Spontaneous atraumatic extensor pollicis longus rupture in the nonrheumatoid population.

INTRODUCTION: Extensor pollicis longus (EPL) tendon rupture is a well-described phenomenon in patients with rheumatoid arthritis. Mechanisms of EPL tendon rupture in the nonrheumatoid population have also been described and include traumatic rupture, repetitive motion strain, and steroid injection into the tendon.

METHODS: The operative records for patients undergoing extensor pollicis longus reconstruction by the senior author were reviewed. Patients with a history of trauma to the wrist or inflammatory arthropathy were excluded.

RESULTS: We identified 3 patients who presented with spontaneous EPL tendon rupture. These patients reported no risk factors (as listed earlier) or inciting event. All 3 patients had some exposure to local steroids but this exposure was not at the site of subsequent tendon rupture. All patients were operatively repaired and went on to full recovery of EPL function.

DISCUSSION: In patients with sudden loss of extension of the thumb interphalangeal joint, a thorough history of steroid exposure including local steroid exposure remote to the affected EPL tendon may be relevant.