Spontaneous rupture of the extensor pollicis longus tendon in a young goalkeeper: a case report

Spontaneous Rupture of the Extensor Pollicis Longus Tendon With Repair and Contralateral Prophylactic Decompression: A Case Report and Review of the Literature

Ruptures of the extensor pollicis longus (EPL) tendon are known to occur primarily from local mechanical causes at Lister's tubercle. Other reasons for ruptures have been proposed including local steroid or even distant steroid injections that might have weakened the tendon, leading to rupture. There have been rare cases in the literature that describe ruptures without any known causes. Here, we describe a case with no known risk factors and with a spontaneous EPL rupture on one side and subclinical tendinopathy on the other. The patient had the EPL repaired on the ruptured side and subsequent prophylactic decompression of the contralateral side. The side without the rupture had preoperative ultrasound and magnetic resonance imaging, and a synovial biopsy was interpreted as showing tendinopathy.

A case of extensor pollicis longus (EPL) tendon rupture in an automotive assembly line worker: an ergonomic evaluation through job strain index (JSI) and musculoskeletal risk factor survey

Background

We report a case of extensor pollicis longus (EPL) tendon rupture caused by repetitive motions and awkward posture on hand and wrist joints.

Case presentation

A 47-year-old right-handed man who worked for 15 years in an assembly line at an automotive manufacturing company has been diagnosed with a complete tear of right EPL tendon. We investigated the patient's occupational history in detail and evaluated the tasks ergonomically through musculoskeletal risk factors survey and job strain index (JSI) using the 22 task-related videos recorded by the patient. Three out of the 12 tasks (25%) were identified as high-risk work on the hand and wrist in the musculoskeletal risk factors survey in 2016. Among the 22 tasks analyzed by JSI, 11 tasks (50%) were evaluated as probably hazardous. In addition, he used localized vibration tools in 19 (86.4%) out of 22 tasks.

Conclusion

We concluded the patient's disease was probably caused by repetitive motion and improper posture of the hand and wrist, and the hand-arm vibration is a possible cause as well.

Spontaneous Rupture of the Extensor Pollicis Longus with the Extensor Pollicis Brevis Deformity

This paper examines three cases of spontaneous ruptures of the extensor pollicis longus (EPL) with the extensor pollicis brevis (EPB) deformity. The patients ranged from 39 to 71 years old. Non-dominant hands were involved in all three cases. There were no trauma nor pathological cause of EPL ruptures. A tendon transfer using the extensor indicis proprius was performed in each case. Intraoperative findings showed hypoplastic EPB in one case and EPB defects in two cases. A weak or defective EPB puts an excessive load on the EPL, which might be one of the causes of spontaneous EPL rupture.

Anatomical Variants of Lister's Tubercle: A New Morphological Classification Based on Magnetic Resonance Imaging

Objective

Lister's tubercle is used as a standard anatomical landmark in hand surgery and arthroscopy procedures. In this study, we aimed to evaluate and propose a classification for anatomical variants of Lister's tubercle.

Materials and Methods

Between September 2011 and July 2014, 360 MRI examinations for wrists performed using 1.5T scanners in a single institution were retrospectively evaluated. The prevalence of anatomical variants of Lister's tubercle based on the heights and morphology of its radial and ulnar peaks was assessed. These were classified into three distinct types: radial peak larger than ulnar peak (Type 1), similar radial and ulnar peaks (Type 2) and ulnar peak larger than radial peak (Type 3). Each type was further divided into 2 subtypes (A and B) based on the morphology of the peaks.

Results

The proportions of Type 1, Type 2, and Type 3 variants in the study population were 69.2, 21.4, and 9.5%, respectively. For the subtypes, the Type 1A variant was the most common (41.4%) and conformed to the classical appearance of Lister's tubercle; whereas, Type 3A and 3B variants were rare configurations (6.4% and 3.1%, respectively) wherein the extensor pollicis longus tendon coursed along the radial aspect of Lister's tubercle.

Conclusion

Anatomical variations of Lister's tubercle have potential clinical implications for certain pathological conditions and pre-procedural planning. The proposed classification system facilitates a better understanding of these anatomical variations and easier identification of at-risk and rare variants.

Spontaneous rupture of EPL and ECRB tendons in a washerwoman: an unusual phenomenon

Spontaneous rupture of the extensor pollicis longus (EPL) tendon is rare, and spontaneous non-traumatic rupture of both extensor pollicis longus (EPL) and extensor carpi radialis brevis (ECRB) tendons is not reported in literature. Rupture of EPL is usually associated with rheumatoid arthritis, systemic or local steroid injections, fractures of the wrist and repetitive and excessive abnormal motion of the wrist joint. We describe a case of spontaneous rupture of the EPL and ECRB tendons in a female patient, washerwoman by occupation, with no predisposing factor. Exploration of the tendons along with end to end tendon repair was done with excellent results. We describe the possible mechanism of the injury and result after one year follow up.

Bilateral rupture of the extensor pollicis longus tendon in a professional goalkeeper following steroid injections for extensor tenosynovitis

We present a rare case of bilateral extensor pollicis longus tendon rupture in a professional football goalkeeper following steroid injection for extensor tenosynovitis. The potential pathogenesis mechanisms are discussed.