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Vaughan-Jackson Syndrome (Treatment)
eMedicine Surgery, 2014Treatment Medical Care Tendon continuity cannot be restored using medical therapy; in fact, the occurrence of tendon rupture may indicate that the current regimen of medical management is inadequate and that additional remittive therapy should be considered.
Adequate medical control of rheumatoid disease is imperative to minimize synovial proliferation, which may otherwise jeopardize the results of surgical reconstruction, place other anatomic areas at risk, or both.
Surgical Care Prophylaxis Prophylactic procedures intended to prevent tendon rupture are generally quite effective and provide function that is superior to the function provided by any method of tendon repair or reconstruction.
Patients with risk factors such as dorsal prominence of the distal ulna, radiographic erosion involving the distal radioulnar joint (DRUJ), or persistent dorsal tenosynovitis that is unresponsive to medical management over a 6-month period should be considered candidates for such surgery.
Weakness or extensor lag of the small-finger metacarpophalangeal (MCP) joint may indicate that one of the tendons that motor this joint has failed, which is usually caused by rupture of the extensor digiti minimi (EDM), with residual function resulting from the intact extensor digitorum communis (EDC) tendon.
This warning sign or pain over the dorsum of the DRUJ associated with motion of the digital extensor tendons should also prompt early exploration.
Tendon rupture following prophylactic surgery, which includes tenosynovectomy and DRUJ reconstruction, is rare (0-4%).
Tendon continuity restoration Surgical efforts to restore tendon continuity must always include thorough dorsal tenosynovectomy with retinaculum transposition and resection or reconstruction of the DRUJ sufficient to remove the bony prominences that produced the tendon rupture.
As noted previously, the choice of DRUJ reconstruction may vary depending on the status of the wrist joint and other individual patient considerations.
Following the loss of small-finger extension, surgical exploration should be undertaken without delay to avoid sequential rupture of the adjacent tendons, which would further complicate reconstruction.
Direct repair Direct repair of ruptured tendons is rarely possible because of the attritional nature of this process and because the zone of tendon injury is usually quite long.