Impingement of a fibroma of the extensor tendon sheath on the extensor retinaculum.
ABSTRACT Deep lacerations to the forearm can cause impaired movement of the digits. This report describes the presentation and management of a self-harmer who presented with loss of motion of her ring finger. Surgical exploration unexpectedly demonstrated the cause to be a fibroma of the tendon sheath impinging on the extensor retinaculum. Full recovery was demonstrated at sixmonth review following removal of the lesion.
- SourceAvailable from: ncbi.nlm.nih.govBMJ Clinical Research 02/2001; 322(7280):213-5. · 14.09 Impact Factor
Article: Fibroma of tendon sheath.Cancer 12/1979; 44(5):1945-54. · 4.90 Impact Factor
Article: Fibroma of tendon sheath.[Show abstract] [Hide abstract]
ABSTRACT: Three cases of fibromas involving tendon sheath of right index finger, left ring finger, and tibial ligament in a 62-, a 54-, and a 30-year-old male patients, respectively, are described. Two cases (1 and 2) represented painless, slowly enlarging masses that limited motion of the involved digits. The third case was discovered at surgery during the repair of a tibial ligament after a motorcycle accident. Following surgical excisions, no recurrences were present 18 months and 9 months after resection. The fibromas of tendon sheath origin are distinct entities and should be separated from other lesions of tendon sheaths. Trauma should be considered as the etiology. The fibromas are benign lesions but may recur.Journal of Surgical Oncology 03/1982; 19(2):90-2. · 2.84 Impact Factor
J Hand Microsurg 2(1):31–32
Shelain Patel (?) ⋅ Henry B. Colaco ⋅ Emma J. Taylor
Department of Orthopaedics and Trauma,
University College Hospital,
235 Euston Road, London, NW1 2BU, UK.
Impingement of a fibroma of the extensor tendon sheath
on the extensor retinaculum
Shelain Patel ⋅ Henry B. Colaco ⋅ Emma J. Taylor
Received: 18 August 2009 / Accepted: 11 November 2009
© Society of Hand and Microsurgeons of India 2010
Abstract Deep lacerations to the forearm can cause
impaired movement of the digits. This report describes
the presentation and management of a self-harmer who
presented with loss of motion of her ring finger. Surgical
exploration unexpectedly demonstrated the cause to be a
fibroma of the tendon sheath impinging on the extensor
retinaculum. Full recovery was demonstrated at six-
month review following removal of the lesion.
Keywords Tendon sheath ⋅ Fibroma ⋅ Impingement ⋅
We report the presentation and management of a self-
harmer who presented with loss of motion of her ring
finger. Surgical exploration unexpectedly demonstrated
the cause to be a fibroma of the tendon sheath impinging
on the extensor retinaculum.
A 20-year-old, right hand dominant lady presented with a
two month history of difficulty in extending her right ring
finger. She was a self-harmer who described her symp-
toms occurring immediately after a self-inflicted lacera-
tion with a knife. The area involved was the dorsal aspect
of the middle third of her forearm and on inspection she
had a visible, well-healed, transverse scar. Examination
of the ring finger demonstrated full active and passive
flexion. However she was unable to actively extend the
metacarpophalangeal joint beyond 15 degrees of flexion
though this was fully correctable passively. A provisional
diagnosis of peritendinous fibrosis was made, though an
extensor tendon laceration with scarring to an adjacent
tendon was also considered. To improve digital function,
the patient elected for an extensor tenolysis.
At surgery, a longitudinal incision was made over the
dorsal aspect of the forearm to expose the extensor ten-
dons. A small amount of subcutaneous scar tissue was
noted around the previous laceration and this was excised
though this was not thought to be able to fully account for
the symptoms. Accordingly, the incision was extended
for exploration. A nodule arising distal to the extensor
retinaculum and on the extensor tendon of the ring finger
was noted (Fig. 1). On excursion of the extensor tendon,
the nodule was noted to impinge upon the retinaculum in
full extension. The nodule was carefully excised and full
extension of the digit was subsequently easily achieved.
Histopathological examination of the nodule identified it
as a fibroma of the tendon sheath. Hand therapy was
32 J Hand Microsurg 2(1):31–32
Fig. 1 Fibroma of the tendon sheath (FTS) can be seen distal
to the extensor retinaculum (ER)
commenced in the early post-operative phase with
instructions given for active range of motion exercises.
At her review at six months, the patient was able to
fully extend the affected digit without difficulty.
The incidence of non-fatal self harm is 100–600 per
100,000 people annually . ‘Cutting episodes’ that
cause impaired movement of the fingers and wrist are the
most common way that a trauma or plastic surgery unit
will encounter affected patients. Presentation can either
be acute due to tendon lacerations, or chronic in which
case peritendinous adhesions and fibrosis are likely.
Benign tumours were originally classified in to one of
four types by Buxton in 1923: lipoma, fibroma, chon-
droma and ganglion . However it was not until 1949
that the term ‘tendon sheath fibroma’ was first used .
Chung and Enzinger  described the largest series of
these benign tumours and reported that they are well-
circumscribed tumours that are often lobular and arise
from either a tendon or its sheath. It has an indistinct and
generic macroscopic appearance that means that it is
commonly misdiagnosed for other types of tumour such
as a ganglion cyst  or a giant cell tumour . Diagno-
sis is therefore based upon the distinct microscopic fea-
Upper extremity involvement occurs in over 80% of
cases though our case is atypical since they tend to be
more common in males and also in flexor compartments.
Furthermore, less than 10% of patients have a history of
antecedent trauma .
In removing the lesion, careful dissection was para-
mount for two reasons. Firstly to avoid causing an iatro-
genic tendon laceration whilst secondly, it may be
assumed that removal of excess tissue at the base of the
fibroma could affect the quality of the tendon and thus its
strength. In such a scenario, there is potential for late
rupture of the tendon leading to a complete loss of exten-
On the basis of this encountered case, we recommend
that assessment of any laceration on the forearm whether
it be new or old, should involve full testing of the under-
lying musculotendinous structures. For old injuries, this
is due to the adhesions that may develop which prevent
full motion of the distal joints. Furthermore this case
illustrates the need for a complete clinical examination
before surgery, even if an ‘evident’ aetiology is seen. It is
possible that palpation and tenodesis tests performed in
combination with ultrasound would have allowed the
diagnosis to be established preoperatively.
1. Isacsson G, Rich CL (2001) Management of patients who
deliberately harm themselves. BMJ 322:213–215
2. Buxton St JD (1923) Tumours of tendon and tendon sheath.
Br J Surg 10:469–474
3. Geschickter CF, Copeland MM (1949) Tumors of bone, 3rd
edn. Lippincott, Philadelphia, pp. 693–695
4. Chung EB, Enzinger FM (1979) Fibroma of tendon sheath,