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Boulazaib I, Lachkar A, Abdeljaouad N, Yacoubi H. Spontaneous Rupture of the Extensor Pollicis Longus in a Semi-professional Bodybuilder. Cureus 2023; 15:e35062. [PMID: 36942170 PMCID: PMC10024541 DOI: 10.7759/cureus.35062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 02/18/2023] Open
Abstract
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.
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Affiliation(s)
- Issam Boulazaib
- Orthopedic Trauma Department, Mohammed VI University Hospital, Oujda, MAR
- Orthopedics, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
| | - Adnane Lachkar
- Orthopedic Trauma Department, Mohammed VI University Hospital, Oujda, MAR
- Orthopedics, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
| | - Najib Abdeljaouad
- Orthopedic Trauma Department, Mohammed VI University Hospital, Oujda, MAR
- Orthopedics, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
| | - Hicham Yacoubi
- Orthopedic Trauma Department, Mohammed VI University Hospital, Oujda, MAR
- Orthopedics, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Oujda, MAR
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Aruma JF, Herickhoff P, Taylor K, Seidenberg P. Spontaneous rupture of the extensor pollicis longus tendon in a lacrosse player. PHYSICIAN SPORTSMED 2022; 50:553-556. [PMID: 35734945 DOI: 10.1080/00913847.2022.2093619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Spontaneous rupture of the extensor pollicis longus (EPL) tendon at the wrist has been reported with predisposing factors to include distal radius fractures, rheumatoid arthritis, systemic or local steroids, and repetitive abnormal motion of the wrist joint.We present a case of an 18-year-old college lacrosse player without history of known predisposing factors who presented with an acute inability to extend the interphalangeal (IP) joint of his right thumb. Preoperative musculoskeletal ultrasound demonstrated rupture of the EPL tendon proximal to the carpometacarpal (CMC) joint of the thumb. A tendon transfer was therefore performed, where the extensor indicis proprius (EIP) was surgically rerouted to reconstruct the ruptured EPL. The athlete eventually returned to competition without sequela.We suggest that the tendon rupture was secondary to repetitive stick checking during play, causing microtrauma to his exposed dorsal wrist. Lacrosse team physicians, athletic trainers, and equipment managers should be aware of this injury mechanism and ensure that their players, and attackmen in particular, are equipped with gloves which adequately pad the dorsal wrist to decrease the risk of microtrauma to the EPL tendon.
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Affiliation(s)
- Jane-Frances Aruma
- Department of Orthopaedics, Penn State College of Medicine, State College, PA, USA
| | - Paul Herickhoff
- Department of Orthopaedics, Penn State College of Medicine, State College, PA, USA
| | - Kenneth Taylor
- Department of Orthopaedics, Penn State College of Medicine, State College, PA, USA
| | - Peter Seidenberg
- Department of Family Medicine, Louisiana State University Health Shreveport, Shreveport, LA, USA
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Louka JG, Zeine G, Pourre D. Spontaneous Rupture of the Extensor Pollicis Longus Tendon in Console Video Game Players: A Case Series. J Orthop Case Rep 2022; 12:42-46. [PMID: 36684505 PMCID: PMC9826693 DOI: 10.13107/jocr.2022.v12.i07.2910] [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: 02/11/2022] [Revised: 04/08/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Extensor pollicis longus (EPL) tendon spontaneous rupture has been related to numerous risk factors including wrist fractures, rheumatoid arthritis, and steroids administered locally or systemically, as well as repetitive and excessive wrist motion. Case Report Four cases of spontaneous rupture of the EPL tendon, diagnosed clinically, in console video game players, were reported by the authors. None of the patients had a predisposing factor. Intraoperatively, the rupture of the EPL tendon was observed at the level of the extensor retinaculum. The ruptured tendon was repaired using a conventional extensor indicis proprius to EPL tendon transplant. At the last follow-up, 2 years following surgery, the patients had satisfactory full extension of the thumb. Conclusion This series reported the spontaneous rupture of the EPL tendon without underlying chronic inflammation or bony abnormalities. It is hypothesized that chronic repetitive movements weaken the tendon leading to rupture. The possibility that playing video games can decrease pain sensation evokes concerns regarding overuse.
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Affiliation(s)
- Jean G. Louka
- Department of Orthopaedics and Traumatology, Simone Veil Hospital, Eaubonne, France,Address of Correspondence: Dr. Jean G. Louka, Department of Orthopaedics and Traumatology, Simone Veil Hospital, Eaubonne, France. E-mail:
| | - Georges Zeine
- Department of Orthopaedics and Traumatology, Simone Veil Hospital, Eaubonne, France
| | - Damien Pourre
- Department of Orthopaedics and Traumatology, Simone Veil Hospital, Eaubonne, France
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Patel HA, Lee MC, Chaudhry S. Extensor Pollicis Longus Tendon Rupture After a Pediatric Distal Radius Fracture: A Case Report and Literature Review. JBJS Case Connect 2020; 10:e2000022. [PMID: 32910621 DOI: 10.2106/jbjs.cc.20.00022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 16-year-old boy underwent closed reduction and pinning of a Salter-Harris II distal radius fracture (DRF). Extensor pollicis longus (EPL) rupture occurred 6 weeks after the injury. Extensor indicis proprius transfer was performed using wide-awake local anesthesia no tourniquet (WALANT) technique. Active thumb range of motion was restored, and the patient returned to all activities, including sports, after 2 months. CONCLUSION Although delayed attritional EPL rupture after DRF is a well-known complication in adults, this is the first reported case in a truly skeletally immature patient. Awareness of this complication prompts monitoring for prodromal signs and symptoms. The WALANT technique is feasible in selected children.
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Affiliation(s)
- Harshadkumar A Patel
- 1Department of Orthopedic Surgery, University of Connecticut, Connecticut Children's Medical Center, Hartford, Connecticut
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Al-Omari AA, Ar Altamimi A, ALQuran E, Saleh AAA, Alyafawee QM, Audat MZ, Bashaireh K. Spontaneous Rupture of Extensor Pollicis Longus Tendon: Clinical and Occupational Implications, Treatment Approaches and Prognostic Outcome in Non-Rheumatoid Arthritis Patients: A Retrospective Study. Open Access Rheumatol 2020; 12:47-54. [PMID: 32425622 PMCID: PMC7196201 DOI: 10.2147/oarrr.s253583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/09/2020] [Indexed: 12/03/2022] Open
Abstract
Background Spontaneous rupture of extensor pollicis longus (EPL) tendon is a rare condition often found in patients actively having regular extensive use of hands and fingers especially the thumb. In this article, we report 7 cases of spontaneous rupture of EPL tendon and investigate the associated factors and treatment outcome. Methods Retrospectively, the databases for the 7 cases were retrieved and studied. These cases represent all cases of spontaneous rupture of EPL in our institution. Demographic data, clinical presentation, any history of trauma or steroid injection, laboratory and clinical findings suggestive for rheumatoid arthritis, co-morbidities and imaging findings were obtained. In addition, the operative technique and findings were retrieved. Moreover, histopathological studies and follow-up assessment were included. Results Six males and one female were included. The mean age was 45.2 years. No prior history of trauma, rheumatological disease or steroid use was detected in any patient. All patients experienced prodromal pain in the radial side. Clinical examination was the most effective diagnostic measure. Magnetic resonance imaging (MRI) was used to confirm the diagnosis and to look for other abnormalities that may predispose to rupture. Five patients underwent extensor indicis proprius to EPL tendon transfer employing Pulvertaft weave technique and one patient underwent primary repair as there was a little gap in the tendon ends. In this study, one patient refused any treatment. All patients achieved a favorable outcome at the last follow-up. Conclusion Diagnosis of spontaneous ruptures of EPL tendon can be confirmed through clinical examination and MRI for patients with restricted thumb movement even with the absence of any identifiable predisposing risk factor. During surgery, detailed attention must be drawn towards the tendon ends which can have unusual gaps and bone abnormalities.
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Affiliation(s)
- Ali A Al-Omari
- Department of Special Surgery, Division of Orthopedics, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Anas Ar Altamimi
- Department of General and Specialized Surgery, Faculty of Medicine, Hashemite University, Zarqa 13133, Jordan
| | - Esra'a ALQuran
- Department of Pathology, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Abed Allah Ahmad Saleh
- Department of Special Surgery, Division of Orthopedics, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Qusai Mustafa Alyafawee
- Department of Special Surgery, Division of Orthopedics, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Mohammad Ziad Audat
- King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Khaldoon Bashaireh
- Department of Special Surgery, Division of Orthopedics, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
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Ghazal L, Nabi M, Little C, Teh J. Ultrasound assessment of extensor pollicis longus tendon rupture following distal radius fracture: a sonographic and surgical correlation. J Ultrason 2020; 20:e1-e5. [PMID: 32320552 PMCID: PMC7266066 DOI: 10.15557/jou.2020.0001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/10/2019] [Indexed: 11/30/2022] Open
Abstract
Aim of the study To assess the features identified on ultrasound in patients presenting with suspected extensor pollicis longus tendon rupture, and correlate this with surgical findings. Material and methods A retrospective case series review was performed in 11 patients (8 female, 3 male) with suspected extensor pollicis longus tendon rupture. All ultrasound examinations were performed by an experienced musculoskeletal radiologist using a high-resolution linear-array probe. The study evaluated the associated sonographic appearances of extensor pollicis longus tendon rupture and correlated with surgical findings. Results Rupture of the extensor pollicis longus tendon was identified in all cases proximally at the level of Lister’s tubercle. The most common associated sonographic finding was an effusion in the sheath of compartment III (10 patients); 9 patients also had fluid within the sheath of compartment II. An empty tendon sheath was observed in 1 patient and tenosynovitis of the extensor pollicis longus sheath was demonstrated in 2 cases. In 9 patients, sonography revealed the retracted tendon ends as enlarged and hypoechoic with loss of their normal fibrillar appearance. Ultrasound depicted fracture involvement of Lister’s tubercle in 8 cases (compared to 4 cases identified radiographically). In the 8 cases that proceeded to operative intervention, all of these were confirmed as extensor pollicis longus tendon rupture. Conclusion Ultrasound is a valuable tool in identifying patients with extensor pollicis longus tendon rupture, providing the surgeon with invaluable details with regard to the level of rupture to aid pre-operative planning. US identifies associated ancillary features of extensor pollicis longus tendon rupture and reliably detects fractures involving Lister’s tubercle.
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Affiliation(s)
- Louy Ghazal
- Department of Radiology , Nuffield Orthopaedic Centre , Oxford , UK
| | - Mohammed Nabi
- Department of Radiology , Nuffield Orthopaedic Centre , Oxford , UK
| | | | - James Teh
- Department of Radiology , Nuffield Orthopaedic Centre , Oxford , UK
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A case of extensor pollicis longus (EPL) tendon rupture in an automotive assembly line worker: an ergonomic evaluation through job strain index (JSI) and musculoskeletal risk factor survey. Ann Occup Environ Med 2019; 31:e2. [PMID: 31543963 PMCID: PMC6751743 DOI: 10.35371/aoem.2019.31.e2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 04/16/2019] [Indexed: 11/27/2022] Open
Abstract
Background We report a case of extensor pollicis longus (EPL) tendon rupture caused by repetitive motions and awkward posture on hand and wrist joints. Case presentation A 47-year-old right-handed man who worked for 15 years in an assembly line at an automotive manufacturing company has been diagnosed with a complete tear of right EPL tendon. We investigated the patient's occupational history in detail and evaluated the tasks ergonomically through musculoskeletal risk factors survey and job strain index (JSI) using the 22 task-related videos recorded by the patient. Three out of the 12 tasks (25%) were identified as high-risk work on the hand and wrist in the musculoskeletal risk factors survey in 2016. Among the 22 tasks analyzed by JSI, 11 tasks (50%) were evaluated as probably hazardous. In addition, he used localized vibration tools in 19 (86.4%) out of 22 tasks. Conclusion We concluded the patient's disease was probably caused by repetitive motion and improper posture of the hand and wrist, and the hand-arm vibration is a possible cause as well.
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Kitridis D, Bei G, Dogramatzis K, Givissis P. Death of an Extensor Pollicis Longus due to a Funeral. J Orthop Case Rep 2018; 8:89-91. [PMID: 30740386 PMCID: PMC6367279 DOI: 10.13107/jocr.2250-0685.1228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Traumatic and atraumatic rupture of the extensor pollicis longus (EPL) tendon has been described as a result of mechanical or biological stresses. Common mechanisms include fractures of the distal radius, rheumatoid arthritis, local injection of steroids, and repetitive motion activities at the wrist. CASE REPORT We report a case involving the spontaneous rupture of the EPL tendon in a relative of a deceased person who carried her coffin in a wrong way with no other predisposing factors. A three-dimensional simulation model was created in an attempt to illustrate the forces applied at his wrist. CONCLUSION Our case indicates that carriage of a coffin should be done by four undertakers, ideally of the same height, on their shoulders. Furthermore, a high level of suspicion is needed when tenderness over Lister's tubercle after any type of trauma is encountered.
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Affiliation(s)
- Dimitrios Kitridis
- Department of Orthopaedics, 424 General Military Hospital, Thessaloniki, Greece,Address of Correspondence: Dr. Dimitrios Kitridis, Department of Orthopaedics, 424 General Military Hospital, Thessaloniki, Greece. E-mail:
| | - Georgia Bei
- Department of Civil Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Panagiotis Givissis
- Department of Orthopaedics, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Pal JN, Bera AK, Roy AN, Bari W. Palmaris Longus Tendon Grafting for Extensor Pollicis Longus Tendon Rupture bScrew Tip after 20 years. J Orthop Case Rep 2017; 6:25-27. [PMID: 28116261 PMCID: PMC5245929 DOI: 10.13107/jocr.2250-0685.486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Spontaneous ruptures of extension pollicis longus tendon predominantly occur after undisplaced or minimally displaced distal radial fracture near Lister tubercle. Systemic inflammatory diseases and systemic or local steroid, mechanical causes like bony ridges, presence of bone plate or external fixator pin may precipitate this. Repetitive uses in certain occupation like cooking, cow milking, tailoring and direct trauma in kick boxer are also identified as cause. In this study it is caused by screw tip that also after 20 years. Instead of tendon transfer, interposition tendon grafting is preferred. Cade Presentaton: A 36-year-old male manual worker was plated for distal radial shaft fracture of left side. Distal most screw length was 3 mm in excess. After 20 years he developed rupture of extensor pollicislongus spontaneously. After excluding probable other causes and confirming by USG tendon ends were explored through dorsal incision. Offending slotted head screw was removed using hollow mill. Ipsilateral Palmaris longus tendon was grafted. Tension was set by extension of thumb and neutral position of the wrist. Removal of stitch after 2 weeks, short arm cast immobilization for 6 week and intermittent splinting and exercises for another 6 weeks yield excellent result. Conclusion: Timely removal of implant when it is applied over tendon rich areas is preferable. In late situation surgeon should be equipped and careful to remove it. To avoid chance of transferring a diseased tendon interposition grafting using Palmaris longus is justified.
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Affiliation(s)
- Jitendra Nath Pal
- Department of Orthopedics, Murshidabad Medical College, PO - Berhampore, District - Murshidabad, West Bengal Pin-742101, India
| | - Amiya Kumar Bera
- Department of Orthopedics, Murshidabad Medical College, PO - Berhampore, District - Murshidabad, West Bengal Pin-742101, India
| | - Amarendra Nath Roy
- Department of Orthopedics, Murshidabad Medical College, PO - Berhampore, District - Murshidabad, West Bengal Pin-742101, India
| | - Wasim Bari
- Department of Orthopedics, Murshidabad Medical College, PO - Berhampore, District - Murshidabad, West Bengal Pin-742101, India
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Hu CH, Fufa D, Hsu CC, Lin YT, Lin CH. Revisiting spontaneous rupture of the extensor pollicis longus tendon: eight cases without identifiable predisposing factor. Hand (N Y) 2015; 10:726-31. [PMID: 26568731 PMCID: PMC4641100 DOI: 10.1007/s11552-015-9746-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Rupture of the extensor pollicis longus (EPL) tendon has been reported in the setting of distal radius fracture, chronic inflammatory arthritis, following steroid injection, and with excessive or repetitive activities. Truly, spontaneous EPL rupture, without an identifiable predisposing factor, has rarely been reported. METHODS We present a retrospective case series of eight patients with spontaneous EPL rupture who were treated in our institution. RESULTS The majority of the cases were female (75 %, n = 6), and the nondominant (75 %, n = 6) hand was most commonly involved. No identifiable predisposing factor could be identified in four patients. While four patients reported a history of a fall, radiographs failed to demonstrate skeletal abnormality in all four cases. No additional pathology could be identified at the time of surgery. Patients were treated using tendon transfer (n = 7) or interpositional graft (n = 1). There has been no case of clinical recurrence in the mean of 74.8 months (range 23-140 months) follow-up period. CONCLUSION The EPL tendon is at risk for spontaneous rupture even in the absence of identifiable predisposing risk factor. Rather than pure mechanical irritation, vascular and metabolic factors may also play a substantial role in the etiology of this uncommon diagnosis.
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Affiliation(s)
- Ching-Hsuan Hu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan, 333 Taiwan
| | - Duretti Fufa
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan, 333 Taiwan
| | - Chung-Chen Hsu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan, 333 Taiwan
| | - Yu-Te Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan, 333 Taiwan
| | - Chih-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan, 333 Taiwan
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Taş S, Balta S, Benlier E. Spontaneous Rupture of the Extensor Pollicis Longus Tendon due to Unusual Etiology. Balkan Med J 2014; 31:105-6. [PMID: 25207178 DOI: 10.5152/balkanmedj.2013.9027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 09/12/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The etiology of spontaneous rupture of the extensor pollicis longus tendon includes systemic or local steroid injections, wrist fracture, tenosynovitis, synovitis, rheumatoid arthritis, and repetitive wrist motions. CASE REPORT We encountered a case of extensor pollicis longus tendon rupture with an unusual etiology, cow milking. In this case, transfer of the extensor indicis proprius tendon was performed successfully. At 1 year after surgery, extension of the thumb was sufficient. CONCLUSION It appears that patients with occupations involving repetitive motions are at a high risk of closed tendon ruptures.
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Affiliation(s)
- Süleyman Taş
- Department of Plastic, Reconstructive and Aesthetic Surgery, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Serkan Balta
- Department of Plastic, Reconstructive and Aesthetic Surgery, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Erol Benlier
- Department of Plastic, Reconstructive and Aesthetic Surgery, Trakya University Faculty of Medicine, Edirne, Turkey
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12
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Gallucci GL, Pacher N, Boretto JG, De Carli P. Bilateral rupture of the extensor pollicis longus tendon. A case report. ACTA ACUST UNITED AC 2013; 32:186-8. [PMID: 23665311 DOI: 10.1016/j.main.2013.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 03/20/2013] [Accepted: 04/08/2013] [Indexed: 10/26/2022]
Abstract
Bilateral rupture of the extensor pollicis longus (EPL) is a rare entity and the few cases that have been reported were associated with an underlying systemic condition such as rheumatoid arthritis or following an injury. We present the case of a patient who was referred to us with a spontaneous rupture of the EPL tendon of the right wrist and that of the left side observed 2 months after tenosynovectomy. The patient had not any pathologic condition or evidence of trauma in both wrists. In the left side, he was operated on and a tenolysis and subcutaneous tendon transposition was performed. Despite this preventive surgery, the patient suffered from a tendon rupture. The possible causes of surgery failure are discussed.
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Affiliation(s)
- G L Gallucci
- Institute of orthopedics and traumatology Prof. Dr. Carlos E. Ottolenghi, hospital Italiano, Buenos Aires, Argentina.
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Choi JC, Kim WS, Na HY, Lee YS, Song WS, Kim DH, Park TH. Spontaneous rupture of the extensor pollicis longus tendon in a tailor. Clin Orthop Surg 2011; 3:167-9. [PMID: 21629480 PMCID: PMC3095790 DOI: 10.4055/cios.2011.3.2.167] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2009] [Accepted: 05/06/2009] [Indexed: 11/06/2022] Open
Abstract
A spontaneous rupture of the extensor pollicis longus (EPL) tendon is associated with rheumatoid arthritis, fractures of the wrist, systemic or local steroids and repetitive, and excessive abnormal motion of the wrist joint. The authors encountered a case of a spontaneous rupture of the EPL tendon. The patient had no predisposing factors including trauma or steroid injection. Although the patient had a positive rheumatoid factor, he did not demonstrate other clinical or radiological findings of rheumatoid arthritis. During surgery, the EPL tendon was found to be ruptured at the extensor retinaculum (third compartment). Reconstruction of the extensor tendon using the palmaris longus tendon was performed. At the 18-month follow-up, the patient showed satisfactory extension of the thumb and 40° extension and flexion at the wrist.
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Affiliation(s)
- Jun Cheol Choi
- Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
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14
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Bhangu A, Lwin M, Dias R. Wimbledon or bust: Nintendo Wii related rupture of the extensor pollicis longus tendon. J Hand Surg Eur Vol 2009; 34:399-400. [PMID: 19457909 DOI: 10.1177/1753193408098906] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Aneel Bhangu
- Department of Trauma and Orthopaedics, New Cross Hospital, Wolverhampton, UK
| | - Michael Lwin
- Department of Trauma and Orthopaedics, New Cross Hospital, Wolverhampton, UK
| | - Richard Dias
- Department of Trauma and Orthopaedics, New Cross Hospital, Wolverhampton, UK
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16
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Wong TC, Chiu Y, Ip FK. Re: spontaneous rupture of the extensor pollicis longus tendon while playing video games. J Hand Surg Eur Vol 2008; 33:225-6. [PMID: 18443081 DOI: 10.1177/1753193408087114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- T. C. Wong
- Department of Orthopaedics and Traumatology, Pamela Youde
Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong SAR, China
| | - Y. Chiu
- Department of Orthopaedics and Traumatology, Pamela Youde
Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong SAR, China
| | - F. K. Ip
- Department of Orthopaedics and Traumatology, Pamela Youde
Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong SAR, China
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Perugia D, Ciurluini M, Ferretti A. Spontaneous rupture of the extensor pollicis longus tendon in a young goalkeeper: a case report. Scand J Med Sci Sports 2008; 19:257-9. [DOI: 10.1111/j.1600-0838.2008.00779.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Parellada AJ, Gopez AG, Morrison WB, Sweet S, Leinberry CF, Reiter SB, Kohn M. Distal intersection tenosynovitis of the wrist: a lesser-known extensor tendinopathy with characteristic MR imaging features. Skeletal Radiol 2007; 36:203-8. [PMID: 17177022 DOI: 10.1007/s00256-006-0238-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Revised: 10/11/2006] [Accepted: 10/17/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To present the MRI imaging findings of extensor tenosynovitis at the distal intersection or crossover between the second (extensor carpi radialis longus (ECRL) and brevis (ECRB)) and third (extensor pollicis longus (EPL)) extensor compartment tendons, and the anatomical details that may play a role in the pathogenesis of this condition. DESIGN AND PATIENTS The imaging studies and clinical records of five patients (three females and two males, with ages ranging between 22 and 78 years; mean age, 49 years) presenting with pain on the dorsal and radial aspect of the wrist were reviewed by two musculoskeletal radiologists in consensus. Three cases were identified serendipitously during routine clinical reading sessions; a follow-up computerized database search for additional cases reported in the prior two years yielded two additional cases. The overall number of cases screened was 1,031. The diagnosis of tendinopathy affecting the second and third compartment extensor tendons was made on the basis of MRI findings and clinical follow-up, or synovectomy. RESULTS All patients showed signs of tenosynovitis: in four patients both the tendons of the second and third extensor compartments were affected; the fifth patient showed signs of tenosynovitis of the EPL tendon, and tendinosis of the extensor carpi radialis tendons. Three patients showed tenosynovitis proximal and distal to the point of intersection; and in two of them, a discrete point of constriction was appreciated at the crossover site in relation to the extensor retinaculum. Two patients showed tenosynovitis limited to the segment distal to the point of decussation. Tendinosis tended to follow the presence of tenosynovitis. In one of the patients, subtendinous reactive marrow edema in Lister's tubercle was noted. CONCLUSION Distal intersection tenosynovitis may be related to the biomechanical pulley effect exerted by Lister's tubercle on the EPL tendon as it leaves the third compartment and crosses over the extensor carpi radialis tendons, as well as the constraining effect of the extensor retinaculum. These anatomical features determine the presence of characteristic MR imaging findings.
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Shigematsu K, Yajima H, Takakura Y. Extensor pollicis longus tendon rupture as a result of scapholunate dissociation: a case report. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2006; 10:307-10. [PMID: 16568534 DOI: 10.1142/s0218810405002899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Accepted: 11/30/2005] [Indexed: 11/18/2022]
Abstract
A 39-year-old patient was presented with, to our knowledge, the first ever diagnosed case of extensor pollicis longus (EPL) tendon rupture as a result of scapholunate (S-L) dissociation. Arthroscopic findings showed that the dorsal aspect of the S-L ligament was ruptured and severe synovitis was revealed around the S-L joint. Direct observation revealed synovium at the rupture site of the EPL tendon. After careful resection of this synovium, an aperture in the S-L joint was observed. Thus, it was considered that the synovium in the S-L joint was connected to the rupture site of the EPL tendon, passing through the dorsal capsule of the S-L joint. The ruptured EPL tendon was reconstructed with extensor indicis proprius tendon transfer, and S-L dissociation was treated with a bone-retinaculum-bone autograft taken from the third dorsal compartment region.
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Affiliation(s)
- Koji Shigematsu
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
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Fujita N, Doita M, Yoshikawa M, Fujioka H, Sha N, Yoshiya S. Spontaneous rupture of the extensor pollicis longus tendon in a professional skier. Knee Surg Sports Traumatol Arthrosc 2005; 13:489-91. [PMID: 16170583 DOI: 10.1007/s00167-004-0539-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2004] [Accepted: 04/14/2004] [Indexed: 12/01/2022]
Abstract
Spontaneous rupture of the extensor pollicis longus (EPL) tendon is uncommon in sports activities. We report a rare case of a professional downhill skier presenting with a rupture of the EPL tendon. Repetitive motion of the wrist joint appeared to cause the rupture. The patient was treated successfully with tendon transfer of the extensor indicis proprius.
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Affiliation(s)
- Norifumi Fujita
- Department of Orthopedic Surgery, Kanebo Memorial Hospital, Kobe, Japan
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De Maeseneer M, Marcelis S, Osteaux M, Jager T, Machiels F, Van Roy P. Sonography of a Rupture of the Tendon of the Extensor Pollicis Longus Muscle: Initial Clinical Experience and Correlation with Findings at Cadaveric Dissection. AJR Am J Roentgenol 2005; 184:175-9. [PMID: 15615970 DOI: 10.2214/ajr.184.1.01840175] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objectives of our study were to report our initial clinical experience with sonography of the wrist for diagnosing a proximal rupture of the tendon of the extensor pollicis longus (EPL) muscle and to perform sonographic-anatomic correlation of the EPL tendon. MATERIALS AND METHODS Clinical and imaging files of five patients who underwent sonography and subsequent open wrist surgery were reviewed retrospectively. Imaging was performed by four radiologists experienced in musculoskeletal sonography. Tendon retraction was evaluated on sonography and at surgery. In cadavers, sonography was performed in concert by two musculoskeletal radiologists during progressive stages of dissection of four embalmed specimens. One specimen was sliced in the transverse plane. RESULTS In cadavers, the EPL tendon was located on or adjacent to Lister's tubercle and extended to the base of the thumb. The EPL tendon crossed over the extensor carpi radialis tendons where it exhibited a flattened aspect. In the five patients in the study, a tubular-shaped hypoechoic area was evident at the position of the ruptured EPL tendon on sonograms. At surgery, this area corresponded to fluid, hemorrhage, and scar tissue in the EPL tendon sheath. The assessment of tendon retraction on sonography correlated with findings at surgery. CONCLUSION Sonography may aid in diagnosing a rupture of the EPL tendon and in the preoperative assessment of gap size and position of the retracted tendon ends. A characteristic tubular hypoechoic area may be seen crossing over the extensor carpi radialis tendons.
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Affiliation(s)
- Michel De Maeseneer
- Department of Radiology, Vrije Universiteit Brussel, Laarbeeklaan 101, Brussels 1090, Belgium.
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Zazryn TR, Finch CF, McCrory P. A 16 year study of injuries to professional kickboxers in the state of Victoria, Australia. Br J Sports Med 2004; 37:448-51. [PMID: 14514540 PMCID: PMC1751360 DOI: 10.1136/bjsm.37.5.448] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the rate and type of injuries occurring to registered professional kickboxers in Victoria, Australia over a 16 year period. METHODS Data describing all fight outcomes and injuries sustained during competition for the period August 1985 to August 2001 were obtained from the Victorian Professional Boxing and Combat Sports Board. RESULTS A total of 382 injuries were recorded from 3481 fight participations, at an injury rate of 109.7 injuries per 1000 fight participations. The most common body region injured was the head/neck/face (52.5%), followed by the lower extremities (39.8%). Specifically, injuries to the lower leg (23.3%), the face (19.4%), and intracranial injury (17.2%) were the most common. Over 64% of the injuries were superficial bruising or lacerations. CONCLUSION The nature of kickboxing, whereby kicking the opponent is the prime movement and the head a prime target, is reflected in the distributions of body regions most commonly injured by participants. Further research into injury patterns in different styles of kickboxing and the mechanism of injury occurrence is required. Exposure adjusted prospective studies are needed to monitor injury rates over time.
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Affiliation(s)
- T R Zazryn
- Department of Epidemiology & Preventive Medicine, Monash University Medical School, Prahran, Victoria, Australia
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Abstract
OBJECTIVE To determine the type and number of injuries that occur during the training and practice of Muay Thai kick boxing and to compare the data obtained with those from previous studies of karate and taekwondo. METHODS One to one interviews using a standard questionnaire on injuries incurred during training and practice of Muay Thai kick boxing were conducted at various gyms and competitions in the United Kingdom and a Muay Thai gala in Holland. RESULTS A total of 152 people were questioned, 132 men and 20 women. There were 19 beginners, 82 amateurs, and 51 professionals. Injuries to the lower extremities were the most common in all groups. Head injuries were the second most common in professionals and amateurs. Trunk injuries were the next most common in beginners. The difference in injury distribution among the three groups was significant (p< or =0.01). Soft tissue trauma was the most common type of injury in the three groups. Fractures were the second most common in professionals, and in amateurs and beginners it was sprains and strains (p< or =0.05). Annual injury rates were: beginners, 13.5/1000 participants; amateurs, 2.43/1000 participants; professionals, 2.79/1000 participants. For beginners, 7% of injuries resulted in seven or more days off training; for amateurs and professionals, these values were 4% and 5.8% respectively. CONCLUSIONS The results are similar to those found for karate and taekwondo with regard to injury distribution, type, and rate. The percentage of injuries resulting in time off training is less.
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Affiliation(s)
- S Gartland
- Department of Orthopaedics, Withington Hospital, Manchester M20 2LR, UK
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