title: Subcutaneous flexor tendon rupture in patients with rheumatoid arthritis.
abstract: OBJECTIVE
  We examined the clinical features and functional outcomes of surgically repaired subcutaneous flexor tendon ruptures in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  This retrospective study included 41 fingers of 24 RA patients who underwent surgical treatment for flexor tendon ruptures. Evaluations performed at the time of presentation following rupture were C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and disease activity score in 28 joints (DAS28)-ESR, as well as Larsen grading for carpal bone destruction. The ruptured tendon and postoperative active range of motion (ROM) of digits were also examined.
  
  
  RESULTS
  The mean CRP was 2.4 mg/dl, ESR was 52 mm/h, and the DAS28-ESR was 4.5. Carpal bone destruction according to Larsen grade IV-V was observed in 18/24 patients. Affected digits were most commonly the thumb (12) and the ring and little fingers (9 each). Tendon ruptures were most common in the carpal tunnel in zone IV. The mean postoperative finger ROM (flexion/extension) was 38°/2° for the interphalangeal (IP) joint of the thumb and 23°/-2° for the distal interphalangeal joint of the other four fingers.
  
  
  CONCLUSIONS
  Patients with flexor tendon ruptures present with high disease activity and advanced bone destruction. It is important to reduce the risk of progressive bone destruction and subsequent tendon rupture via tight control of disease activity.
authors.affiliation: a Department of Orthopaedic Surgery , Fujita Health University , Toyoake , Aichi , Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Funahashi
authors.affiliation: a Department of Orthopaedic Surgery , Fujita Health University , Toyoake , Aichi , Japan.|b Department of Orthopaedic Surgery , Keio University School of Medicine , Tokyo , Japan , and.|c Department of Orthopaedic Surgery , Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: b Department of Orthopaedic Surgery , Keio University School of Medicine , Tokyo , Japan , and.|c Department of Orthopaedic Surgery , Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Takuji
authors.initials: T
authors.lastname: Iwamoto
authors.affiliation: a Department of Orthopaedic Surgery , Fujita Health University , Toyoake , Aichi , Japan.
authors.forename: Kanae
authors.initials: K
authors.lastname: Shizu
authors.affiliation: b Department of Orthopaedic Surgery , Keio University School of Medicine , Tokyo , Japan , and.
authors.forename: Noboru
authors.initials: N
authors.lastname: Matsumura
authors.affiliation: b Department of Orthopaedic Surgery , Keio University School of Medicine , Tokyo , Japan , and.|c Department of Orthopaedic Surgery , Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Ochi
authors.affiliation: c Department of Orthopaedic Surgery , Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Ikari
authors.affiliation: b Department of Orthopaedic Surgery , Keio University School of Medicine , Tokyo , Japan , and.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sato
authors.affiliation: b Department of Orthopaedic Surgery , Keio University School of Medicine , Tokyo , Japan , and.
authors.forename: Masaya
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: b Department of Orthopaedic Surgery , Keio University School of Medicine , Tokyo , Japan , and.
authors.forename: Morio
authors.initials: M
authors.lastname: Matsumoto
authors.affiliation: c Department of Orthopaedic Surgery , Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Momohara
authors.affiliation: a Department of Orthopaedic Surgery , Fujita Health University , Toyoake , Aichi , Japan.
authors.forename: Katsuji
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: a Department of Orthopaedic Surgery , Fujita Health University , Toyoake , Aichi , Japan.
authors.forename: Harumoto
authors.initials: H
authors.lastname: Yamada
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000601:surgery*; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D005385:Fingers / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D013708:Tendon Injuries / Q000150:complications / Q000601:surgery*; D014955:Wrist Joint / Q000601:surgery
chemical_list: D002097:C-Reactive Protein
keywords: Flexor tendon rupture; Rheumatoid arthritis; Tendon grafting; Tendon transfer