Flexor carpi radialis tendinopathy after the hammock procedure for trapeziometacarpal arthritis

Suspension arthroplasty using the abductor pollicis longus (APL) tendon is widely performed for advanced trapeziometacarpal (TMC) arthritis. The hammock method involves wrapping the APL tendon around the flexor carpi radialis (FCR) tendon for suspension. Although outcomes are generally favorable, FCR tendon-related complications-such as tendinitis and rupture-have been reported, though detailed analyses remain limited.

In this retrospective study, 21 hands in 21 patients who underwent the hammock procedure for primary TMC arthritis were evaluated, with a follow-up of more than 1 year. FCR tendinopathy, including inflammation and rupture, was assessed. Occupation was considered a potential risk factor. Fisher's exact test was used for statistical analysis.

FCR tendinopathy occurred in seven patients (33.3%), including tendinitis in three (14.3%) and tendon rupture in four (19.0%). Manual workers had a higher incidence of FCR tendinopathy (50%) than non-manual workers (18.2%), with an odds ratio of 4.5, though not statistically significant (p = 0.1818). Tendon ruptures occurred within 6 months postoperatively, often following wrist-stressing activities. Conservative treatments-such as nonsteroidal anti-inflammatory drugs and bracing-were effective for tendinitis, whereas surgical intervention was required for tendon ruptures.

The hammock method effectively treats TMC arthritis but carries a notable risk of FCR tendinopathy, particularly among manual workers. The first postoperative year is critical, necessitating close monitoring and complication prevention. Surgical modifications and postoperative restrictions may help reduce risks. Further research involving larger cohorts and longer follow-up periods is warranted to refine the surgical strategies and improve outcomes.