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Mannerfelt Syndrome (Overview)

eMedicine Surgery, 2011

Introduction Mannerfelt syndrome refers to rupture of the flexor pollicis longus tendon from attrition caused by a bony spur in the carpal tunnel.
In 1949, James reported a flexor tendon rupture from a sharp bony spicule that had pierced through the carpal tunnel floor in a patient with Kienböck disease.
Linscheid and Lipscomb described flexor pollicis longus tendon rupture at the insertion into the distal phalanx, under the annular ligament and at the junction with the muscle in rheumatoid hands.
Fowler suggested that attrition flexor tendon rupture is related to the hook of the hamate and the trapezium.
Lipscomb believed that flexor tendon ruptures occur where synovial membrane is present as in the carpal tunnel and along the digits.
Finally, in 1969, Mannerfelt published his series of attrition flexor tendon ruptures in rheumatoid arthritis caused by bony spurs in the carpal tunnel.
Flexor pollicis longus tendon was the most common flexor tendon to rupture from attrition by a bony spur in the carpal tunnel.
Even if the tendon has ruptured, continuity may exist through the paratendinous sheath or a pseudotendon.
Flexor tendon ruptures occur consecutively, starting with the flexor pollicis longus and thereafter affecting other flexor tendons in a more ulnar direction.
Frequency In his series of patients with affected flexor tendons in the carpal tunnel, Mannerfelt reported that 20 of 25 patients had involvement of the flexor pollicis longus tendon and that nearly all flexor tendon attritions occurred in women.
Etiology Bony spurs between erosions at the distal volar scaphoid and proximal volar trapezium cut through the carpal tunnel floor and lead to attrition of the flexor tendons (see ).