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Flexor Tendon Injury, Wrist and Hand
Kambiz Motamedi, MD, FACR; Carol L. Andrews, MD
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KEY FACTS

  • Imaging

    • Pathology

      TERMINOLOGY

      • Definitions

        • Bowstring sign (bowstringing): flexor tendon and sheath pull away from volar aspect of phalanx
        • Jersey finger (rugby finger): flexor digitorum profundus (FDP) tendon avulsion; most commonly affects ring finger; results from sudden hyperextension of actively flexed finger (e.g., grabbing opponent's jersey)
        • Gamer's thumb/finger (gamer grip, Nintendo thumb, Nintendo-itis, PlayStation thumb, iPod thumb, text messaging syndrome): repetitive injury resulting in pain, swelling, tendinopathy, and tenosynovitis
        • Trigger finger: restricted ROM due to thickening of A1 pulley and adjacent tendon and sheath

      IMAGING

      • General Features

        • Radiographic Findings

          • CT Findings

            • MR Findings

              • Ultrasonographic Findings

                • Imaging Recommendations

                  PATHOLOGY

                  • Staging, Grading, & Classification

                    • Relevant Anatomy

                      • Mechanisms of Injury

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Rehwald C et al: 3T magnetic resonance imaging of the wrist tendons. Top Magn Reson Imaging. 29(5):221-35, 2020
                                    2. Nacey NC et al: Ultrasound imaging of the hand and wrist: fundamentals and new perspectives. Curr Radiol Rep, 4:43, 2016
                                    3. Plotkin B et al: MR imaging and US of the wrist tendons. Radiographics. 36(6):1688-700, 2016
                                    4. Bayer T et al: Evaluation of finger A3 pulley rupture in the crimp grip position-a magnetic resonance imaging cadaver study. Skeletal Radiol. 44(9):1279-85, 2015
                                    5. Korstanje JW et al: Ultrasonographic assessment of flexor tendon mobilization: effect of different protocols on tendon excursion. J Bone Joint Surg Am. 94(5):394-402, 2012
                                    6. Nugent N et al: The use of ultrasound in evaluating flexor tendons following surgical repair. Plast Reconstr Surg. 129(2):392e-4e, 2012
                                    7. Yeh PC et al: Tendon ruptures: mallet, flexor digitorum profundus. Hand Clin. 28(3):425-30, xi, 2012
                                    8. Puippe GD et al: Prospective morphologic and dynamic assessment of deep flexor tendon healing in zone II by high-frequency ultrasound: preliminary experience. AJR Am J Roentgenol. 197(6):W1110-7, 2011
                                    9. Lisle DA et al: MR imaging of traumatic and overuse injuries of the wrist and hand in athletes. Magn Reson Imaging Clin N Am. 17(4):639-54, vi, 2009
                                    10. Wessely K et al: Ultrasound findings of the locked metacarpophalangeal joint. Skeletal Radiol. 38(1):85-9, 2009
                                    11. Guerini H et al: Sonographic appearance of trigger fingers. J Ultrasound Med. 27(10):1407-13, 2008
                                    12. Schöffl VR et al: Finger pain in rock climbers: reaching the right differential diagnosis and therapy. J Sports Med Phys Fitness. 47(1):70-8, 2007
                                    13. Beredjiklian PK: Biologic aspects of flexor tendon laceration and repair. J Bone Joint Surg Am. 85-A(3):539-50, 2003
                                    14. Martinoli C et al: Sonographic evaluation of digital annular pulley tears. Skeletal Radiol 29:387-91, 2000
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Imaging

                                      • Pathology

                                        TERMINOLOGY

                                        • Definitions

                                          • Bowstring sign (bowstringing): flexor tendon and sheath pull away from volar aspect of phalanx
                                          • Jersey finger (rugby finger): flexor digitorum profundus (FDP) tendon avulsion; most commonly affects ring finger; results from sudden hyperextension of actively flexed finger (e.g., grabbing opponent's jersey)
                                          • Gamer's thumb/finger (gamer grip, Nintendo thumb, Nintendo-itis, PlayStation thumb, iPod thumb, text messaging syndrome): repetitive injury resulting in pain, swelling, tendinopathy, and tenosynovitis
                                          • Trigger finger: restricted ROM due to thickening of A1 pulley and adjacent tendon and sheath

                                        IMAGING

                                        • General Features

                                          • Radiographic Findings

                                            • CT Findings

                                              • MR Findings

                                                • Ultrasonographic Findings

                                                  • Imaging Recommendations

                                                    PATHOLOGY

                                                    • Staging, Grading, & Classification

                                                      • Relevant Anatomy

                                                        • Mechanisms of Injury

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Rehwald C et al: 3T magnetic resonance imaging of the wrist tendons. Top Magn Reson Imaging. 29(5):221-35, 2020
                                                                      2. Nacey NC et al: Ultrasound imaging of the hand and wrist: fundamentals and new perspectives. Curr Radiol Rep, 4:43, 2016
                                                                      3. Plotkin B et al: MR imaging and US of the wrist tendons. Radiographics. 36(6):1688-700, 2016
                                                                      4. Bayer T et al: Evaluation of finger A3 pulley rupture in the crimp grip position-a magnetic resonance imaging cadaver study. Skeletal Radiol. 44(9):1279-85, 2015
                                                                      5. Korstanje JW et al: Ultrasonographic assessment of flexor tendon mobilization: effect of different protocols on tendon excursion. J Bone Joint Surg Am. 94(5):394-402, 2012
                                                                      6. Nugent N et al: The use of ultrasound in evaluating flexor tendons following surgical repair. Plast Reconstr Surg. 129(2):392e-4e, 2012
                                                                      7. Yeh PC et al: Tendon ruptures: mallet, flexor digitorum profundus. Hand Clin. 28(3):425-30, xi, 2012
                                                                      8. Puippe GD et al: Prospective morphologic and dynamic assessment of deep flexor tendon healing in zone II by high-frequency ultrasound: preliminary experience. AJR Am J Roentgenol. 197(6):W1110-7, 2011
                                                                      9. Lisle DA et al: MR imaging of traumatic and overuse injuries of the wrist and hand in athletes. Magn Reson Imaging Clin N Am. 17(4):639-54, vi, 2009
                                                                      10. Wessely K et al: Ultrasound findings of the locked metacarpophalangeal joint. Skeletal Radiol. 38(1):85-9, 2009
                                                                      11. Guerini H et al: Sonographic appearance of trigger fingers. J Ultrasound Med. 27(10):1407-13, 2008
                                                                      12. Schöffl VR et al: Finger pain in rock climbers: reaching the right differential diagnosis and therapy. J Sports Med Phys Fitness. 47(1):70-8, 2007
                                                                      13. Beredjiklian PK: Biologic aspects of flexor tendon laceration and repair. J Bone Joint Surg Am. 85-A(3):539-50, 2003
                                                                      14. Martinoli C et al: Sonographic evaluation of digital annular pulley tears. Skeletal Radiol 29:387-91, 2000