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4b - Answer: 50-year-old male presents with left thumb pain

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 50-year-old male presents with left thumb pain. Trigger thumb surgery five days prior did not help. Thumb still does not bend. Unable to bend thumb for two months. No specific injury.

(QUIZ ANSWER) PRIMARY FINDING IN THIS CASE: 

Rupture of flexor pollicis longus tendon.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS: 

Rupture of the flexor pollicis longus tendon at the level of the mid metacarpal, with tendinopathy and partial tearing of the distal stump, extending almost to its insertion. The distal stump lies 1.4 cm proximal to the proximal articular surface of the 1st metacarpal and the length of the distal stump is 7.5-8 cm.

The proximal end of the tendon is not visible and retracted into the forearm.

Thin tendon of flexor pollicis brevis appears intact.

Marked soft tissue swelling surrounds the extensor pollicis longus tendon, extending into the thenar eminence and the thumb itself. Some of this may be related to recent surgery.

Insufficiency of the A1 pulley of the thumb. Tear of the oblique pulley of the thumb.

Volar plate at the 1st metacarpophalangeal joint is intact. Sesamoid bones are intact without sesamoiditis.

Extensor mechanism of the thumb is intact.

Radial and ulnar collateral ligaments at the metacarpophalangeal joint and adductor aponeurosis are intact.

Mild arthrosis at the 1st carpometacarpal joint, with minimal arthrosis at the 1st metacarpophalangeal joint.

CONCLUSION:

1. Rupture of the flexor pollicis longus tendon at the level of the mid metacarpal, with tendinopathy and partial tearing of the distal stump extending almost to its insertion. The distal stump lies 1.4 cm proximal to the proximal articular surface of the 1st metacarpal and the length of the distal stump is 7.5-8 cm.

2. The proximal end of the tendon is not visible and retracted into the forearm. Forearm MRI could be considered to identify the proximal stump.

3. Insufficiency of the A1 pulley of the thumb and tear of the oblique pulley of the thumb.

LESSON 2, TOPIC 12

Case Challenge: Thumb & Finger MRI Cases

Case Challenge

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Content reviewed: October 27, 2021

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