Radiographic Findings and Novel Intraoperative Approach to Saddle Syndrome: A Case Presentation.

INTRODUCTION: Saddle syndrome is caused by post-traumatic adhesions between the interosseous and lumbrical tendons and the intermetacarpal ligament in the webspaces of the hand. Diagnosis can be challenging, requiring a high index of suspicion with inadequately defined diagnostic criteria. CASE REPORT: We present a case of saddle syndrome secondary to repetitive motorcycle use in a 56-year-old female to highlight the pathoanatomy, workup, diagnostic magnetic resonance imaging findings, and a new surgical approach for this disorder. Given persistent symptoms, surgical intervention was pursued using a commissural approach that provided superior en face visualization of the pathological anatomy. The adhesions between the intrinsic tendons and the intermetacarpal ligament were released with partial ligament resection. CONCLUSION: Immediate post-operative mobilization led to complete pain resolution and return to full function by 3 months. This report provides the first high-quality in vivo photographs correlating with advanced imaging findings and demonstrates how a commissural surgical approach offers improved anatomical visualization for treating this condition. LEVEL OF EVIDENCE: V.