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Hayakawa K, Suzuki T, Furuhata R, Kimura H, Matsumura N, Iwamoto T, Nakamura M. Artificial Lunate Arthroplasty for Kienböck Disease With Multiple Extensor Tendon Ruptures: A Case Report. JBJS Case Connect 2023; 13:01709767-202306000-00053. [PMID: 37319274 DOI: 10.2106/jbjs.cc.23.00147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
CASE A 73-year-old woman presented with wrist pain and loss of extension in the middle and ring fingers. Radiography revealed a dorsally displaced lunate fragment, resulting in a diagnosis of Kienböck disease with extensor tendon rupture. Artificial lunate replacement and tendon transfer were performed as treatment. Two years postoperatively, the pain was relieved, and the extension lag was 0°. The wrist motion and carpal height had also improved. CONCLUSION Lunate excision, partial wrist arthrodesis, or proximal row carpectomy are known treatments for Kienböck disease with extensor tendon rupture. Lunate arthroplasty is a novel, useful treatment option for this condition.
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Affiliation(s)
- Katsuya Hayakawa
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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2
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Closed extensor tendon rupture caused by Kienböck disease: a case report. Arch Plast Surg 2022; 49:76-79. [PMID: 35086314 PMCID: PMC8795655 DOI: 10.5999/aps.2021.01522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022] Open
Abstract
Kienböck disease, a rare disease that can cause chronic pain and motor dysfunction, occurs due to avascular necrosis of the lunate bone, which leads to dislocation of the carpal bone. Among various other etiologies, Kienböck disease can cause closed tendon rupture of the finger. In this report, we introduce a case of total rupture of the second extensor digitorum communis and the extensor indicis proprius tendons caused by undiagnosed Kienböck disease in an elderly female patient.
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Suganuma S, Tada K, Takagawa S, Yasutake H, Shimanuki K, Tsuchiya H. Spontaneous extensor tendon rupture due to scaphoid osteophyte: A case report and literature review. JPRAS Open 2021; 28:66-71. [PMID: 33786359 PMCID: PMC7994726 DOI: 10.1016/j.jpra.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/26/2021] [Indexed: 12/01/2022] Open
Abstract
Spontaneous attritional extensor tendon ruptures of the index finger due to carpal bone lesions are uncommon. Here, we report the case of a patient with a spontaneous rupture of the extensor indicis proprius (EIP) and index extensor digitorum communis (EDC2) tendons due to a previously symptomatic dorsal scaphoid osteophyte. A healthy 60-year-old man with right-hand dominance experienced mild pain over the dorsum of his left hand for no particular cause. He was a maker of tatami mats. Nine months later, he noted a sudden snap on the dorsum of his right hand while he was making tatami mats and he became unable to extend his index finger. Plain radiography revealed an osteophyte on the dorsal side of the scaphoid. Computed tomography revealed a bone fragment on the dorsal side between the scaphoid and lunate, which seemed to be derived from the scaphoid osteophyte. He underwent surgery 24 days after the incident. First, the fragment was excised; then tendon transfer was performed. EIP and EDC2 tendons were bundled using a side-to-side suture and connected to the middle extensor digitorum communis tendon using interlacing sutures. Histopathological findings of the resected bone were compatible with osteoarthritic change. Tatami mat making requires repeated radioulnar deviation, which could be a risk factor for scaphoid osteophytes. To our knowledge, the present case is the first to report extensor tendon rupture due to a scaphoid osteophyte in a healthy person. Although there is no consensus on the appropriate management of symptomatic scaphoid osteophytes, early intervention at the first sign of tenosynovitis might be necessary to prevent extensor tendon ruptures.
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Affiliation(s)
- Seigo Suganuma
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratsuki-higashi,Kanazawa, Ishikawa 920-8530, Japan
| | - Kaoru Tada
- Department of Orthopaedic Surgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Shingo Takagawa
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratsuki-higashi,Kanazawa, Ishikawa 920-8530, Japan
| | - Hidetoshi Yasutake
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratsuki-higashi,Kanazawa, Ishikawa 920-8530, Japan
| | - Keito Shimanuki
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratsuki-higashi,Kanazawa, Ishikawa 920-8530, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Hospital, Kanazawa, Japan
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Kim TG, Heo YM, Min YK. Extensor Tendon Rupture Due to Advanced Kienböck's Disease: Two Case Reports and a Review of Literature. J Hand Surg Asian Pac Vol 2020; 25:123-128. [PMID: 32000607 DOI: 10.1142/s2424835520720042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Extensor tendon rupture of the finger is a very rare complication of Kienböck's disease. However, advanced Kienböck's disease can cause an attritional rupture of extensor tendons due to displaced lunate fragment. An extensor tendon of the thumb is frequently damaged in the distal radial fracture, and an extensor tendon of the fifth finger is mainly ruptured in arthritis of distal radio-ulnar joint. On the other hand, the extensor tendons of the 2nd, 3rd and 4th fingers are usually ruptured in advanced Kienböck's disease. We report two elderly patients diagnosed with advanced Kienböck's disease after non-traumatic rupture of extensor tendon of the fingers. Since the extensor tendon rupture in Kienböck's disease present as a loss of active extension of metacarpophalangeal joint in the central fingers, these patients should undergo imaging of the wrist joints to ascertain concomitant Kienböck's disease.
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Affiliation(s)
- Tae Gyun Kim
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Youn Moo Heo
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Young Ki Min
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea
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Tomori Y, Nanno M, Takai S. Closed rupture of extensor tendon resulting from untreated Kienböck disease: A case report and a review of the literature. Medicine (Baltimore) 2019; 98:e16900. [PMID: 31415435 PMCID: PMC6831435 DOI: 10.1097/md.0000000000016900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Spontaneous closed extensor tendon rupture is a rare complication of Kienböck disease with only 23 cases reported in the English literature. PATIENT CONCERNS We present a case of painless attritional rupture of the extensor tendons of the right fourth finger in a 69-year-old woman with Kienböck disease and review reported cases of Kienböck disease with subcutaneous closed tendon rupture. DIAGNOSES Physical examination had shown mild painless swelling of the dorsum of the right hand. Plain radiographs showed a dorsally displaced fragment of collapsed lunate bone fracture (Lichtman grade IIIb). Although surgery was recommended, the patient did not desire surgery because she had no pain and no interference with the activities of daily living. Six months later, however, the patient returned to our hospital with complaints of loss of spontaneous extension of the fourth finger. CT and MRI showed aseptic necrosis and large dorsally displaced fragments of the lunate under the extensor tendons of the fingers, suggesting a subcutaneous fourth extensor tendon rupture. INTERVENTIONS Surgery was performed to achieve functional recovery of the ring extensor and to prevent further subcutaneous tendon rupture. The extensor digitorum communis (EDC) of the ring finger was found to be ruptured and the EDCs to the third and fifth fingers were frayed due to attrition from the protrusion of the dorsal fragmented lunate bone. Inspection of the floor of the compartment revealed that the dorsally displaced fragment of the lunate bone had perforated the wrist capsule and protruded into the fourth compartment. The dorsal and volar fragments of the lunate bone were excised completely and scaphocapitate arthrodesis followed by the reconstruction of the fourth extensor tendon was performed. OUTCOMES A year after the surgery, radiography showed complete union of the scaphocapitate arthrodesis. The joint motion reached 45% of normal without any pain and there was full active extension of the fourth finger. LESSONS Because dorsally displacement of collapsed lunate bone fragments is a risk factor for attritional closed rupture of tendons, radiography, and MRI are essential to diagnose and to treat any closed tendon rupture.
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Affiliation(s)
- Yuji Tomori
- Departments of Orthopaedic Surgery, Nippon Medical School Musashi Kosugi Hospital, Kanagawa
- Departments of Orthopaedic Surgery, Ukima Central Hospital
| | - Mitsuhiko Nanno
- Departments of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Shinro Takai
- Departments of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
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Turner K, Sheppard NN, Norton SE. Flexor Tendon Rupture Due to Previously Undiagnosed Kienböck Disease: A Case Report. Hand (N Y) 2017; 12:NP37-NP38. [PMID: 28453342 PMCID: PMC5480672 DOI: 10.1177/1558944716668861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spontaneous flexor tendon rupture is rare and most common in the little finger. The pathogenesis of spontaneous tendon ruptures is unclear but may occur through attrition or mechanical abrasion over a bony prominence. Kienböck disease is avascular necrosis of the lunate, with an unknown etiology. METHODS We present a case of spontaneous rupture of flexor digitorum profundus due to Kienböck disease, which we believe is the first recorded case of flexor tendon rupture attributable to osteonecrosis of the lunate. RESULTS The patient underwent single-stage reconstruction of FDP and regained a good range of motion at the affected DIPJ. CONCLUSIONS This case illustrates the the importance of plain radiographs in the assessment of a patient presenting with spontaneous flexor tendon rupture in the hand to exclude bony pathology as a cause.
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Affiliation(s)
- Kenrick Turner
- Norfolk and Norwich University Hospital, UK,Kenrick Turner, Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK.
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Hernández-Cortés P, Pajares-López M, Gómez-Sánchez R, Garrido-Gómez J, Lara-García F. Rupture of extensor tendon secondary to previously undiagnosed Kienböck disease. J Plast Surg Hand Surg 2012; 46:291-3. [PMID: 22747360 DOI: 10.3109/2000656x.2012.668325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report three patients with an unusual pattern of rupture of the extensor tendon. All were found to have previously undiagnosed Kienböck disease. Radiographic study of the wrist is essential before treating any closed rupture of an extensor tendon. Lesions may be progressive and extend to adjacent tendons and should be treated urgently.
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Affiliation(s)
- Pedro Hernández-Cortés
- Hand Surgery Unit, Orthopaedic Surgery Department of San Cecilio University Hospital of Granada, Granada, Spain.
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Mazhar T, Rambani R. Vaughan-Jackson-like syndrome as an unusual presentation of Kienböck's disease: a case report. J Med Case Rep 2011; 5:325. [PMID: 21787412 PMCID: PMC3158122 DOI: 10.1186/1752-1947-5-325] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Accepted: 07/25/2011] [Indexed: 11/21/2022] Open
Abstract
Introduction Kienböck's disease is a condition of osteonecrosis of the lunate bone in the hand, and most patients present with a painful and sometimes swollen wrist with a limited range of motion in the affected wrist. Vaughan-Jackson syndrome is characterized by the disruption of the digital extensor tendons, beginning on the ulnar side with the extensor digiti minimi and extensor digitorum communis tendon of the small finger. It is most commonly associated with rheumatoid arthritis. We describe a case of a patient with an unusual presentation of Kienböck's disease with symptoms similar to those of Vaughan-Jackson syndrome. Case presentation A 40-year-old man of Indian ethnic origin with no known history of trauma presented to our clinic with a ten-day history of an inability to extend his right little and ring fingers with associated pain in his right wrist. He was being treated with long-term steroids but had no other significant medical history. His examination revealed an inability to extend the metacarpal and phalangeal joints of the right ring and little fingers with localized tenderness over the lunate bone. Spontaneous disruption of the extensor tendons was diagnosed clinically and, after radiological investigation, was confirmed to be secondary to dorsal extrusion of the fragmented lunate bone. The patient underwent surgical repair of the tendons and had a full recovery afterward. Conclusion Kienböck's disease, though rare, is an important cause of spontaneous extensor tendon rupture. The original description of Vaughan-Jackson syndrome was of rupture of the extensor tendons of the little and ring fingers caused by attrition at an arthritic inferior radioulnar joint. We describe a case of a patient with Kienböck's disease that first appeared to be a Vaughan-Jackson-like syndrome.
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Affiliation(s)
- Tooba Mazhar
- Department of Orthopaedics, Hull & East Yorkshire Hospitals, NHS Trust, Analaby Road Hull, HU3 2JZ UK.
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Niwa T, Uchiyama S, Yamazaki H, Kasashima T, Tsuchikane A, Kato H. Closed tendon rupture as a result of Kienböck disease. J Plast Surg Hand Surg 2010; 44:59-63. [PMID: 20367065 DOI: 10.3109/02844310903351301] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Closed tendon rupture is a well-known complication of Kienböck disease, but only 11 cases have been reported. We reviewed six cases of Kienböck disease with subcutaneous rupture of a tendon. There were five cases of 4th extensor tendons and one case of the flexor digitorum profundus tendons of the ring finger and little finger. Radiographs showed protrusion of the segmented lunate or the deformed lunate in all cases. Intraoperative findings confirmed rupture of the wrist joint capsule by these lunate lesions. We then reviewed 11 reported cases in English and 48 cases in Japanese and confirmed that all cases had similar clinical characteristics and radiological features to our own, except the involved digits of flexor tendon rupture. Our case was unique in that the ulnar side tendons were ruptured, while in the reported cases the radial flexor tendons were more susceptible to rupture than the ulnar ones. Closed rupture of tendons should be recognised as a complication in patients over middle age with stage IIIb or IV asymptomatic or less symptomatic Kienböck disease.
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Affiliation(s)
- Tomoyuki Niwa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, Japan.
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10
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Unusual case of closed rupture of both extensor tendons of the index finger. EUROPEAN JOURNAL OF PLASTIC SURGERY 2008. [DOI: 10.1007/s00238-008-0292-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Pacha-Vicente D, Sevilla-Tirado J, López-Martínez R, Lluch-Bergadà A, Mir-Bulló X, Llusá-Pérez M. Extensor digiti minimi damage due to longstanding Kienböck's disease. J Hand Surg Eur Vol 2007; 32:231. [PMID: 17222487 DOI: 10.1016/j.jhsb.2006.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2006] [Revised: 11/05/2006] [Accepted: 11/14/2006] [Indexed: 02/03/2023]
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12
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Ali SM, O'Farrel D. Extensor tendon rupture of finger while playing Uileann pipe. Ir J Med Sci 2007; 175:81. [PMID: 17312838 DOI: 10.1007/bf03167976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Park JW, Kim SK, Park JH, Wang JH, Jeon WJ. Multiple extensor tendon ruptures with advanced Kienböck's disease. J Hand Surg Am 2007; 32:233-5. [PMID: 17275599 DOI: 10.1016/j.jhsa.2006.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Revised: 11/03/2006] [Accepted: 11/03/2006] [Indexed: 02/02/2023]
Abstract
We describe a patient with spontaneous multiple extensor tendon ruptures that were caused by a displaced fragment of the lunate in advanced Kienböck's disease. Complete excision of the lunate, limited carpal fusion, and extensor tendon reconstructions relieved the patient's symptom and restored function.
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Affiliation(s)
- Jong Woong Park
- Department of Orthopaedic Surgery, College of Medicine, Korea University, Seoul, Korea.
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Kaneko K, Uta S, Mogami A, Mizuno J, Iwase H, Kurosawa H. Lunatomalacia in association with congenital synostosis between the capitate and the hamate. CHIRURGIE DE LA MAIN 2001; 20:312-6. [PMID: 11582910 DOI: 10.1016/s1297-3203(01)00052-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This report describes a case of lunatomalacia associated with congenital synostosis between the capitate and the hamate, an association not previously reported. The case was examined in detail, and compared to the findings in the literature including observation regarding prognosis of lunatomalacia.
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Affiliation(s)
- K Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, 1129 Nagaoka, Izunagaoka, Tagata, Shizuoka #410-2295, Japan
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