The Prodrome of Extensor Pollicis Longus Tendonitis and Rupture: Rupture May Be Preventable

Current literature suggests that tendonitis of the extensor pollicis longus (EPL) is a rare condition that has a high rate of progression to rupture. This study documents the prodrome of impending EPL rupture in patients with prior nondisplaced distal radial fracture. A retrospective study identified patients with EPL tendonitis or tendon rupture. Seven patients (6 females and 1 male) had sustained a nondisplaced distal radius fracture within the past year. Among these 7 patients, 4 eventually developed EPL tendon rupture and 3 had tendonitis without rupture. Of the 4 patients with EPL rupture, 2 presented to another provider before rupture with prodromal symptoms documented in the medical record, with pain and difficulty extending the affected thumb at the interphalangeal (IP) joint. The 3 patients with EPL tendonitis but no EPL tendon rupture all presented following a nondisplaced distal radius fracture with tenderness over the EPL tendon and pain with thumb motion. These 3 patients underwent EPL tendon decompression and subsequently did not go on to experience EPL rupture. Extensor pollicis longus tendonitis is a condition that is classically seen in the setting of nondisplaced distal radius fractures and often progresses to tendon rupture. In this study, the following prodrome of impending EPL rupture was identified: tenderness over the EPL tendon and Lister's tubercle and pain with thumb motion. This study suggests that patients with EPL tendonitis and possible impending rupture present with a prodrome of symptoms. If these patients can be identified, they may undergo EPL tendon decompression, which may prevent EPL tendon rupture. [Orthopedics. 2016; 39(5):318-322.].