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Dominika Michno, Wojciech Konczalik MRCS, Saif Ramman MRCS, Akhavani Mohammed FRCS(Plast)
Department of Plastic & Reconstructive Surgery , Royal Free Hospital, London, United Kingdom
Case report of a complication of local corticosteroid therapy which has
not been previously reported in the literature. We describe a rupture of
a previously repaired extensor pollicis brevis which occurred
spontaneously three months after the administration of triamcinolone
into the first dorsal extensor compartment of the recently injured wrist.
A 29 year old male carpenter presented to the hand therapists with
De Quervain’s Tenosynovitis three months after sustaining a circular saw
injury which resulted in transection of both tendons in the first extensor
compartment of the affected wrist. The inflammatory symptoms were
deemed severe enough to warrant triamcinolone injection into the site of
previous repair and despite initial improvement the patient re-presented to
clinic twelve weeks after steroid administration with spontaneous
weakness of thumb extension. The extensor pollicis brevis could not be
palpated clinically and subsequent ultrasonography confirmed tendon
rupture in the vicinity of the previous injury.
OBJECTIVE
METHODS
Figure A: A marked difference in maximum
extension between the two thumbs can be
seen. Hyperextension of the interphalangeal
joint of the left thumb confirms that extensor
pollicis longus is intact.
Figure B: Active extension of the thumbs
demonstrates the extensor pollicis brevis and
extensor pollicis longus clearly in the right
thumb. These tendons cannot be visualised on
the contralateral side.
Intra-operative findings confirmed rupture of the extensor pollicis brevis at
the site of previous repair with gelatinous degeneration of the tendon
stumps which required debridement prior to re-approximation.
The patient made a good recovery following this intervention and was able
to return to work as a carpenter three months after surgery.
RESULTS
CONCLUSIONS
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3. Elliot D, Giesen T. Treatment of unfavourable results of
flexor tendon surgery: Ruptured repairs, tethered repairs and
pulley incompetence. Indian Journal of Plastic Surgery :
Official Publication of the Association of Plastic Surgeons of
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4. Peck FH, Kennedy SM, Watson JS, Lees VC. An evaluation
of the influence of practitioner-led hand clinics on rupture
rates following primary tendon repair in the hand. British
journal of plastic surgery. 2004;57(1):45-9.
acetate injection in De Quervain's tenosynovitis: a randomized
controlled trial. Journal of acupuncture and meridian
studies. 2014;7(3):115-21
Our case suggests that corticosteroid therapy may negatively impact the
healing process of a recently repaired tendon and reduce its tensile
strength resulting in spontaneous rupture. It also highlights the
importance of adopting a more conservative approach in patients with a
background of traumatic hand injuries who present to clinic with
inflammatory symptoms of the hand and wrist affecting a previously
repaired tendon. In these instances, we recommend abstaining from local
corticosteroid administration altogether and instead managing these
patents with splinting, targeted physiotherapy or tenolysis.
REFERENCES