Rupture of the extensor pollicis longus tendon: a study of aetiological factors

Abstract

Although rupture of the extensor pollicis longus (EPL) tendon is a well-known complication of distal radial fractures, a number of patients rupture the EPL because of other conditions. We have retrospectively studied the aetiology of 27 ruptures of the EPL in 26 consecutive patients. Of 19 patients with injured wrists 12 had distal radial fractures, five had blunt trauma, and two had stab wounds that resulted in rupture. In the radial fractures operated on, the EPL rupture was caused by chafing against a dorsal plate (n = 2) or wear against the pins of an external fixator (n = 2). Six patients were taking steroids for systemic diseases and in two cases a local steroid injection was given just before the rupture. We conclude that previous injury is the most common cause of rupture of the EPL. but that rheumatoid arthritis or local or systemic steroids, or both, are also important aetiological factors. Seven patients had an iatrogenic cause for their rupture.

Revisiting Spontaneous Rupture of the Extensor Pollicis Longus Tendon: Eight Cases without Identifiable Predisposing Factor

“…These mechanical factors are thought to be compounded by the EPL tendon's relatively poor blood supply in the region of the Lister tubercle. Microangiographic studies have revealed that the EPL has a distal and proximal blood supply with a relatively avascular zone in the area of the Lister tubercle [4,8]. When pressure increases in the surrounding tendon sheath due to inflammation following distal radius fracture or other trauma, the direct blood supply may be compromised, leaving only diffusion through the synovial fluid to supply adequate nutrition.…”

“…Rupture of the EPL tendon is uncommon, but when reported, a predisposing factor such as distal radius fracture [12], blunt trauma [4], repetitive and excessive abnormal motion [6,16], inflammatory disease [24], and systemic or local steroid injection [4] can generally be identified. In this study, we presented eight cases in which none of these classical precipitating factors could be identified.…”

“…Nondisplaced fracture of the distal radius is a well-established risk factor with an incidence of EPL rupture of 0.2-5 % [22]. Other predisposing factors that have been reported in the literature include chronic inflammatory conditions such as rheumatoid arthritis [2,4,8,14,20,24], systemic or local steroid injections, and repetitive or excessive abnormal motion of the wrist [6,16]. Several factors are thought to contribute to EPL rupture in these clinical settings.…”

“…Several factors are thought to contribute to EPL rupture in these clinical settings. These fall grossly into mechanical and vascular categories [4,8,9,13]. The EPL is particularly susceptible to mechanical irritation due to its close anatomic relationship to the dorsal radius and particularly the Lister tubercle [9,13].…”

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

“…fractures, prolonged nonunion of the scaphoid, dorsal subluxation of the distal ulna after trauma, and Madelung's deformity [1][2][3][4] . Moreover, the nutrition impairment theory is the main theory describing the cause of spontaneous tendon ruptures, and increased pressure on Lister's tubercle has been reported to lead to ischemia and subsequent spontaneous rupture of the EPL tendon 5 .…”