Extensor pollicis longus rupture

Case contributed by Dr Akos Jaray

Presentation

Fell off ladder to right hand. Unable to extend first distal interphalangeal joint on the right. Flexion is preserved.

Patient Data

Age: 35 years
Gender: Male
ultrasound

Dynamic ultrasound studies show normal movement of extensor pollicis longus (EPL) tendon for passive flexion and ruptured EPL on the right with 5 mm gap between the thickened ruptured ends.

Right thumb

x_ray

No fracture or avulsion fracture detected.

Incidental finding of early trapeziometacarpal osteoarthritis.

Case Discussion

Comparing the musculoskeletal ultrasound findings with the contralateral side is a useful tool to avoid pitfalls. Tendon ruptures are not visible on x-ray and tiny avulsion fractures can also be missed on radiographs. Dynamic ultrasound examination might provide further information on the degree of tendon injuries.

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