Spontaneous atraumatic extensor pollicis longus rupture in the nonrheumatoid population

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Rheumatology

Background:

• Extensor pollicis longus (EPL) tendon rupture is common in rheumatoid arthritis.
• In nonrheumatoid patients, rupture causes include trauma, repetitive strain, and direct steroid injection.
• Spontaneous EPL rupture without known risk factors is less understood.

Purpose of the Study:

• To investigate spontaneous extensor pollicis longus tendon ruptures in patients without typical risk factors.
• To identify potential contributing factors for spontaneous EPL tendon rupture.

Main Methods:

• Review of operative records for EPL tendon reconstruction.
• Exclusion of patients with trauma or inflammatory arthropathy history.
• Analysis of patient history for risk factors and steroid exposure.

Main Results:

• Identified 3 patients with spontaneous EPL tendon rupture.
• These patients had no identified risk factors or inciting events.
• All patients had prior local steroid exposure, not directly at the rupture site.
• All patients underwent successful surgical repair and regained full EPL function.

Conclusions:

• Sudden loss of thumb interphalangeal joint extension warrants a detailed history.
• Consider local steroid exposure, even remote from the affected tendon, as a potential factor.
• Spontaneous EPL rupture may be linked to systemic or remote local steroid effects.