Presentation
Fall on outstretched hand eight months ago with initial negative radiographs, now has chronic pain in the right wrist at the snuff box.
Patient Data
MRI of the right wrist shows a complete tear of the EPL tendon in the vicinity of Lister’s tubercle with increased signal and expansion as it travels superficially over the second extensor compartment. There is edema around the torn tendon. A bony spur with notching is present near Lister’s tubercle, which may have contributed to the tear. No fracture is seen.
Case Discussion
The extensor pollicis longus (EPL) is the extensor tendon found in the third extensor tendon compartment of the wrist. It is located medial/ulnar to Lister’s tubercle, which separates the second and third extensor tendon compartments.
EPL tendon rupture is associated with fracture of the distal radius, inflammatory response, and repeated abnormal movements of the wrist joint. Generally, conditions causing narrowing of the third extensor tendon compartment will increase the incidence of EPL tears 1. The narrowing can result in chronic damage to the tendon via disruption of tendon vascularity 2,3. In our patient, the history of a traumatic injury and the presence of a bony spur near Lister’s tubercle likely contributed to the spontaneous rupture of the EPL tendon.
Case courtesy of Dr. Emad Allam - Assistant Professor of Radiology, Loyola University Medical Center
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