Carpometacarpal boss is a rare cause of pain and swelling on the dorsum of the hand. Literature is limited on the etiology of this condition and there is no consensus on treatment. We report an unusual case of a 53-year-old man with extensor tendon rupture caused by carpometacarpal boss. Surgical excision of the bony growth and repair of the EIP utilizing interpositional tendon autograft resulted in relief of symptoms and return of function. KeywordsCarpometacarpal boss, Extensor tendon rupture presented with a 5-week history of dorsal hand swelling, that resembled a ganglion cyst, after sustaining a non-traumatic injury to his right hand. He complained of dull pain, which increased on applying pressure to that region. Symptoms were aggravated by increased activity and improved with rest. He denied any trauma. On physical examination, he had tenderness to palpation over a firm, bony protuberance over the dorsum of the base of the second metacarpal base on the right radiating into the index finger. There was visible limitation in range of motion of the index finger on extension, suggesting a possible rupture of the extensor tendon. Active wrist motion on the affected side was about 60 degrees in both flexion and extension. Pain was elicited by passive extension of the wrist and upon palpation of the extensor tendons to the index and middle fingers. Plain radiographs showed a bony protuberance at the base of the second metacarpal on the right. Due to concern of the extensor tendon rupture, conservative treatment was not indicated. The patient was offered surgical excision of the carpometacarpal boss and possible extensor tendon repair and consented to the procedure.The procedure was performed under WALANT (Wide Awake Local Anesthetic No Tourniquet). The right upper extremity was prepped and draped in normal sterile fashion and a midline incision, approximately 6 cm in length, over the base of the second metacarpal was utilized. Dissection was taken down to the extensor tendons for exploration and a complete rupture of the extensor digitorum communis (EDC) tendon to the index finger and the extensor indicis proprius (EIP) tendon was found. The junctura tendinae were still intact. The proximal aspects of the tendon stumps were not identifiable within this region and hence the incision was extended proximally by another 4-5 cm. At the base of
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