Skiing-induced rupture of the extensor pollicis longus tendon: a report of three cases

Spontaneous Rupture of the Extensor Pollicis Longus in a Semi-professional Bodybuilder

Spontaneous rupture of the extensor pollicis longus is a rare injury. Distal radius fractures and rheumatisms are the principal causes, but there is an increase in cases related to some professional or sports activities. We report a case of a semi-professional bodybuilder who presented with a full loss of interphalangeal thumb extension and retropulsion following trivial trauma of the left wrist. Ultrasound confirmed the diagnosis of spontaneous rupture of extensor pollicis longus, and MRI revealed a very rare and aggressive anatomical variant of Lister's tubercle. The patient underwent a transfer of the extensor indicis propius, which is the most popular technique used for hyperextension and retropulsion restitution. Aggressive anatomical forms of Lister's tubercle can explain the frequent occurrence of spontaneous rupture of extensor pollicis longus in patients who practice sports or professions with a repetitive movement of the wrist.

Functional Recovery Following an L-Lengthening Local Tendon Flap for Extensor Pollicis Longus Chronic Ruptures

PURPOSE

Extensor indicis proprius tendon transfer has been considered the reference standard technique for extensor pollicis longus (EPL) chronic ruptures, but relevant complications have been reported. We describe a new reconstructive technique for chronic EPL ruptures and assess functional recovery after this procedure.

METHODS

We observed 31 patients who fulfilled inclusion criteria an average of 6.8 months after treatment. An L-shaped local tendon flap was prepared by making a transverse incision to the middle of the tendon and then longitudinally toward the end of one of the tendon stumps. Absorbable suture was used to coapt the free ends and as a reinforcement suture. We used the total active motion scale to classify results.

RESULTS

Total active motion in patients who completed the follow-up period was 89% of the normal side; 97% of patients returned to their previous employment. Surgical complications were infrequent and only one patient (3%) required surgery for extensor tendon adhesions.

CONCLUSIONS

This technique permits reconstruction of the EPL tendon without the need for a tendon graft or tendon transfer.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.