Treatment of Acute Adhered Flexor Tendons Following Proximal Phalangeal Fracture: A Case Study

Abstract

Adhered flexor tendons are an uncommon complication following the conservative management of proximal phalangeal (PP) fractures. However, failure to diagnose this condition in the acute setting will result in significant long-term digital stiffness and disability. Flexor tendons can become adhered following phalangeal fracture because the flexor tendons lie intimately aligned to the phalanges of the finger. Injury to the synovial lining of the tendons can result in inflammation and scarring. Callus formation may also cause adherence of tendons to bone. A case study is presented in which both flexor tendons are adhered at the proximal phalanx following two and a half weeks immobilisation after fracture. Treatment, involving a technique of non-surgical tenolysis of the flexor tendons, was employed. An anaesthetic block was used to remove pain and the patient encouraged to actively engage the digital flexor muscles to free the adhesions. The tendons freed with a ‘pop’ and active flexor tendon glide was immediately improved. Post-traumatic flexor tenosynovitis was evident following tendon release. This was successfully treated with steroid infiltration of the flexor sheath. Following exercise and oedema control, the patient was discharged after five treatments with a full range of movement of the affected finger.