Flexor Pollicis Longus Tendon Rupture in the Rheumatoid Patient (Mannerfelt Syndrome): Evaluation and Surgical Management

Description

This presentation features Dr. Michael Guss discussing a complex case of flexor pollicis longus (FPL) tendon rupture in a rheumatoid arthritis patient. Dr. Guss provides insights into the evaluation and surgical management of this condition, emphasizing that rheumatoid arthritis, a chronic autoimmune disorder, often leads to attritional flexor tendon ruptures such as the Mannerfelt lesion. The issue is more common among women and typically results in a significant loss of thumb functionality due to tendon rupture.



The FPL tendon is commonly affected, leading to diminished active flexion at the interphalangeal (IP) joint of the thumb. The surgical indication for intervention arises when conservative treatments fail to restore function. Dr. Guss outlines their preferred approach: transferring the flexor digitorum superficialis (FDS) tendon to the FPL, often supplemented with a carpal tunnel release and synovectomy if required.



A detailed surgical technique is then described, which includes multiple incisions to access the affected areas, identifying specific anatomical structures, and harvesting the donor tendon. The presentation stresses the importance of protecting the median nerve during the procedure and ensuring proper tension during the tendon transfer to facilitate rehabilitation. Post-operative care and precautions are discussed, including the use of a thumb spica splint and a gradual return to movement. This comprehensive approach not only addresses immediate surgical concerns but also emphasizes long-term patient outcomes and complications to monitor for following surgery.

Specialties