Acute Iatrogenic Flexor Digitorum Profundus Rupture after Percutaneous A1 Pulley Release: MRI and Intraoperative Correlation

Abstract

Percutaneous A1 pulley release is commonly used to treat trigger finger, but the blind nature of the procedure may expose adjacent structures to injury. This case report describes an acute iatrogenic rupture of the flexor digitorum profundus tendon after percutaneous release and correlates the preoperative magnetic resonance imaging findings with the intraoperative observations. A 54-year-old woman presented one week after undergoing percutaneous release of the left middle-finger A1 pulley elsewhere. She reported immediate loss of active finger flexion after the procedure, accompanied by pain and swelling in the palm. Examination demonstrated loss of active flexion at the distal interphalangeal joint and tenderness around the A1 pulley without neurovascular deficit. Magnetic resonance imaging showed discontinuity of the flexor digitorum profundus tendon at the A1 pulley, proximal retraction to the palm, and partial injury to the volar plate of the metacarpophalangeal joint. Surgical exploration confirmed complete tendon rupture, tenosynovitis, frayed tendon edges, and partial volar-plate injury without joint instability. The tendon was mobilised and repaired using a multistrand modified Tsuge technique. Postoperative management included a dorsal blocking splint and supervised mobilisation. At six months, the patient had regained full active flexion of the distal interphalangeal joint, with a residual 10° terminal extension loss and no recurrent triggering or rerupture. Immediate loss of active flexion after percutaneous release should prompt assessment for tendon injury, and magnetic resonance imaging can support diagnosis and operative planning.