Yan R, Zhang Z, Wu L, Wu ZP, Yan HD. Iatrogenic flexor tendon rupture caused by misdiagnosing sarcoidosis-related flexor tendon contracture as tenosynovitis: A case report. World J Clin Cases 2023; 11(36): 8512-8518 [PMID: 38188214 DOI: 10.12998/wjcc.v11.i36.8512]
Corresponding Author of This Article
He-De Yan, MD, PhD, Director, Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No. 666 Oushi Road, Dongtou District, Wenzhou 325026, Zhejiang Province, China. yanhede@hotmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 26, 2023; 11(36): 8512-8518 Published online Dec 26, 2023. doi: 10.12998/wjcc.v11.i36.8512
Iatrogenic flexor tendon rupture caused by misdiagnosing sarcoidosis-related flexor tendon contracture as tenosynovitis: A case report
Rui Yan, Zhe Zhang, Long Wu, Zhi-Peng Wu, He-De Yan
Rui Yan, The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
Zhe Zhang, Long Wu, Zhi-Peng Wu, Department of Orthopedics (Division of Hand Surgery), The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325026, Zhejiang Province, China
He-De Yan, Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325026, Zhejiang Province, China
Author contributions: Yan R and Zhang Z prepared the initial draft of this manuscript and made subsequent revisions; Wu L and Wu ZP performed the data collection and manuscript review and editing; Yan HD performed the conceptualization and validation of the study and acquired funding of the report; all authors have reviewed and approved the final manuscript.
Supported byZhejiang Provincial Natural Science Foundation of China, No. LY23H090009; Clinical Research Foundation of the Second Affiliated Hospital Wenzhou Medical University, No. SAHoWMU-CR2018-08-417.
Informed consent statement: The study participant provided written informed consent before study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest related to this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: He-De Yan, MD, PhD, Director, Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No. 666 Oushi Road, Dongtou District, Wenzhou 325026, Zhejiang Province, China. yanhede@hotmail.com
Received: August 26, 2023 Peer-review started: August 26, 2023 First decision: November 9, 2023 Revised: November 18, 2023 Accepted: December 7, 2023 Article in press: December 7, 2023 Published online: December 26, 2023 Processing time: 117 Days and 23.4 Hours
Abstract
BACKGROUND
Sarcoidosis is a multisystem disease characterized by granuloma formation in various organs. Sarcoidosis-related flexor tendon contractures are uncommon in clinical settings. This contracture is similar to stenosing tenosynovitis and potentially leads to misdiagnosis and mistreatment. Herein, we report a rare case of sarcoidosis-related finger flexor tendon contracture that was misdiagnosed as tenosynovitis.
CASE SUMMARY
A 44-year-old woman presented to our department with flexion contracture of the right ring and middle fingers. The patient was misdiagnosed with tenosynovitis and underwent acupotomy release of the A1 pulley of the middle finger in another hospital that resulted in iatrogenic rupture of both the superficial and profundus flexors. Radiological presentation showed multiple sarcoid involvements in the pulmonary locations and ipsilateral forearm. A diagnosis of sarcoidosis was made based on the presence of non-caseating granulomas with tubercles consisting of Langhans giant cells with lymphocyte infiltration on biopsy, and the patient underwent surgical repair for the contracture. After 2 mo, the patient experienced another spontaneous rupture of the repaired middle finger tendon and underwent surgical re-repair. Satisfactory results were achieved at the 10 mo follow-up after reoperation.
CONCLUSION
Sarcoidosis-related finger contractures are rare; thus, caution should be exercised when dealing with such patients to avoid incorrect treatment.
Core Tip: Finger contracture due to tenosynovitis is frequently encountered in clinical settings. However, misdiagnosis can occur when rare causes such as sarcoidosis are neglected. Here, we report a case in which such a misdiagnosis led to an iatrogenic injury. The mainstream treatment method for contractures related to sarcoidosis is surgical excision of muscular lesions, with varied outcomes in several case reports. In our case, considering the contracture lesion at the flexor digitorum profundus (FDP) and the initial iatrogenic tendon rupture, cross-lengthening of the flexor digitorum superficialis and FDP was attempted to restore flexion and achieve satisfactory results.
