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Published on: August 6, 2015
A case report of heterotopic ossification of the tendon sheath after blunt trauma
Kazuhiro Otani1, Ryosuke Kakinoki1, Koji Gotoh1
1Department of Orthopedic Surgery, Faculty of Medicine, Kindai University, Osaka-Sayama, Osaka, Japan.
Rationale:
Heterotopic ossification of the hand is relatively rare. Herein we report a case of heterotopic ossification around the tendon sheath.
Patient Concerns:
A 46-year-old man presented to the hospital with an inability to flex his right index finger, and with pain during motion. He had a history of blunt trauma to the right index finger during work. Clinical examination revealed a localized mass and tenderness in the volar aspect of the right index finger. Active flexion of the affected fingers was limited. No limitations on active finger extension and passive flexion were noted. Radiography and computed tomography revealed a ring-like bony lesion on the palmar aspect of the proximal phalanx that appeared to develop around the flexor tendon.
Diagnoses:
Constriction of the flexor tendons at the annular 2 pulley where heterotopic ossification occurred was thought to be the etiology of symptoms.
Interventions:
Complete resection of the ossified lesion and the distal half of the annular 2 pulley was performed. Postoperative recovery was uneventful.
Outcomes:
Six months after surgery, complete extension and flexion of the finger were evident, without symptoms.
Lessons:
This case report demonstrates that heterotopic ossification can occur at the tendon sheath of the finger. Heterotopic ossification at the flexor tendon sheath may result in the limitation of finger movement. Radiographic examinations are helpful to confirm the presence of osseous lesions in cases with suspected heterotopic ossification. Complete excision of ossified lesions improves symptoms.
