First Digit Of The Hand Injury - Collegiate Basketball Player

HISTORY: A 21-year-old Division I male basketball player initially presented with a minor laceration to the first metacarpophalangeal (MCP) joint of the left hand after falling from a mobile scooter. The patient reported minimal pain and had full range of motion (ROM) upon initial evaluation. The wound was cleaned and checked for foreign bodies. Once cleaned with normal saline and prepped with a thumb spica splint, Dermabond was applied to close the wound, followed by pressure dressing, and oral antibiotics (Cephalexin 500 mg po QID) were prescribed to the patient. PHYSICAL EXAMINATION: Initially, the patient presented with a minor laceration to the palmar surface of his thumb, showing minimal pain and full ROM. However, on the third day post-injury, there was a significant change in his condition, with the patient reporting severe pain, swelling, and loss of ROM. This sudden change in symptomatology, disproportionate to the initial diagnosis of a partial tear of the flexor pollicis longus tendon of the first digit, prompted the patient's referral to the emergency room for advanced imaging. DIFFERENTIAL DIAGNOSIS: 1. Laceration to dermis on palmar side 2. Digital nerve lesion 3. Laceration of flexor pollicis longus tendon TEST AND RESULTS: Exam: US Non-Vascular Extremity Musculoskeletal Complete Findings: left thumb demonstrates full-thickness laceration/ complete tear of flexor pollicis longus tendon, roughly at the level of the first metacarpophalangeal (MCP) joint, with a gap tear measuring 2.8 cm in length FINAL/WORKING DIAGNOSIS: Laceration of flexor pollicis longus tendon of left thumb TREATMENT AND OUTCOMES: 1. Left thumb flexor pollicis longus tendon repair, Zone 1, neurolysis of ulnar digital nerve 2. Occupational therapy biweekly for 3 months 3. Range of motion and relative muscle strengthening started 1-week post-surgery (flexion, extension, anteposition, opposition, abduction, adduction) 4. Actively working to get back to normal strength and ROM parameters, pass a functional field test, and return to play (currently 1-month post-surgery)