Spontaneous atraumatic, nonrheumatic rupture of the extensor pollicis longus tendon: A case report

Abstract

A 19-year-old female college student complained of inability to extend the thumb of her left, nondominant hand. The patient stated that she was turning the steering wheel of her car when she felt pain, which was short lived, in the dorsal aspect of her left wrist. Immediately thereafter she noted the loss of extensor power in her thumb metacarpophalangeal joint. She was seen one day later. The patient had no history of repetitive motions with the hand and denied any previous wrist trauma. Physical examination showed fullness and tenderness to palpation over the dorsal aspect of the left wrist. No effusion was evident in the wrist joint. There was diminished extensor power at the thumb metacarpophalangeal and interphalangeal joints, and the extensor pollicis longus tendon could not be palpated. At surgery the extensor pollicis longus tendon was found to be disrupted at Lister’s tubercle. There was no evidence of inflammation or synovitis. The tendon was rerouted through the subcutaneous tissue radial to Lister’s tubercle and was easily reapproximated. The tendon was primarily repaired with a nonabsorbable 3-O suture and a modified Bunnell suturing technique. The wrist was then placed in a cast in slight extension and radial deviation, with the thumb metacarpophalangeal and interphalangeal joints in extension. The cast was removed at 4 weeks, and therapy was begun. At 2 months after the surgical procedure full thumb motion