Spontaneous rupture of extensor pollicis longus in isolated trapeziometacarpal arthritis

A spontaneous rupture of the extensor pollicis longus (EPL) tendon occurred in a patient with trapeziometacarpal arthritis. We hypothesize that a mechanical attrition by protrusion at the trapeziometacarpal joint alone was responsible of a spontaneous rupture of the extensor pollicis longus tendon.     

Spontaneous rupture of the extensor pollicis longus tendon

An extensor pollicis longus tendon, ruptured after treatment of a giant cell tumor of the distal radius by packing the cavity with polymethylmethacrylate cement. The lack of extension was treated successfully with tendon transfer of the extensor indicis proprius to the extensor pollicis longus. Pathophysiology of the rupture is discussed.     

Extensor pollicis brevis tendon can hyperextend thumb interphalangeal joint in absence of extensor pollicis longus:Case report and review of the literature

We are reporting a case of extensor pollicis longus tendon rupture which did not require tendon transfer owing to the ability of the intact extensor pollicis brevis(EPB) to fully hyperextend the thumb interphalangeal joint. The thumb metacarpophalangeal joint was also able to be fully actively extended by the EPB. Previous anatomical studies have demonstrated that the insertional anatomy of the EPB tendon is highly variable and sometimes inserts onto the extensor hood and distal phalanx, which is likely the mechanism by which our patient was able to fully extend the thumb interphalangeal joint. Despite the potential for the EPB to extend the IP joint of the thumb, virtually all previously reported cases of extensor pollicis longus(EPL) tendon rupture had deficits of thumb IP extension requiring tendon transfer. This case highlights the potential ability of the EPB tendon to completely substitute for the function of the EPL tendon in providing thumb IP joint extension.     

自发性手指伸肌腱断裂的修复重建

目的探讨不同部位手指伸肌腱自发断裂的治疗方案及其疗效。方法29例患者总结如下：伸肌腱Ⅰ区22例、中环小指伸肌腱Ⅵ区3例、拇长伸肌腱4例，修复重建后配合功能锻炼。结果Ⅰ区原位直接缝合修复，优良率100％；食指固有伸肌腱移位拇长伸肌腱，优良率85％；桡侧腕短伸肌腱修复中环小指伸肌腱Ⅵ区，优良率75％。结论伸肌腱自发断裂常伴有炎症侵蚀或骨折端磨损的病理基础，在伸肌腱Ⅰ区时首选原位直接缝合修复，无条件修复时可行远指间关节融合术；对于中环小指伸肌腱Ⅵ区及拇长伸肌腱断裂行相邻协同肌肌腱转位修复，疗效确切。     

Sequential rupture of extensor tendons after a Colles fracture

Rupture of the extensor pollicis longus tendon occurred 6 weeks after a Colles fracture. The condition was treated successfully by a tendon transfer, but spontaneous rupture of the extensor digitorum communis tendon to the long finger occurred 10 months after injury. The cause of these ruptures could not be established.     

Acute rupture of extensor pollicis longus tendon due to avulsed fracture of the second metacarpal base: a case report.

Acute tendon rupture of the extensor pollicis longus (EPL) is rare. We present acute EPL tendon rupture associated with avulsed fracture of the second metacarpal at the insertion of extensor carpi radialis longus. Tendon rupture of the EPL was repaired with end-to-end suture and avulsed fracture of the second metacarpal base was treated with open reduction and internal fixation.     

Rupture of the extensor digitorum communis tendons caused by occupational overuse

Spontaneous rupture of the extensor pollicis longus tendon in excessive exertion is well-recognised, but similar rupture is rare in the common extensor tendons of the fingers. Two cases caused by occupational overuse are reported. Mechanical attrition at the distal edge of the extensor retinaculum produced by excessive use was thought to be responsible for the rupture.     

Delayed rupture of the extensor pollicis longus tendon: a retrospective study

Eight patients with delayed rupture of the extensor pollicis longus tendon are presented. Six had suffered from a fracture of the wrist without dislocation. This is in our opinion a predisposing factor in the etiology of delayed tendon rupture. Our treatment of choice is transfer of the extensor indicis proprius tendon. In all patients satisfactory thumb function was restored.     

Extensor pollicis longus tenosynovitis mimicking de Quervain's disease because of its course through the first extensor compartment: a report of 2 cases

We present 2 cases of extensor pollicis longus tenosynovitis caused by the unusual course of the extensor pollicis longus tendon. The extensor pollicis longus tendon passed through the first extensor compartment and was constricted severely. The symptoms were similar to those of de Quervain's disease. The clinical presentation, diagnosis, and surgical technique of this very rare anatomic condition are discussed.     

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.     

Late spontaneous rupture of extensor pollicis longus tendon after blunt trauma with no residual fracture

Spontaneous rupture of extensor pollicis longus tendon was first reported by Dupley in 1876. This rupture has been reported after distal radius fracture (Colles fracture), rheumatoid arthritis, steroid injections or systemic steroid treatment, and occupational tenosynovitis. The main etiologies of this rupture are the fracture of the tendon over the irregular bone surface following the fracture or inflammatory processes as in rheumatoid arthritis. Most ruptures are usually found at Lister’s tubercle. Some authors suggested ischemic etiology in the cases following wrist trauma with no residual fracture. We describe a case of rupture of the extensor pollicis longus tendon 1 month after a blunt wrist trauma with no residual fracture. The rupture was at the myotendinous junction (MTJ). To highlight on this rupture, we believed it was caused from both vascular and mechanical factors. The mechanical factor was the position of the myotendinous junction under the extensor retinaculum. The vascular factor was the nature of the myotendinous junction being the most sensitive to ischemia.Level of Evidence: Level V, diagnostic study.     

Rupture of the extensor pollicis longus tendon without fracture after wrist trauma: case reports.

Four cases of rupture of the tendon of the extensor pollicis longus without detectable fracture after wrist injury are reported. The clinical features of this condition did not differ materially from those of rupture occurring after a Colles fracture. All patients were rather young, the average age being 40 years. In one patient rupture occurred a day after injury. In all patients satisfactory thumb function was restored with extensor indicis proprius tendon transfer.     

Sehnenrupturen in der Folge distaler Radiusfrakturen

After distal radial fractures, closed ruptures of the extensor pollicis longus (EPL) tendon may be caused by protruding screws of a volar plate but also occur after conservative fracture treatment. The time interval between accident and rupture is a few weeks to a few months. Tendon transfer of the extensor indicis tendon or a tendon interposition graft are good options for reconstruction. Fusion of the IP joint is not a solution, as the second function of the EPL tendon is to withdraw the thumb ray out of volar abduction. Closed ruptures of the flexor pollicis longus (FPL) tendon exclusively occur after volar plate ORIF, the time interval being years to more than a decade. Volar plates of the distal radius should generally be removed after bone healing and urgently when the patient reports tendon crepitation or pain. A ruptured FPL tendon may be reconstructed by tendon interpositional graft or by tendon transfer but IP joint fusion is a good alternative as the flexor pollicis brevis muscle shows a good thumb metacarpophalangeal joint flexion.     

Effects of extensor pollicis longus transposition and extensor indicis proprius transfer to extensor pollicis longus on thumb mechanics

PURPOSE: The spatial relationship of the extensor pollicis longus (EPL) to the thumb carpometacarpal (CMC) joint may be altered by its transposition from the third dorsal wrist compartment and by subcutaneous extensor indicis proprius (EIP) to EPL tendon transfer. Changes in tendon position could alter thumb function. This study examined changes in the EPL adduction moment arm after EPL tendon transposition from its extensor compartment or EIP transfer. METHODS: The EPL adduction moment arm at the thumb carpometacarpal joint was determined under 4 tendon conditions: (1) intact extensor pollicis longus, (2) transposed extensor pollicis longus, (3) extensor indicis proprius to extensor pollicis longus tendon transfer through an extensor retinacular pulley, and (4) extensor indicis proprius tendon transfer through a subcutaneous route. Each tendon condition was tested in 2 wrist positions: neutral and 40 degrees of flexion. RESULTS: The wrist neutral/flexion moment arms for the 4 tendon conditions, in millimeters, were 9.2/7.3, 3.6/1.2, 8.3/5.1, and 4.8/1.0. CONCLUSIONS: EPL transposition produces a significant decrease of its adduction moment arm at the thumb CMC joint, an effect exacerbated by wrist flexion. The moment arm mechanics of the pulley and subcutaneous EIP tendon transfer resemble those of the intact and transposed EPL, respectively. Diminution of the adduction moment arm could impair thumb function, especially adduction.     

Rupture of the extensor pollicis longus--a crush injury

It is suggested that rupture of a previously normal tendon of extensor pollicis longus after Colles fracture may be due in some cases to crushing of the tendon between the styloid process of the third metacarpal and the dorsal tubercle of the radius, when the wrist is forced into extreme extension.     

Extensor tendon rupture associated with Smith's fracture. A case report

A 14-year-old boy sustained closed rupture of the extensor digitorum communis, extensor pollicis longus, and extensor indicis proprius tendons following a volarly displaced Salter-Harris Type II fracture of the distal end of the radius. The condition was treated with tendon grafts, but some limitation of metacarpophalangeal flexion remained.     

Clinical and microangiographic studies on rupture of the E.P.L. tendon after distal radial fractures

The authors have treated 14 cases of spontaneous rupture of extensor pollicis longus tendon after fractures of the distal end of the radius, most of which were undisplaced or only slightly displaced. A microvascular study on five cadavers revealed that this tendon is subject to mechanical bending and attrition, has no mesotenon and has a poorly vascularised portion about 5 mm in length, which may be a cause of spontaneous rupture of the tendon.     

Rupture of the extensor pollicis longus tendon after Colles fracture and by rheumatoid arthritis

During the period 1973-1986, 116 patients with rupture of the extensor pollicis longus tendon were operated upon. The lesions were categorised into three anatomical levels: proximal, intermediate and distal. Direct suture was performed for acute lesions; later reconstructive procedures were by means of tendon transfers or free tendon grafts.     

Delayed rupture of the flexor pollicis longus tendon after inappropriate placement of the pi plate on the volar surface of the distal radius

The pi plate (Synthes Ltd, Paoli, PA) was designed to fit the unique contour of the dorsal aspect of the distal radius. Complications of pi plate fixation of the dorsal distal radius have been previously reported to include both extensor tenosynovitis and delayed extensor tendon rupture. We report a case of rupture of the flexor pollicis longus tendon associated with inappropriate placement of the pi plate on the volar surface of the distal radius.     

Spezielle Verletzungen der Strecksehnen an der Hand

Extensor tendon injuries at the end joint, middle joint, and long thumb extensor tendon are mainly closed. At the distal interphalangeal joint there are either tendinous or fragment avulsions. Therapy is nonoperative in most cases.At the proximal interphalangeal joint the tractus intermedius or additionally the tractus laterales may be affected. The amount of the damage determines whether operative or nonoperative treatment is indicated. The rupture of the extensor pollicis longus tendon is caused by local deterioration in its osteofibrous compartment near Lister’s tubercle. The treatment of choice is tendon transfer of extensor indicis.