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Alsaedi OF, Alshahir AA, Alzahim AF, Alharbi WM, Alsaygh EF, Alhamaid YA, Alahmadi HM, Beek AS, Elgarya IM. Etiology of Traumatic Causes of Extensor Pollicis Longus Tendon Rupture: A Systematic Review. J Hand Microsurg 2024; 16:100038. [PMID: 38855526 PMCID: PMC11144643 DOI: 10.1055/s-0043-1768485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Introduction The extensor pollicis longus (EPL) is a muscle that follows a complex anatomical course in the hand to allow for thumb extension. Almost all manual activities require the use of the EPL; therefore, when ruptured it can be very disabling for patients. The etiologies behind traumatic EPL rupture were mostly attributed to distal radius fracture in the literature. However, EPL rupture remains uncommon, and other traumatic etiologies exist. Therefore, this systematic review aimed to provide a holistic view of the traumatic etiologies behind the EPL rupture and fill the global lack of knowledge regarding this rare injury. Materials and Methods We searched among Cochrane Central Register of Controlled Trials (CENTRAL) Embase, Medline, and Cochrane Database of systematic review register databases via Ovid, with no restriction on the date, including studies containing data about the etiology of traumatic causes of EPL tendon rupture with available full text, and excluding non-English and animal studies. Results A total of 37 articles with 371 cases constituted the basis of this review. We classified the etiology of the EPL rupture into three groups according to the affected anatomical structure that caused the EPL rupture (fracture-related, soft tissue-related, and mallet thumb). Conclusion Distal radius fractures remain the most common cause of EPL rupture; however, other causes, such as lacerations, blunt trauma, and direct cuts to the EPL tendon, should be considered.
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Affiliation(s)
| | | | | | | | - Ehab Fayez Alsaygh
- College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
| | | | | | - Asem Saleh Beek
- College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
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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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Ikumi A, Okuwaki S, Hara Y, Yoshii Y, Kawamura H. Spontaneous rupture of the extensor pollicis longus tendon in systemic lupus erythematosus: A case report and literature review. Mod Rheumatol Case Rep 2022; 6:29-32. [PMID: 34505159 DOI: 10.1093/mrcr/rxab004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/30/2021] [Accepted: 05/25/2021] [Indexed: 06/13/2023]
Abstract
Spontaneous tendon rupture is a rare entity. Herein, we report a case of spontaneous rupture of the extensor pollicis longus (EPL) tendon in a 61-year-old woman with systemic lupus erythematosus (SLE). The patient worked as an aesthetician and had a 42-year history of SLE that was well controlled using oral steroids. She presented with an inability to extend her left thumb, with no prior history of trauma or symptoms. On imaging, there was no evidence of degenerative changes or osteophyte formation in the gliding area of the EPL tendon. Intraoperatively, there was evidence of tendon rupture around Lister's tubercle. We performed a tendon transfer of the extensor indicis proprius for repair. The patient recovered active thumb extension and returned to work 4 months after surgery without any complications. We suspected that spontaneous EPL tendon rupture was caused by a combination of disease-related factors, including long-term steroid use, chronic inflammation, and continuous mechanical stress from her work and daily activity. This case report demonstrates the multifactorial aetiology of spontaneous tendon rupture in patients with SLE and the importance of monitoring for this complication during routine follow-up.
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Affiliation(s)
- Akira Ikumi
- Department of Orthopaedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Ibaraki, Japan
| | - Shun Okuwaki
- Department of Orthopaedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Ibaraki, Japan
| | - Yuki Hara
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Haruo Kawamura
- Department of Orthopaedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Ibaraki, Japan
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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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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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