Atraumatic A3 Pulley Rupture in Ulcerative Colitis: A Discussion of Implications for Inflammatory Pathology of the Hand.

Inflammatory bowel disease can profoundly affect the joints and tendons of the hand. We present here the first published case of an atraumatic rupture of the A3 pulley of the right second digit in a 27-year-old woman with ulcerative colitis. The patient presented with pain and functional compromise of the second digit as well as a 90° flexion contracture at the proximal interphalangeal joint. Imaging revealed rupture of the A3 pulley and bowstringing of the flexor digitorum profundus tendon despite no history of hand or finger trauma. Multidisciplinary conservative management and adjustment of antirheumatic medication resulted in partial resolution of the flexion contracture and return of pain-free function.