was sutured to the remnant of the A2 pulley. Postoperatively, she was managed by immobilisation for three weeks, followed by active and passive mobilisation. She made a poor functional recovery following this and required further surgery three months later.
At the second operation, dense scar tissue was found around the site of the tendon repairs. A tenolysis was performed and postoperatively she was managed with early active mobilisation. She