Presentation
Right wrist palmar region laceration due to glass injury one month before the presentation.
Patient Data
There is a complete tear of the flexor pollicis longus tendon. Its proximal end is at the distal wrist crease level / in proximal carpal tunnel with extended fingers. The proximal end shows about 25 mm retraction with flexed fingers. The distal end of the tendon is at the mid- thenar region. The distance between two ends of the tendon with extended fingers 45 to 50 mm. There is a focal hypoechoic thickening with loss of normal echopattern involving the median nerve proximal to the carpal tunnel. Its deeper most fibers are spared.
1st photo shows two ends of the ruptured flexor pollicis longus tendon and median nerve neuroma. The last two photos show median nerve neuroma excision. The nerve ends approximation was possible without nerve grafting.
Case Discussion
A young male presented with palmar wrist laceration due to a glass injury. The patient developed a loss of thumb interphalangeal joint flexion and reduced sensation in radial side fingers.
The patient was referred with the clinical diagnosis of the flexor pollicis longus tendon tear and median nerve injury. The ultrasound shows tendon and nerve injury which were repaired.
Intraoperative photos courtesy: operating surgeon Dr. Vitrag Shah.