Mannerfelt Syndrome Workup

  • Author: Dimitrios Danikas, MD; Chief Editor: Harris Gellman, MD   more...
 
Updated: May 11, 2012
 

Imaging Studies

  • Plain radiographs can reveal only gross radiocarpal changes. An axial projection of the carpal tunnel is not easy to obtain because of wrist stiffness.
  • Linear tomography does not show sufficient detail. Mannerfelt used circular tomography with an angle of 42°. The tomographic plane was perpendicular to the long axis of the forearm, and an axial projection of the carpal tunnel was obtained. This method revealed the carpal tunnel floor and the opposing aspects of the hamate hook and trapezium.
  • MRI can accurately depict the level of rupture and the gap between the tendon ends. MRI also reveals the appearance of the adjacent tendons. MRI may thus assist the surgeon in choosing suture, graft, or tendon transfer.[22]
Next

Other Tests

  • To differentiate incomplete anterior interosseous nerve paralysis and rupture of the flexor pollicis longus tendon, dorsiflex the patient's wrist and hyperextend the thumb at both the carpometacarpal and metacarpophalangeal joints.[20]
    • If the flexor pollicis longus is intact but paralyzed, the interphalangeal joint flexes spontaneously and resists passive extension when tested.
    • If the tendon is ruptured, the interphalangeal joint remains extended.
Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Dimitrios Danikas, MD  Attending Plastic Surgeon, Bayhealth Medical Center

Dimitrios Danikas, MD is a member of the following medical societies: American Academy of Anti-Aging Medicine, American College of Surgeons, American Society of Plastic Surgeons, and Northeastern Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Michael Neumeister, MD, FRCSC, FRCSC, FACS  Chairman, Professor, Division of Plastic Surgery, Director of Hand/Microsurgery Fellowship Program, Chief of Microsurgery and Research, Institute of Plastic and Reconstructive Surgery, Southern Illinois University School of Medicine

Michael Neumeister, MD, FRCSC, FRCSC, FACS is a member of the following medical societies: American Association for Hand Surgery, American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, American Society of Plastic Surgeons, Association of Academic Chairmen of Plastic Surgery, Canadian Society of Plastic Surgeons, Illinois State Medical Society, Illinois State Medical Society, Ontario Medical Association, Plastic Surgery Research Council, Royal College of Physicians and Surgeons of Canada, and Society of University Surgeons

Disclosure: Nothing to disclose.

Richard Brown, MD, FACS  Clinical Professor, Department of Surgery, Division of Plastic and Reconstructive Surgery, Southern Illinois University School of Medicine

Disclosure: Nothing to disclose.

Sotirios Papafragkou, MD  Chair, Department of Surgery, Hand and Microvascular Surgery, Northern Maine Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael S Clarke, MD  Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Arthroscopy Association of North America, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

N Ake Nystrom, MD, PhD  Associate Professor of Orthopedic Surgery and Plastic Surgery, University of Nebraska Medical Center

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

References

  1. Von Zander W. Trommerlahmung. Berlin:. 1891.

  2. James JI. A case of rupture of flexor tendons secondary to Kienböck's disease. J Bone Joint Surg. 1949;31B:521.

  3. Laine VA, Vainio KJ. Spontaneous ruptures of tendons in rheumatoid arthritis. Acta Orthop Scand. 1955;24:250.

  4. Linscheid RL, Lipscomb PR. Advances in surgical treatment of the rheumatoid hand. Minnesota Med. 1962;45:273.

  5. Fowler SB. The hand in rheumatoid arthritis. Am Surg. 1963;29:403.

  6. Lipscomb PR. Surgery of the arthritic hand. Mayo Clinic Proc. 1965;40:132.

  7. Mannerfelt L, Norman O. Attrition ruptures of flexor tendons in rheumatoid arthritis caused by bony spurs in the carpal tunnel. A clinical and radiological study. J Bone Joint Surg Br. May 1969;51(2):270-7. [Medline].

  8. Ferlic DC. Rheumatoid flexor tenosynovitis and rupture. Hand Clin. Aug 1996;12(3):561-72. [Medline].

  9. Spar I. Flexor tendon ruptures in the rheumatoid hand: bilateral flexor pollicis longus rupture. Clin Orthop. 1977;(127):186-8. [Medline].

  10. Sivakumar B, Akhavani MA, Winlove CP, Taylor PC, Paleolog EM, Kang N. Synovial hypoxia as a cause of tendon rupture in rheumatoid arthritis. J Hand Surg [Am]. Jan 2008;33(1):49-58. [Medline].

  11. O'Dwyer KJ, Jefferiss CD. Scaphoid exostosis causing rupture of the flexor pollicis longus. Acta Orthop Belg. 1994;60(1):124-6. [Medline].

  12. Vaughan-Jackson OJ. Rupture of extensor tendons by attrition at the inferior radio-ulnar joint. J Bone Joint Surg. 1948;30B:528.

  13. Walker LG. Flexor pollicis longus rupture in rheumatoid arthritis secondary to attrition on a sesamoid. J Hand Surg [Am]. Nov 1993;18(6):990-1. [Medline].

  14. Webb JB, Elliot D. Spontaneous rupture of the flexor pollicis longus tendon on a sesamoid bone. J Hand Surg [Br]. Jun 1997;22(3):381-2. [Medline].

  15. O'Dwyer KJ, Jefferiss CD. Spontaneous rupture of the flexor pollicis longus tendon: a report of three cases. Injury. Jul 1989;20(4):200-2. [Medline].

  16. Valbuena SE, Cogswell LK, Baraziol R, Valenti P. Rupture of flexor tendon following volar plate of distal radius fracture. Report of five cases. Chir Main. Apr 2010;29(2):109-13. [Medline].

  17. Casaletto JA, Machin D, Leung R, Brown DJ. Flexor pollicis longus tendon ruptures after palmar plate fixation of fractures of the distal radius. J Hand Surg Eur Vol. Aug 2009;34(4):471-4. [Medline].

  18. Adham MN, Porembski M, Adham C. Flexor tendon problems after volar plate fixation of distal radius fractures. Hand (N Y). Dec 2009;4(4):406-9. [Medline]. [Full Text].

  19. Figl M, Weninger P, Jurkowitsch J, Hofbauer M, Schauer J, Leixnering M. Unstable distal radius fractures in the elderly patient--volar fixed-angle plate osteosynthesis prevents secondary loss of reduction. J Trauma. Apr 2010;68(4):992-8. [Medline].

  20. Mody BS. A simple clinical test to differentiate rupture of flexor pollicis longus and incomplete anterior interosseous paralysis. J Hand Surg [Br]. Oct 1992;17(5):513-4. [Medline].

  21. Melton JT, Murray JR, Lowdon IM. A simple clinical test of flexor pollicis longus rupture. J Hand Surg [Br]. Dec 2005;30(6):624-5. [Medline].

  22. Drape JL, Tardif-Chastenet de Gery S, Silbermann-Hoffman O, et al. Closed ruptures of the flexor digitorum tendons: MRI evaluation. Skeletal Radiol. Nov 1998;27(11):617-24. [Medline].

  23. Chu PJ, Lee HM, Hou YT, Hung ST, Chen JK, Shih JT. Extensor-tendons reconstruction using autogenous palmaris longus tendon grafting for rheumatoid arthritis patients. J Orthop Surg. Apr 24 2008;3:16. [Medline].

  24. Unglaub F, Bultmann C, Reiter A, Hahn P. Two-staged reconstruction of the flexor pollicis longus tendon. J Hand Surg [Br]. Aug 2006;31(4):432-5. [Medline].

  25. Mannerfelt LG. Tendon transfers in surgery of the rheumatoid hand. Hand Clin. May 1988;4(2):309-16. [Medline].

  26. Stahl S, Stahl S, Calif E. Failure of flexor pollicis longus repair caused by anomalous flexor pollicis longus to index flexor digitorum profundus interconnections: a case report. J Hand Surg [Am]. May 2005;30(3):483-6. [Medline].

  27. Schneider LH, Wiltshire D. Restoration of flexor pollicis longus function by flexor digitorum superficialis transfer. J Hand Surg [Am]. Jan 1983;8(1):98-101. [Medline].

 
Previous
Next
 
Mannerfelt syndrome. The patient is unable to flex the interphalangeal joint of the thumb after spontaneous rupture of the flexor pollicis longus tendon.
Mannerfelt syndrome. The edges of the ruptured flexor pollicis longus tendon can be seen. A bony spur is present at the floor of the carpal tunnel.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.