scholarly journals Rupture of Extensor Pollicis Longus Tendon Caused by Scaphoid Nonunion Advanced Collapse Wrist

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Takahito Kojima ◽  
Masataka Yasuda ◽  
Shunpei Hama ◽  
Makoto Fukuda ◽  
Kenta Minato
Keyword(s):  
Bone Growth ◽  
Tendon Rupture ◽  
X Rays ◽  
Scaphoid Nonunion ◽  
Extensor Pollicis Longus ◽  
Extensor Indicis Proprius ◽  
Dorsal Ridge ◽  
Tendon Surgery ◽  
Tendon Ruptures ◽  
Snac Wrist

We report the case of a 69-year-old male patient with extensor pollicis longus (EPL) tendon rupture associated with a scaphoid nonunion advanced collapse (SNAC) wrist. He could not actively extend the left thumb interphalangeal joint and visited our institution for an examination. Plain X-rays revealed advanced stage SNAC and an enlarged soft tissue shadow owing to dorsal ridge growth. The patient was diagnosed with EPL tendon subcutaneous rupture due to SNAC. During surgery, the EPL tendon was found to be absent, a proximal-type scaphoid nonunion was detected, and bone growth to the dorsal part of the dorsal ridge was observed. Considering that the EPL tendon rupture was associated with the bone growth, we performed scaphoid lunate advanced collapse (SLAC) reconstruction and extensor indicis proprius tendon transfer which needed a revision tendon surgery afterward. To the best of our knowledge, EPL tendon ruptures caused by SLAC or SNAC are considered rare and have not yet been reported.

scholarly journals Traumatic index extensor tendon attenuation mimicking closed tendon rupture: two case reports

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Yusuke Miyashima ◽  
Takuya Uemura ◽  
Takuya Yokoi ◽  
Shunpei Hama ◽  
Mitsuhiro Okada ◽  
...  
Keyword(s):  
High Speed ◽  
Tendon Rupture ◽  
Case Reports ◽  
English Literature ◽  
Extensor Tendon ◽  
Sports Injury ◽  
Tendon Graft ◽  
Metacarpophalangeal Joints ◽  
Extensor Indicis Proprius ◽  
Tendon Ruptures

Abstract Background While some traumatic closed index extensor tendon ruptures at the musclotendinous junction have been previously reported, closed index extensor tendon pseudorupture due to intertendinous attenuation is exceedingly rare with only one case report of a gymnastics-related sports injury in the English literature. Herein, we report two non-sports injury related cases of traumatic index extensor tendon attenuation mimicking closed tendon rupture, including the pathological findings and intraoperative video of the attenuated extensor indicis proprius tendon. Case presentation A 28-year-old man and a 30-year-old man caught their hands in a high-speed drill and lathe, respectively, which caused a sudden forced flexion of their wrists. They could not actively extend the metacarpophalangeal joints of their index fingers. Intraoperatively, although the extensor indicis proprius and index extensor digitorum communes tendons were in continuity without ruptures, both tendons were attenuated and stretched. The attenuated index extensor tendons were reconstructed either with shortening by plication or step-cut when the tendon damage was less severe or, in severely attenuated tendons, with tendon grafting (ipsilateral palmaris longus) or tendon transfer. Six months after the operation, the active extension of the index metacarpophalangeal joints had recovered well. Conclusions Two cases of traumatic index extensor tendon attenuation were treated successfully by shortening the attenuated tendon in combination with tendon graft or transfer. We recommend WALANT (wide-awake local anesthesia and no tourniquet) in the reconstruction surgery of index extensor tendon attenuation to determine the appropriate amount of tendon shortening or optimal tension for tendon grafting or transfer. Intraoperative voluntary finger movement is essential, as it is otherwise difficult to judge the stretch length of intratendinous elongation and extent of traumatic intramuscular damage affecting tendon excursion.

Extensor Tendon Rupture Associated with Osteoarthritis of the Distal Radioulnar Joint

2008 ◽  
Vol 33 (4) ◽  
pp. 469-474 ◽  
Author(s):  
H. YAMAZAKI ◽  
S. UCHIYAMA ◽  
Y. HATA ◽  
N. MURAKAMI ◽  
H. KATO
Keyword(s):  
Risk Factors ◽  
Tendon Rupture ◽  
Extensor Tendon ◽  
Distal Radioulnar Joint ◽  
X Rays ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Sigmoid Notch ◽  
Tendon Ruptures ◽  
Grade 3

Non-rheumatoid osteoarthritis of the distal radioulnar joint can cause extensor tendon rupture. We analysed the radiographic morphology of the distal radioulnar joint to identify the risk factors for this complication. Forty-one wrist X-rays of 37 patients with extensor tendon rupture caused by distal radioulnar joint osteoarthritis were evaluated retrospectively for the severity of osteoarthritis by the Kellgren/Lawrence scoring system. Measurements were obtained from posteroanterior views. All but one wrist had severe osteoarthritic changes exceeding grade 3. The radiographic features that were different from those of the contralateral wrists included deepening and widening of the sigmoid notch, radial shift of the ulnar head and dorsal inclination of the sigmoid notch. There was no significant association between tendon rupture and the morphology of the ulnar head or ulnar variance. The scallop sign, dorsal inclination of the sigmoid notch and radial shift of the ulnar head are radiological risk factors for extensor tendon ruptures.

EXTENSOR POLLICIS LONGUS TENDON RUPTURE AS A RESULT OF SCAPHOLUNATE DISSOCIATION: A CASE REPORT

Hand Surgery ◽  
2005 ◽  
Vol 10 (02n03) ◽  
pp. 307-310 ◽  
Author(s):  
Koji Shigematsu ◽  
Hiroshi Yajima ◽  
Yoshinori Takakura
Keyword(s):  
Tendon Rupture ◽  
Scapholunate Dissociation ◽  
Extensor Pollicis Longus ◽  
The Third ◽  
Extensor Indicis Proprius ◽  
Dorsal Aspect ◽  
Arthroscopic Findings ◽  
Bone Autograft ◽  
Rupture Site ◽  
Extensor Pollicis Longus Tendon

A 39-year-old patient was presented with, to our knowledge, the first ever diagnosed case of extensor pollicis longus (EPL) tendon rupture as a result of scapholunate (S-L) dissociation. Arthroscopic findings showed that the dorsal aspect of the S-L ligament was ruptured and severe synovitis was revealed around the S-L joint. Direct observation revealed synovium at the rupture site of the EPL tendon. After careful resection of this synovium, an aperture in the S-L joint was observed. Thus, it was considered that the synovium in the S-L joint was connected to the rupture site of the EPL tendon, passing through the dorsal capsule of the S-L joint. The ruptured EPL tendon was reconstructed with extensor indicis proprius tendon transfer, and S-L dissociation was treated with a bone-retinaculum-bone autograft taken from the third dorsal compartment region.

scholarly journals Riešo vidurinio sąnario artrodezė gydant laivelio pseudoartrozę

2003 ◽  
Vol 1 (4) ◽  
pp. 0-0
Author(s):  
Arūnas Jankauskas
Keyword(s):  
Grip Strength ◽  
Late Results ◽  
Pain Scale ◽  
X Rays ◽  
Scaphoid Nonunion ◽  
Carpal Collapse ◽  
Flexion Extension ◽  
Vilnius University ◽  
Snac Wrist ◽  
Midcarpal Arthrodesis

Arūnas JankauskasVilniaus universiteto Ortopedijos, traumatologijosir plastinės chirurgijos klinikaVilniaus greitosios pagalbos universitetinė ligoninėŠiltnamių g. 29, LT-2043 VilniusEl paštas: [email protected] Įvadas / tikslas VU Ortopedijos, traumatologijos ir plastinės chirurgijos klinikoje riešo potrauminis kolapsas, atsiradęs po laivelio pseudoartrozės, gydomas riešo vidurinio sąnario artrodezės metodu. Tyrimo tikslas – įvertinti riešo vidurinio sąnario artrodezės vėlyvuosius rezultatus ir išsiaiškinti, ar tikslinga šiuo metodu gydyti laivelio pseudoartrozę. Ligoniai ir metodai Straipsnyje pateikiami 31 paciento, operuoto 1992–2002 metais Vilniaus greitosios pagalbos universitetinėje ligoninėje, vėlyvieji gydymo rezultatai. Gydant laivelio pseudoartrozę ir riešo potrauminį kolapsą, įvykusį po laivelio pseudoartrozės, šiems pacientams buvo atlikta riešo vidurinio sąnario artrodezė. Riešo sąnario judesiai buvo vertinami "neutralaus nulio" metodu. Plaštakos jėga buvo matuojama Jamar II dinamometru. Rentgenologiškai laivelio pseudoartrozė klasifikuota S. L. Filan ir T. J. Herbert būdu. Pseudoartrozės vietai apibūdinti taikyta Mayo klasifikacija. Riešo sąnario aukštis vertintas pagal Y. Youm indeksą. Šoninės projekcijos rentgenogramoje matuoti kampai tarp riešakaulių išilginių ašių. Buvo ieškoma riešo nugarinio nestabilumo požymių. Riešo aukščio sumažėjimas vadintas riešo potrauminiu kolapsu. Riešo potrauminis kolapsas buvo skirstomas į tris stadijas. Rankos neįgalumo klausimynu DASH subjektyviai įvertinta gyvenimo kokybė. Po riešo vidurinio sąnario artrodezės retrospektyviai įvertintas skausmas. Naudota skausmo skalė VAS. Riešo vidurinio sąnario artrodezės indikacijos buvo D4 tipo laivelio pseudoartrozė pagal S. L. Filan ir T. J. Herbert klasifikaciją ir riešo potrauminis kolapsas. Rezultatai Patikimai sumažėjo skausmas, vertinamas pagal skausmo skalę (p < 0,001). Patikimai padidėjo tiesimo ir lenkimo judesių suma (p = 0,009), atitraukimo ir pritraukimo judesių suma (p < 0,001), plaštakos jėga (p < 0,001). Riešo potrauminis kolapsas diagnozuotas 30 (97%) atvejų. Nustatytas tiesioginis riešo potrauminio kolapso ryšys su vėlyvaisiais rezultatais. Riešo potrauminio kolapso stadija koreliavo su tiesimo ir lenkimo judesių amplitude po operacijos (p = 0,008), plaštakos jėga po operacijos (p = 0,05), skausmo skale (p = 0,04). Rankos neįgalumo klausimyno taškų vidurkis buvo 28,9 ± 12,8. Nustatytas šio klausimyno rezultatų patikimas ryšys su skausmo skale (p = 0,001) ir traumuotos plaštakos jėga po operacijos (p = 0,006). Lytis, amžius, dominuojančios rankos pažeidimas, pseudoartrozės trukmė, pooperacinio laikotarpio trukmė, pseudoartrozės vieta ir tipas, viso laivelio arba jo dalies pašalinimas įtakos riešo vidurinio sąnario artrodezės rezultatams neturėjo. Pseudoartrozės tipas koreliavo su pseudoartrozės trukme ir vieta (p < 0,001). Išvados Riešo vidurinio sąnario artrodezė yra patikima potrauminio kolapso, įvykusio po laivelio pseudoartrozės, gydymo metodika. Riešo vidurinio sąnario artrodezės rezultatai tiesiogiai priklauso nuo potrauminio kolapso stadijos. Prasminiai žodžiai: laivelio pseudoartrozė, potrauminis riešo kolapsas, riešo vidurinio sąnario artrodezė Midcarpal arthrodesis in treatment of scaphoid nonunion Arūnas Jankauskas Background / objective At the Vilnius University Department of Orthopaedics, Traumatology and Plastic Surgery midcarpal arthrodesis is used for the treatment of posttraumatic carpal collapse. The aim of the study was to evaluate late postoperative results concerning midcarpal arthrodesis and determine the suitability of the method for the treatment of scaphoid pseudoarthrosis. Methods In this study patients surgically treated for scaphoid pseudarthrosis at Vilnius University Emergency Hospital from 1992 till 2002 were analyzed. The object of the study was scaphoid nonunion advanced collapses (SNAC wrist). In assessing the late results of midcarpal arthrodesis, 31 patients took part. The age of pseudarthrosis varied from 1 to 32 years. The follow-up time ranged from 1 to 7 years. Movement of the carpal joint was assessed by the method of "neutral zero". Grip strength was measured with a Jamar II dynamometer. PA and lateral X-rays were analyzed. Scaphoid pseudarthroses were classified according to S. L. Filan and T. J. Herbert and Mayo. In PA X-rays carpal height was measured by the Youm index. In lateral X-ray views, angles between the carpal bone longitudinal axes were measured. In the cases when the angle between the scaphoid and the lunate was greater than 70°, between the radius and the lunate greater than 10°, between the capitate and the lunate less than 10°, the condition was called dorsal intercalated segment instability (DISI). Carpal height reduction due to scaphoid pseudoarthrosis was called scaphoid nonunion advanced collapse (SNAC wrist). Posttraumatic carpal collapse was divided into 3 stages. The patient's daily activities and general quality of life were estimated with the DASH (Disability of arm, shoulder, hand) questionnaire. Pain was evaluated by a visual analogue scale (VAS 0–100). Indications for midcarpal arthrodesis were D4 type scaphoid pseudarthrosis according to S.L. Filan and T. J. Herbert as well as to SNAC. Results 1. Pain significantly decreased in comparison with the preoperative situation (p < 0.001). 2. The flexion–extension ROM increased significantly (p = 0.009) and reached 52% of healthy hand flexion-extension range. 3. The abduction–adduction ROM increased significantly (p < 0.001) and reached 57% of healthy wrist abduction-adduction movement. 4. Grip strength increased significantly (p < 0.001) and was equal to 72% of the opposite side. 5. Posttraumatic carpal collapse was diagnosed in 30 cases (97%). The severity of the SNAC correlated significantly with the late results. The grade of posttraumatic carpal collapse correlated with flexion–extension movement range postoperatively (p = 0.008), grip strength after operation (p = 0.005), pain scale (p = 0.004). 6. The total DASH score reached 28.9 ± 12.8. A reliable relation was noted between this questionnaire results and pain scale (p = 0.001), injured wrist grip strength after operation (p = 0.006). 7. Gender, age, dominated arm disability, pseudarthrosis age, postoperative period duration, pseudarthrosis localization, pseudarthrosis classification according to S. L. Filan and T. J. Herbert, complete or partial scaphoid excision had no influence on the results. 8. Pseudoarthrosis type correlated with pseudoarthrosis age and localization (p < 0.001). Conclusions Midcarpal arthrodesis is a reliable method of treatment of scaphoid nonunion advanced collapse. Midcarpal arthrodesis results directly depend on the grade of posttraumatic collapse. Keywords: scaphoid nonunion, posttraumatic carpal collapse, midcarpal arthrodesis

Ultrasound Changes in the Extensor Pollicis Longus Tendon Following Fractures of the Distal Radius—A Preliminary Report

2007 ◽  
Vol 32 (4) ◽  
pp. 467-471 ◽  
Author(s):  
K. L. OWERS ◽  
J. LEE ◽  
N. KHAN ◽  
J. HEALY ◽  
R. ECKERSLEY
Keyword(s):  
Distal Radius ◽  
Tendon Rupture ◽  
Underlying Mechanism ◽  
Tendon Sheath ◽  
X Rays ◽  
Extensor Pollicis Longus ◽  
Longus Tendon ◽  
Intraarticular Fractures ◽  
Extensor Compartment ◽  
Extensor Pollicis Longus Tendon

Extensor pollicis longus tendon rupture occurs in 0.2% to 3% of fractures of the distal radius. The underlying mechanism, or mechanisms, of rupture are unknown. This study evaluated this tendon and its surrounding structures using high-resolution ultrasound in 62 patients with distal radius fracture at 6 weeks after injury. The uninjured wrist was examined as a control. The ultrasound measurements at 6 weeks were then correlated with the patients’ presenting X-rays. Significant findings included a reduced peak velocity of tendon movement and an increased thickness of both the extensor retinaculum and the tendon sheath on the fractured side. In respect of tendon sheath thickness, these changes were particularly associated with intraarticular fractures. We postulate that the increased thickness of the EPL tendon sheath may further impair an already tenuous blood supply and/or affect the diffusion of nutrients to the tendon within the third extensor compartment, leading to tendon attrition and rupture.

Flexor Pollicis Longus Tendon Ruptures after Palmar Plate Fixation of Fractures of the Distal Radius

2009 ◽  
Vol 34 (4) ◽  
pp. 471-474 ◽  
Author(s):  
J. A. CASALETTO ◽  
D. MACHIN ◽  
R. LEUNG ◽  
D. J. BROWN
Keyword(s):  
Standard Treatment ◽  
Plate Fixation ◽  
Flexor Pollicis Longus ◽  
Distal Radial Fractures ◽  
Extensor Pollicis Longus ◽  
Longus Tendon ◽  
Palmar Plate ◽  
Tendon Ruptures ◽  
Flexor Pollicis Longus Tendon ◽  
Palmar Plate Fixation

Palmar plate fixation of distal radial fractures is becoming a standard treatment for this common injury. Ruptures of the extensor pollicis longus tendon have been reported in 8.6% of cases after this procedure. Although palmar plate fixation has also been associated with flexor pollicis longus (FPL) tendon problems, the majority of reported cases pre-date the use of newer anatomically precontoured locking plates. In this paper seven cases of FPL rupture are presented. This complication does not appear to be unique to one type of implant. The possible aetiologies for FPL ruptures are discussed and ways to reduce the incidence of this complication are suggested.

scholarly journals The Influence of Diabetes on Acute Achilles Tendon Rupture Repair

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0028
Author(s):  
Jonathan Kaplan ◽  
Jeffery Hillam ◽  
Amiethab Aiyer ◽  
Niall Smyth
Keyword(s):  
Diabetes Mellitus ◽  
Postoperative Complications ◽  
Achilles Tendon ◽  
Power Analysis ◽  
Tendon Rupture ◽  
Surgical Repair ◽  
Achilles Tendon Rupture ◽  
The United States ◽  
Foot And Ankle ◽  
Tendon Ruptures

Category: Sports Introduction/Purpose: Diabetes Mellitus (DM) is an epidemic affecting millions of individuals in the United States. Multiple studies have demonstrated an increase in complications in foot and ankle surgery in patients with DM, including wound healing complications, surgical site infections (SSI), or surgical failure. The goal of this study was to retrospectively review outcomes data from the National Surgical Quality Improvement Program (NSQIP) to determine the impact of DM on operative treatment of achilles tendon ruptures. Methods: Using the NSQIP from 2006-2015, patients were identified using common procedure terminology (CPT) for Achilles tendon ruptures. Diabetic and non-diabetic cohorts were evaluated to compare demographics, comorbidities, perioperative details and 30-day outcomes. Statistical evaluation included a power analysis for the primary outcome measure of wound disruption as well as univariate analysis was performed using chi-squared or Fisher’s exact and Wilcoxon signed-rank tests. Results: A total of 2,014 patients were identified having sustained an Achilles tendon rupture. There were 1,981 patients without DM and 33 patients with DM. There were no significant differences in postoperative complications, including SSI, medical complications, and 30-day outcomes between patients with DM and non-DM patients undergoing surgical repair of acute Achilles tendon ruptures. The power analysis for wound disruption showed a P=0.9 with an alpha of 0.05, sample size of n=2014, and Pearson correlation coefficient of r=0.0721 Conclusion: While DM has been shown to have an increase in complications in various foot and ankle procedures, this study demonstrates that there is no significant difference in postoperative complications and 30-day outcomes between patients with DM and non-DM patients undergoing surgical repair of acute Achilles tendon ruptures using the NSQIP database from 2006-2015. Based on this data, patients with diabetes mellitus can be considered adequate surgical candidates for acute Achilles tendon rupture repair.

scholarly journals Gouty Tenosynovitis of the Distal Biceps Tendon Insertion Complicated by Partial Rupture

Hand ◽  
2016 ◽  
Vol 12 (1) ◽  
pp. NP1-NP5 ◽  
Author(s):  
Rick J. Fairhurst ◽  
Arnold M. Schwartz ◽  
Leo M. Rozmaryn
Keyword(s):  
Tendon Rupture ◽  
Biceps Tendon ◽  
Partial Rupture ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
First Case ◽  
Biceps Tendon Rupture ◽  
History Of ◽  
Tendon Ruptures ◽  
Tendon Insertion

Background: Given the appreciable prevalence of gout, gout-induced tendon ruptures in the upper extremity are extremely rare. Although these events have been reported only 5 times in the literature, all in patients with a risk factor for or history of gout, they have conspicuously never been diagnosed in the shoulder or elbow. Methods: A 45-year-old, right-hand-dominant man with a history of gout presented with pain in his right anterior elbow and weakness in his forearm after a trivial injury. Results: Here, we report the first case of gouty tenosynovitis of the distal biceps tendon insertion complicated by partial rupture, a composite diagnosis supported by both intraoperative and histological observations. Conclusions: In patients who are clinically diagnosed with biceps tendon rupture and have a history of gout, it is important to consider the possibility of a gout-related pathological manifestation causing or simulating tendon rupture.

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