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Case Reports
. 2021 Jun 8;14(6):e241306.
doi: 10.1136/bcr-2020-241306.

Snapping thumb: a rare case of stenosing tenosynovitis of the extensor pollicis longus tendon

Andrea Lund  1 , Pelle Hanberg  2 , Anders Ditlev Foldager-Jensen  2 , Maiken Stilling  2
Affiliations
Case Reports

Snapping thumb: a rare case of stenosing tenosynovitis of the extensor pollicis longus tendon

Andrea Lund et al. BMJ Case Rep. .

Abstract

Tenosynovitis of the extensor pollicis longus (EPL) is rarely reported in patients without rheumatoid arthritis but may lead to thumb snapping as a consequence of EPL stenosing tenosynovitis.This case presents painful thumb snapping that developed after a wrist trauma and repetitive loading. Ultrasound and MRI were used as diagnostic tools, before surgical release of the EPL in the third extensor compartment was performed. Neither EPL tenosynovitis nor thumb snapping were found at follow-up.

Keywords: musculoskeletal and joint disorders; orthopaedics; tendonopathies.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Axial T1 Spin Echo (SE) MRI sequence of the left wrist in neutral position before surgery, which demonstrates fluid in the third extensor department indicating tenosynovitis (arrows), at the distal level of the extensorcompartment (A+B) and where the EPL crosses the extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB) (C+D). EPL, extensor pollicis longus.
Figure 2
Figure 2
Release of the third extensor compartment. (A) The left third extensor compartment is sliced open and tenosynovitis of the EPL tendon is removed. In the picture, a thick mass of tenosynovitis on the tendon is still left at its extracompartmental course (arrow). (B) The EPL tendon is pulled and inspected, the tenosynovitis was only found locally at the extensor compartment. (C) The EPL is held radially and the extensor retinaculum is elevated sharply from Lister’s tubercle, the bone tubercle is flattened, and the extensor retinaculum is closed (arrows) with resorbable sutures. (D) The EPL tendon is left subcutaneously and dorsal to the extensor retinaculum (arrow). EPL, extensor pollicis longus.
Figure 3
Figure 3
Axial T1 SE MRI of the left wrist in pronation 8 months after surgery. (A) At the axial level of Lister’s tubercle MRI demonstrate a flat tubercle (*) and no sign of tenosynovitis around the extensor pollicis longus (EPL) tendon, which is located subcutaneously above the third extensor compartment. (B) Distal to the radius and the extensor compartments, the EPL cross the ECRL and ECRB tendons subcutaneously, and there is no sign of tenosynovitis around the EPL. ECRB, extensorcarpi radialis brevis; ECRL, extensorcarpi radialis longus.
See this image and copyright information in PMC

References

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