Painful Pseudotendon of the Flexor Carpi Radialis Tendon: A Literature Review and Case Report

Abstract

Background: Flexor tendon ruptures in the wrist are uncommon. Flexor carpi radialis (FCR) tendon rupture can occur in rheumatoid patients, following cortisone injection for tenosynovitis, and following trauma. Following tendon rupture, tethering of the ruptured FCR tendon, or pseudotendon, can form which may or may not be symptomatic. Methods: A literature review was done reviewing treatment and outcomes of FCR tendon lesions. A case report of painful FCR pseudotendon following a fall is presented. The patient presented 4 months after injury with a tender lump 6 cm proximal to the wrist joint with pain and weakness aggravated with wrist motion and gripping. Results: The literature review reveals operative excision of a symptomatic FCR pseudotendon lesion results in great patient satisfaction with no morbidity. In this case report, in spite of conservative measures including cortisone injection and activity modification, the patient had persistent symptoms. The patient proceeded with surgery for complete excision of both the painful pseudotendon and retracted FCR tendon stump. Post-operatively, his wrist motion and grip strength returned to normal, and his Disabilities of the Arm, Shoulder, and Hand (DASH) score was significantly improved from 72 to 9. Conclusions: FCR pseudotendon is an uncommon condition and can be seen following trauma. Majority of FCR tendon ruptures resolve with non-operative treatment. Based on the excellent outcomes following complete FCR tendon harvest for thumb carpometacarpal (CMC) joint reconstruction, complete excision of a symptomatic pseudotendon results in excellent relief of symptoms with no long-term morbidity.