Duplicate extensor tendons of the thumb mimicking rupture of the extensor pollicis longus tendon

We report a patient with duplicate extensor pollicis longus tendons, who complained of inability to extend the thumb fully because of impingement of the musculotendinous junction of the duplicate tendons. Extension of the thumb recovered completely after Lister's tubercle was excised and the extensor retinaculum was released. Selective windowing with highlighting of the soft tissue in the axial T1‐weighted magnetic resonance image at the level of the distal radioulnar joint showed two tendons in the third extensor compartment.     

Hazards of steroid injection: Suppurative extensor tendon rupture

Local steroid injections are often administered in the office setting for treatment of trigger finger, carpal tunnel syndrome, de Quervain''s tenosynovitis, and basal joint arthritis. If attention is paid to sterile technique, infectious complications are rare. We present a case of suppurative extensor tenosynovitis arising after local steroid injection for vague symptoms of dorsal hand and wrist pain. The progression of signs and symptoms following injection suggests a natural history involving bacterial superinfection leading to tendon rupture. We discuss the pitfalls of local steroid injection and the appropriate management of infectious extensor tenosynovitis arising in such situations.     

Closed rupture of the extensor digitorum longus tendon: A case report and biomechanical analysis of rupture mechanism

Closed subcutaneous rupture of the extensor digitorum longus tendon (EDL) has been rarely documented. We present a case report of a patient with closed subcutaneous rupture of EDL. To identify the site of tendon rupture, three-dimensional computed tomography (3D-CT) was performed. The 3D-CT (volume rendering) images indicated tendon rupture of EDL on the dorsal region of the left foot. To identify the mechanisms of EDL rupture we also performed a biomechanical study using three cadavers. The patient granted permission for submission of personal data for publication. From biomechanical findings, pressure of the EDL on the inferior extensor retinaculum was 4.9–10.7 times higher in plantar flexion than in dorsal flexion of the ankle. Therefore, we believe that EDL rupture occurred with a passive flexion force pressing onto the toe tip in the plantar flexion position of the ankle joint.     

Partial extensor carpi radialis longus turn-over tendon transfer for reconstruction of the extensor pollicis longus tendon in the rheumatoid hand: case report

Reconstruction of a distally ruptured extensor pollicis longus tendon in the rheumatoid patient generally involves a tendon transfer or intercalary graft. We present an alternative technique using the radial half of the extensor carpi radialis longus as a turn-over graft. Using the turn-over technique with a half-slip of the extensor carpi radialis longus avoids the traditional limitations of the extensor carpi radialis longus tendon in distal extensor pollicis longus tendon repairs and precludes the need for a free tendon graft.     

股四头肌腱自发性断裂1例

患者,男,25岁,因右膝关节上楼时自觉肿痛、无力、伸膝障碍40 d,于2015年7 月10 日入院就诊.既往患者肾病综合征病史3 年,肾活检电镜诊断为微小病变肾小球肾炎,长期使用激素治疗,高血压病史8 个月,糖尿病病史2 年.40 d前因膝关节疼痛、肿胀至我院肾内科就诊,行膝关节 X线、超声及 MRI检查后诊断为右膝关...     

Avulsion of both extensor carpi radialis tendons: a case report

Closed traumatic avulsion of both extensor carpi radialis tendons is reported in a young healthy patient. Early diagnosis important because the tendons tend to retract and anatomic repositioning is more difficult to perform with passing time. Diagnostic markers are the inability to actively extend the wrist and the presence of dorsal bone fragments on the lateral radiograph of the wrist. We recommend fixation of the avulsed fragments to restore the length and strength of the wrist extensors.     

Neglected bilateral rupture of the patellar tendon: A case report

Simultaneous bilateral rupture of the patellar tendon (PT) is extremely rare and is generally associated to some chronic diseases. When the rupture becomes chronic, it is more difficult to repair that as it remained untreated.The diagnosis, which is clinical, is often delayed, guided by standard radiography and confirmed by ultrasound or MRI.The management of a bilateral neglected, chronic patellar tendon rupture must address some serious difficulties: the proximally retracted patella, the reconstruction of the patellar tendon, finally, the temporary protection of this repair.We report a case of neglected bilateral rupture of the patellar tendon in a chronic hemodialysis patient, treated with a plastic surgery of the ipsilateral quadriceps tendon.     

Spontaneous rupture of the extensor carpi radialis brevis in a 51-year-old man: case report

Dorsal hand osteophytes are common findings in the general population, frequently presenting with dorsal pain and treated with surgical excision. We report the spontaneous rupture of the extensor carpi radialis brevis in association with a previously asymptomatic dorsal scaphoid spur. Following conservative management, surgical excision of dorsal hand osteophytes should be considered for both resolution of pain and prevention of attritional tendon rupture.     

Volar dislocation of the extensor carpi ulnaris tendon on magnetic resonance imaging is associated with extensor digitorum communis tendon rupture in rheumatoid wrists

PURPOSE: Extensor tendon rupture in rheumatoid wrists is a common problem and causes immediate dysfunction of the digits. The best treatment for tendon rupture may be prophylactic management, although the factors associated with tendon rupture must first be identified. The purpose of this study was to evaluate structures around rheumatoid wrists using magnetic resonance imaging with forearm rotation and to identify factors associated with extensor tendon rupture as indications for prophylactic surgery. METHODS: The subjects were 34 patients (40 wrists) with active rheumatoid arthritis. The extensor digitorum communis (EDC) tendons were ruptured in 15 wrists. Magnetic resonance imaging of the wrists was performed in maximally pronated and supinated positions of the forearm. Axial images of the distal radioulnar joints (DRUJs) were selected to evaluate DRUJ synovitis, dorsal tenosynovitis, volar dislocation of the extensor carpi ulnaris (ECU) tendon, sigmoid notch angle, and the radioulnar ratio (RUR) (ie, the degree of DRUJ subluxation). RESULTS: No significant correlations were found between EDC tendon rupture and DRUJ synovitis, dorsal tenosynovitis, or RUR in pronation. Extensor digitorum communis tendon rupture correlated significantly with volar ECU tendon dislocation, sigmoid notch angle, and RUR in supination. Radioulnar ratio correlated significantly with volar ECU tendon dislocation only in supination and not in pronation. Thus, DRUJ subluxation was advanced even in the supinated wrist with volar ECU tendon dislocation. As a factor associated with EDC tendon rupture, volar ECU tendon dislocation had 87% sensitivity and 76% specificity. CONCLUSIONS: Volar ECU tendon dislocation is associated with increased RUR in supination and EDC tendon rupture. Volar ECU tendon dislocation can thus be considered a factor associated with EDC tendon rupture, and its presence may indicate the need for prophylactic surgical intervention in a subset of rheumatoid arthritis patients.     

Simultaneous chronic rupture of quadriceps tendon and contra-lateral patellar tendon in a patient affected by tertiary hyperparatiroidism

Spontaneous ruptures of the extensor mechanism of the knee are very rare. They tend to increase considerably in patients with metabolic diseases such as chronic renal failure, hyperparathyroidism, diabetes, gout, and systemic lupus erythematosus. The reported case regards a 48-year-old man with chronic, spontaneous and simultaneous quadriceps, and contra-lateral patellar tendon rupture. The patient suffered from chronic renal failure and for the past year from tertiary hyperparathyroidism. Ruptured tendons were repaired and both knee were evaluated monthly for the next 12 months. Good functional recovery was achieved on both knees without relapse. This case emphasizes the importance of long-term high parathyroid hormone level in the etiology of tendons ruptures.     

Levofloxacin-induced bilateral Achilles tendon rupture: a case report and review of the literature

We present a rare case of spontaneous bilateral Achilles tendon rupture induced by levofloxacin, one of the fluoroquinolone antibiotics. A 76-year-old man was diagnosed with acute appendicitis and was commenced on oral levofloxacin 300mg/day for 2 weeks. Seven days afterward he developed pain in both Achilles tendons, and at 14 days he developed swelling in the tendons. Four days later he felt a sharp, painful snap in both Achilles tendons while changing trousers. Both Achilles tendons ruptured completely at the mid-portion. There was no obvious underlying disease or pathophysiological factor causing fragility of his Achilles tendons. Despite the relatively large volume of case-based evidence, the pathophysiology of fluoroquinolone-induced tendinitis and tendon rupture is unclear. When tendinitis develops during fluoroquinolone therapy, the physician should consider the possible association between the fluoroquinolone and tendon rupture.     

Flexor carpi radialis tendon rupture as a complication of a closed distal radius fracture: a case report

Although extensor pollicis longus tendon ruptures have been noted as a complication of distal radius fractures, flexor tendon ruptures in association with acute fractures of the distal radius are rare. We report a rupture of the flexor carpi radialis tendon as a complication of an acute distal radius fracture that was discovered during operative management of the fracture.     

Comparison of adverse events and postoperative mobilization following knee extensor mechanism rupture repair: A systematic review and network meta-analysis

BackgroundExtensor mechanism rupture (EMR) of the knee is a rare but potentially debilitating injury that often occurs due to trauma. While a wide variety of surgical treatments have been reported, there is currently no consensus on the most successful treatment method. The timing of post-operative joint mobilization is also critical for successful recovery after EMR repair. Despite the traditional method of complete immobilization for 6 weeks, there is an increasing trend towards early post-operative knee mobilization. The purpose of this network meta-analysis was to compare adverse event rates and function outcomes between repair methods and between post-operative mobilization protocols.MethodsMEDLINE, EMBASE, Web of Science, and Cochrane Central electronic databases were searched in August 2016 for observational studies involving repair of acute, traumatic EMRs. Data extraction included functional outcomes, adverse events, and additional surgeries. Cohort studies that were used in functional outcome analysis were assessed for risk of bias by the Newcastle-Ottawa Quality Assessment Scale (NOS).ResultsTwenty-three studies (709 patients) were included for adverse event analysis. There were no significant differences in adverse event or additional surgery rates between EMR repair methods However, early mobilization produced significantly higher adverse event rates (p = 0.02) and total event rates (p < 0.001) than late mobilization, but the difference in additional surgery rates was not significant (p = 0.06). Six studies (85 patients) were included for functional outcome analysis. There were no significant differences in thigh girth atrophy or muscle strength compared to the contralateral leg between patients treated with transosseous drill holes and simple end-to-end sutures.ConclusionsWe performed the first network meta-analysis to date comparing treatment of EMRs. Our results support the current body of knowledge that there is no single superior repair method. Although there is an increasing trend towards early or immediate post-operative knee mobilization, we found that early mobilization is associated with significantly higher adverse event and total event rates compared to fixed immobilization for a minimum of 6 weeks, implicating an increased financial burden and decreased quality of life associated with early post-operative mobilization.     

Rupture of the extensor pollicis longus tendon: a study of aetiological factors

Although rupture of the extensor pollicis longus (EPL) tendon is a wellknown complication of distal radial fractures, a number of patients rupture the EPL because of other conditions. We have retrospectively studied the aetiology of 27 ruptures of the EPL in 26 consecutive patients. Of 19 patients with injured wrists 12 had distal radial fractures, five had blunt trauma, and two had stab wounds that resulted in rupture. In the radial fractures operated on, the EPL rupture was caused by chafing against a dorsal plate (n?=?2) or wear against the pins of an external fixator (n?=?2). Six patients were taking steroids for systemic diseases and in two cases a local steroid injection was given just before the rupture. We conclude that previous injury is the most common cause of rupture of the EPL, but that rheumatoid arthritis or local or systemic steroids, or both, are also important aetiological factors. Seven patients had an iatrogenic cause for their rupture.     

Spontaneous flexor tendon ruptures of the hand: case series and review of the literature

Spontaneous flexor tendon ruptures within the hand are incompletely understood. We report 5 cases of spontaneous tendon rupture involving the flexor digitorum profundus tendon. One case involves an abnormal intertendinous connection between the ring and small finger profundus tendons and another involves a lumbrical muscle variant. To our knowledge, the latter has not been reported in association with spontaneous tendon rupture. In reviewing the literature for spontaneous flexor tendon ruptures, a total of 50 spontaneous ruptures in 43 cases was found. The majority involve the profundus tendon of the small finger in the palm. The ruptures most often occur during periods of peak strain but can also occur without identifiable trauma. The pathogenesis of spontaneous tendon ruptures is still unclear and is likely multifactorial. Spontaneous flexor tendon ruptures of the hand occur more often than one might recognize.     

Tendon allograft for treatment of chronic Achilles tendon rupture: A systematic review

BackgroundTo summarize available evidence and determine if tendon allograft is an effective treatment for chronic Achilles tendon rupture.MethodsA search was performed in the PubMed, Web of Science, Embase and Cochrane Database from 1960 to April 2017 to identify relevant articles. Predefined inclusion and exclusion criteria were applied to identify all eligible articles.ResultsTotal 186 articles were identified through our systematic search. Of these, 9 publications met the inclusion criteria. Five studies were case reports; three were case series; and one were expert opinion. Of a total 35 patients, 34 underwent Achilles tendon allograft repair and 1 peroneus brevis tendon allograft reconstruction. All patients experienced good clinical and functional results, but most reports used non-validated outcome measures.ConclusionsThe evidence suggests that tendon allograft offers favorable outcomes in patients with chronic Achilles tendon rupture. However, randomized controlled trials which use validated functional outcome measures are required to determine effectiveness of this intervention.Level of evidence: Level V, systematic review of Level IV and V studies.     

锚钉联合腓骨短肌腱加强跖肌腱覆盖治疗激素性跟腱断裂

目的：探讨锚钉联合腓骨短肌腱加强跖肌腱覆盖治疗激素性跟腱断裂的临床疗效。方法：自2005年3月至2010年4月,采用锚钉联合腓骨短肌腱加强跖肌腱覆盖治疗激素性跟腱断裂患者10例,其中男8例,女2例;年龄21—68岁,平均（46．80±2．83）岁。术后观察并发症的情况,踝关节活动范围和末次随访患足连续的足跟抬起和单腿跳的个数。跟腱功能恢复情况根据美国足踝外科协会踝一后足评分（aoFAS）评分系统进行评估。结果：10例患者获得随访,平均随访时间为13．5个月（12—18个月）。伤口均Ⅰ期愈合,无伤口感染、跟腱再断裂及排斥反应等并发症发生。末次随访时患足踝关节活动范围（54．5±6．3）°,与健足（56．8±3．8）°比较差异无统计学意义（t=0．989,P=0．336）;患足可进行10个连续的足跟抬起和单腿跳。术前AOFAS评分（67．3±7．6）,与术后（95．5±7．6）比较差异有统计学意义（t=8．297,P-0．000）,患足功能评分95．5±7．6,与健足98．5±6．3比较差异无统计学意义（t=0．961,P=0．349）。跟腱功能恢复情况：优9例,良1例。结论：锚钉联合腓骨短肌腱加强跖肌腱覆盖治疗激素性跟腱断裂手术操作简单、固定牢固、并发症少,是一种较可靠而有效的治疗方法。     

Closed multiple tendinous rupture of flexors and extensors of hand: a case report

Multiple ruptures of the extensor and flexor tendons of the fingers, thumb and wrist at the musculotendinous junctions are reported after a blast injury.     

Surgical treatment for partial rupture of the distal biceps tendon using palmaris longus tendon graft: A case report

We report a case of a partial rupture of the distal biceps tendon that was surgically treated using a palmaris longus tendon graft. A 58-year-old man complained of increasing pain with resisted elbow flexion and supination in the antecubital fossa. Magnetic resonance imaging revealed the irregularity of a distal attachment of the biceps brachii and peripheral signal changes. We diagnosed a partial rupture of the distal biceps tendon. Because conservative treatment failed, surgical treatment was performed through a single anterior approach. The insertion of the tendon was partially ruptured at the radial tuberosity. After the involved site was debrided, the palmaris longus tendon was grafted with suture anchors to reinforce the remaining tendon. Postoperative immobilization was not performed, and all moves were freed after 3 weeks. At the 6-year postoperative follow-up, the patient no longer experienced pain and returned to his original job without any limitations.