Rupture of extensor tendon secondary to previously undiagnosed Kienböck disease

Artificial Lunate Arthroplasty for Kienböck Disease With Multiple Extensor Tendon Ruptures: A Case Report

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.

Closed extensor tendon rupture caused by Kienböck disease: a case report

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.

Spontaneous extensor tendon rupture due to scaphoid osteophyte: A case report and literature review

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.

Extensor Tendon Rupture Due to Advanced Kienböck's Disease: Two Case Reports and a Review of Literature

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 2^nd, 3^rd and 4^th 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.

Closed rupture of extensor tendon resulting from untreated Kienböck disease: A case report and a review of the literature

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.

Flexor Tendon Rupture Due to Previously Undiagnosed Kienböck Disease: A Case Report

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.