Flexor Carpi Radialis Tendinitis to Rupture: A Case Series and Algorithm

Flexor carpi radialis (FCR) tendinitis is an uncommon but important cause of volar radial wrist pain that can be a diagnostic and therapeutic challenge. We present a series of patients with FCR tendinitis managed successfully with an algorithm developed by the senior author.

A retrospective review of patients treated for FCR tendinitis at a hand practice was performed. The percent of the FCR rupture, determined with magnetic resonance imaging (MRI) and intraoperative confirmation, determined specific treatment. Patients with <50% rupture on MRI were treated conservatively. Surgery was indicated if this failed to yield relief or MRI suggested >50% rupture. On intraoperative examination, patients with <50% rupture underwent tenosynovectomy and excision of trapezial osteophytes. Patients with >50% rupture underwent an FCR-sacrificing procedure. Patient-reported outcomes, including severity of pain with activities of daily living and ability to return to previous levels of activity, were obtained.

Sixteen patients were treated for FCR tendinitis. Five were treated conservatively, with complete relief of symptoms and return to full activity without sequelae in three of five cases. Four of the 11 surgical patients were found to have <50% of tendon rupture and underwent an FCR-sparing procedure. The remaining seven patients had >50% tendon involvement, which required an FCR-sacrificing procedure. All surgical patients achieved satisfactory results in both functional and clinical outcomes.

This series demonstrates acceptable patient outcomes using the described FCR algorithm, using 50% FCR involvement as a benchmark.

Level IV.