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A Case Report of Extensor Pollicis Longus Tendon Rupture: Delayed Diagnosis in a Professional Rugby Player.

Siddhant P Nayak¹, Molly Papadopoullos², Niyam Amanullah²

¹Physiology, Development and Neuroscience, Human Anatomy Centre, University of Cambridge, Cambridge, GBR.

|November 11, 2024

Summary

Spontaneous rupture of the extensor pollicis longus (EPL) tendon is rare. A protruding screw after distal radius fracture surgery may cause EPL tendon rupture due to friction, even over a year post-op.

Keywords:

distal end radius fracture extensor indicis tendon transfer pulvertaft weave technique screw abrasion with tendon upper limb orthopedic surgery volar plating

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Area of Science:

Orthopedic Surgery
Hand and Wrist Surgery
Sports Medicine

Background:

Spontaneous rupture of the extensor pollicis longus (EPL) tendon is an uncommon condition.
Prior surgery to the distal radius is a known precipitating factor for EPL tendon rupture.

Observation:

An 18-year-old professional athlete presented with inability to extend the left thumb one year after open reduction and internal fixation (ORIF) for a distal radius fracture.
Physical examination revealed findings consistent with EPL tendon rupture.

Findings:

The patient underwent surgical tendon transfer using the extensor indicis tendon.
A dorsally protruding surgical screw was removed from the volar aspect of the radius.
Repetitive friction from the protruding screw likely caused abrasion and subsequent rupture of the EPL tendon.

Implications:

A protruding volar plate screw can cause delayed EPL tendon rupture due to chronic friction.
This mechanism should be considered in cases of EPL tendon rupture, even long after distal radius fracture surgery.
Early identification and removal of problematic hardware may prevent such complications.