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Case Reports
. 2024 Oct 11;16(10):e71265.
doi: 10.7759/cureus.71265. eCollection 2024 Oct.

A Case Report of Extensor Pollicis Longus Tendon Rupture: Delayed Diagnosis in a Professional Rugby Player

Siddhant P Nayak  1 , Molly Papadopoullos  2 , Niyam Amanullah  2 , Christos Kitsis  3 , Cecilia Brassett  1 , Neil Ashwood  3
Affiliations
Case Reports

A Case Report of Extensor Pollicis Longus Tendon Rupture: Delayed Diagnosis in a Professional Rugby Player

Siddhant P Nayak et al. Cureus. .

Abstract

Spontaneous rupture of the extensor pollicis longus (EPL) tendon has been reported to be uncommon. Several possible causes and precipitating factors have been reported for this rupture, including prior surgery to the distal radius. We report the case of an 18-year-old male professional athlete who presented with an inability to extend their left thumb. They presented with this condition after open reduction and internal fixation (ORIF) for a fractured left distal radius. Findings were consistent with the rupture of the EPL tendon. The typical presentation of such a rupture is one to four months after ORIF surgery, a shorter delay than seen in the present case, which exceeds one year. They underwent surgical tendon transfer using the extensor indicis tendon, and a dorsally protruding surgical screw was removed from the volar aspect of the radius. In this case, we suggest that repetitive friction from the protruding surgical screw, following volar plating of a distal radius fracture, may have caused abrasion of the EPL tendon. This may have predisposed it to rupture. This can occur long after the placement of a volar plate and must be considered as a potential cause of an EPL tendon rupture.

Keywords: distal end radius fracture; extensor indicis tendon transfer; pulvertaft weave technique; screw abrasion with tendon; upper limb orthopedic surgery; volar plating.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. The patient was asked to extend both thumbs, lifting them off a flat surface. His inability to do so on the left due to a ruptured EPL tendon is clearly shown.
EPL, extensor pollicis longus
Figure 2
Figure 2. Diagrams and images to show positions of EPL and extensor indicis proprius on the posterior (back of the) forearm and hand.
A) Diagram to show the position of EPL on the skeleton of the forearm and hand. B) Diagram to show the position of EPL and extensor indicis proprius relative to other soft tissues of the hand. C) Image to show surface anatomy of EPL and extensor Indicis Proprius. EPL, extensor pollicis longus
Figure 3
Figure 3. Ultrasound scan of distal left radius.
A) Transverse view of the distal left radius at the level of Lister's tubercle. B) Longitudinal view of the distal left radius in line with the EPL EPL, extensor pollicis longus
Figure 4
Figure 4. Longitudinal view of the distal left radius in line with the EPL tendon.
A) Patient with a ruptured EPL tendon. B) Healthy volunteer with intact EPL tendon. EPL, extensor pollicis longus
Figure 5
Figure 5. A) AP X-ray of the left wrist with a volar plate. B) Lateral X-ray of the left wrist with a volar plate.
Figure 6
Figure 6. A) Incision to show the hole formed by a penetrating screw from the volar plate. B) 28 mm long penetrating screw after removal.
Figure 7
Figure 7. Pulvertaft weave with the distal tendon passing through the proximal tendon.
See this image and copyright information in PMC

References

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