Subcutaneous flexor pollicis longus (FPL) tendon rupture caused by scapho-trapezio-trapezoidal (STT) osteoarthritis is rare. Wide-awake surgery under local anesthesia has become widespread in tendon-related hand surgeries because surgeons can precisely evaluate a patient's voluntary active finger motion. Herein, we present the first case of an 86-year-old woman with FPL tendon rupture secondary to asymptomatic STT osteoarthritis treated with wide-awake tendon grafting. Intraoperatively, the FPL tendon completely ruptured owing to friction from the osteophyte in the STT joint. After resection of the bony spurs, the ruptured FPL tendon was reconstructed with grafting of the palmaris longus tendon, and the optimal tension was determined during active thumb movement. The patient was able to actively flex the interphalangeal joint of the thumb 12 months postoperatively. This case highlights that asymptomatic STT osteoarthritis can potentially cause FPL tendon rupture through bony spurs and that wide-awake surgery offers advantages for precise intraoperative evaluation and repair.
Matsumoto et al. (Sun,) studied this question.