Arch Hand Microsurg.  2018 Jun;23(2):93-98. 10.12790/ahm.2018.23.2.93.

Idiopathic Rupture of the Extensor Pollicis Longus Tendon due to Carpometacarpal Joint Arthritis of the Thumb: A Case Report

• Lee SK
• Kim SM
• Choy WS

• KMID: 2412478
• DOI: http://doi.org/10.12790/ahm.2018.23.2.93

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. Various causes of spontaneous rupture of the EPL tendon have been reported, but EPL rupture due to carpometacarpal (CMC) arthritis has not been reported. We had a case of an idiopathic rupture of the EPL tendon due to CMC joint arthritis of the thumb. The patient had no predisposing factors including trauma or steroid injection. The ruptured tendon was operated. During the surgery, both ends of the ruptured EPL tendon were found around the dorsum of the first CMC joint, and an osteophyte was observed in the dorsal aspect of the first CMC joint. The osteophyte was removed and an extensor indicis proprius tendon transfer was performed. Three monthss post-surgery, the patient was satisfied.

Keyword

Extensor pollicis longus; Spontaneous rupture; CMC arthritis; EIP tendon transfer

MeSH Terms

Arthritis*
Arthritis, Rheumatoid
Carpometacarpal Joints*
Causality
Humans
Joints
Osteophyte
Rupture*
Rupture, Spontaneous
Steroids
Tendon Transfer
Tendons*
Thumb*
Wrist
Wrist Joint
Steroids

Figure

• 

  Fig. 1 On plain radiographs, an osteophyte (circle&arrow) is suspected around the dorsum of the right first CMC joint. (A, B) on the right wrist magnetic resonance imaging, osteoarthritic changes and subchondral cysts of the first metacarpal base (arrow) are observed around the first CMC joint (C) and the osteophyte (arrow) in the dorsum of the first CMC joint (D, E). CMC: carpometacapal.

• 

  Fig. 2 (A) An incision was made in the anatomical snuff box of the hand following the running of the extensor pollicis longus tendon and dorsum of the second metacarpophalangeal joint. (B) In the incision of the anatomical snuff box, we identified only the tendon sheath where the tendon parenchyma itself does not exist. (C) We found the osteophyte in the dorsum of the first carpometacarpal joint.

• 

  Fig. 3 The extensor indicis proprius tendon was transferred to the distal stump of the extensor pollicis longus tendon by using Pulvertaft's technique.

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  Fig. 4 Three months after the operation, the patient was examined in the outpatient clinic. The patient was allowed full extension of the right thumb (A) and there was no recurrence of the osteophyte at the carpometacarpal joint of the thumb on computed tomography of the right wrist (B).

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