Rupture extensor policis longus

Case contributed by Jack Ren


Painful left wrist post fall

Patient Data

Age: 26
Gender: Female

X-ray at time of injury

An acute minimally displaced fracture traverses the distal left radius, with the main fracture lines parallel to the articular surface of the wrist joint. Distal articular is mildly dorsally angulated ~100.  The wrist joint is enlocated.

Two corticated bony fragments are demonstrated adjacent to the distal ulna, widening the medial wrist joint space. The larger measures 7 mm and the smaller 2 mm. These are in keeping with an old injury. 


Later X-ray

There is increasing sclerosis at the transverse fracture line of the distal radius and early callus formation consistent with healing. Callus formation is more prominent dorsally.

Thin longitudinal component to the fracture is also noted. Previous avulsion injury of the ulnar styloid.


Rupture of the extensor pollicis longus tendon. First 2 images of the series best show thickening of the tendon sheath with absence of tendon fibres and increased vascularity. Compare these images with the normal extensor indicis in the following images.

Ultrasound survey along the extensor indicis tendon (Images 3-7) shows the tendon is intact and normal throughout its length.

Case Discussion

Extensor pollicis longus tendon rupture occurs in 0.2-3% of distal radial fractures 3, often without any warning symptoms. It is said to occur more commonly in undisplaced fractures where the extensor retinaculum remains in tact so that the tendon is tightly held against the bone and at risk of abrasian against fracture callus1.

It may also occur in the presence of fracture spikes or where there is impingement against fixation devices. Others have postulated tendon ischaemia secondary to injury as a cause2.

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Case information

rID: 30128
Published: 2nd Aug 2014
Last edited: 8th Dec 2015
Inclusion in quiz mode: Included

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