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FCR tendon was ruptured and removed. Hand started shaking. What is causing this?

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Orthopaedic Surgeon
Practicing since : 2000
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Yes, I have an issue with my hand shaking since my fcr tendon was ruptured and removed...my doctor seems stumped by this, as he uses this tendon to repair others that get damaged. I think since I ruptured it from work activity, that I must actually have been using it more than someone who had it removed just to fix one that was damaged. My hand tremors occur when I try to turn my hand (pronation and supination)...and this started right after I partially ruptured it (90%) and just got worse after the tendon was removed...I have been researching and found some doctors believe that since this FCR tendon uses the tuberosity on the scaphoid as a pulley before it's insertion point on the metacarpals that removing it can cause wrist instability. Does this sound like a possibility to you? Thanks, XXXXXXX
Posted Wed, 29 Aug 2012 in Bones, Muscles and Joints
 
 
Answered by Dr. Atul Wankhede 2 hours later
Dear XXXXXXX
Welcome to HealthcareMagic and thanks for posting your query.

Since you must have researched on this particular topic already, you must have noted that if the tendon is ruptured (partially or completely,) or is directed elsewhere for other purpose (like in tendon transfer), then it loses its normal functioning. If the tendon is removed then the remenant part of the FCR muscle must have fused/fibrosed at a convenient position, which obviously would not function as a flexor any longer. Hence its unlikely cause for tremors. The tremors if felt only during pronation and supination means there are other muscles (like pronator quad/biceps etc) with weakness or partial tear.

In my opinion, one must confirm the cause of shaking before further treatment. An MRI would most appropriately tell us the XXXXXXX condition, aided with a supplements, splints and physiotherapy and gradual resuming of wrist functions must be planned. And do not worry, FCR is not the only stabilising structure in wrist.

Hope this answers your query, for any doubts I'm available for follow up.
Regards.
Above answer was peer-reviewed by
 
Follow-up: FCR tendon was ruptured and removed. Hand started shaking. What is causing this? 16 hours later
Doctor Wankhede,
thanks for your response...but I do not feel that the FCR muscle is causing the tremors...I believe that because it is no longer using the scaphoid tuberosity as a pulley, the lack of tension it caused at the pulley on the scaphoid is what is causing the instability...By virtue of the bowstringing effect on the scaphoid tuberosity the FCR is capable of helping to dynamically stabilize the wrist by supporting the position of the distal pole of the scaphoid and resisting the innate tendency of the scaphoid to collapse under load. Many researchers believe the FCR has no small role as a palmar stabilizer of wrist motion.
I have had EMG and nerve conduction testing and the neurologist does not believe it is a neurological issue. The MRI that was done to find the initial rupture did not show any other issues as far as my Doctor has said. The therapists I was sent to said that there was no other exercises they could give me....my grip strength is very good...AND, as long as I have my hand on something solid like the equipment at the the rehab center, (even though I don't have near the strength turning things that I used to have), I can turn the handles on the machines.....BUT I CANNOT turn my hand while holding a screwdriver, pliers, ratchet, etc.(tools I would use at my job) without my hand shaking so badly that I can't keep the screw driver on the screw head while trying to put a screw in. The inside of my arm at the elbow is constantly aching....I keep trying to do anything I can to build up muscles in other areas to try and compensate, (which is not always the safest thing, since I have already slipped and run a screw driver into my left hand), and I will keep trying.
So, what I am trying to say is since I am not having a so-called "normal" reaction to this FCR tendon removal, I am researching and reaching out to anyone who may have some answers or have possibly seen or heard of this before, or has the "connections" to check into it further than I can. I obviously am NOT a cookie cutter person like most others....somehow I am different, and it wouldn't be the first time I have been told that medically. If you have any resources that could point you toward anyone that could help with my problem, I would greatly appreciate your assistance. My frustration is reaching a critical level, since it is 2 years this month that it all started......Thank you,XXXXXX
 
 
Answered by Dr. Atul Wankhede 11 hours later
Dear XXXXXXX
Thanks for replying back. Apologies for the late reply.

It seems to have been investigated well and we have no other option but to believe that its a resultant deficit of the FCR's bowstringing. But even in that case, it does not render the wrist unstable, since pronation and supination occur at proximal and distal radius and ulna. So if tremors come only during pronation and supination, the other aiding muscles (even though normal as confirmed in MRI) might fatigue early as compared to its counterparts. I wonder how could they find nothing wrong in myography. Muscle tremors must show some pattern on electronic stimulation.

The pain in inner elbow can also be explained as the flexor muscles all originate from medial epicondyle of humerus. I'm afraid strengthening of adjoining antagonist muscles is the only physical therapy advisable.

I understand your unique condition and honestly I haven't seen such case before. So my advise is based on assumptions on similar symptoms elsewhere, and the shortness is regretted. Indeed your spirit to dig XXXXXXX is appreciated and I hope you find a solution soon.
Regards.
Above answer was peer-reviewed by
 
Follow-up: FCR tendon was ruptured and removed. Hand started shaking. What is causing this? 24 hours later
Dr. XXXXXXX Wankhede
Thank you for your assistance...I wonder if you know of anyone else in this partcular field of study that I could contact for any possible research results on this issue....the more people I ask about this may possible stimulate more research and possibly more answers to the problem in the future....possibily a teaching hospital?
Many Thanks, XXXXXX
 
 
Answered by Dr. Atul Wankhede 7 hours later
Dear XXXXXXX
Pleased to see your reply.

As a matter of fact I do know one extremely talented hand surgeon in Mumbai, Dr XXXXXXX Warrier, whom you may try getting in touch with via details available on search engines.

I further regret the inability to assist you in this case. Good luck.
Regards.
Above answer was peer-reviewed by
 
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