Rupture of extensor tendon secondary to previously undiagnosed Kienböck disease

Abstract

We report three patients with an unusual pattern of rupture of the extensor tendon. All were found to have previously undiagnosed Kienböck disease. Radiographic study of the wrist is essential before treating any closed rupture of an extensor tendon. Lesions may be progressive and extend to adjacent tendons and should be treated urgently.

Closed rupture of extensor tendon resulting from untreated Kienböck disease

“…[8,14,15,18,19] On the other hand, causes of closed extensor tendon ruptures in Kienböck disease have been reported to be associated with dorsal protrusion of lunate bone fragments or a mass of ectopic bone. [8,9,10,11,12,13,16,17,20] In our case, the dorsally displaced lunate fragments had pierced the capsule of the wrist, resulting in chronic attrition of the extensor tendons.…”

“…Spontaneous closed tendon rupture has been described as the one of the well-known complications in Kienböck disease. [8,9,10,11,12,13,14,15,16,17,18,19,20] To our knowledge, however, only 23 cases (extensor 18, flexor 5 cases) have been reported in the English literature (Table 1). Although painless swelling was the prodromal symptom of closed extensor rupture in our case, prodromal symptoms of spontaneous closed tendon ruptures have been reported in only a few cases.…”

“…Although painless swelling was the prodromal symptom of closed extensor rupture in our case, prodromal symptoms of spontaneous closed tendon ruptures have been reported in only a few cases. Before the occurrence of closed tendon ruptures, only 7 patients had complained of mild wrist pain and 8 patients had prodromal symptoms, such as swelling or pain in the dorsum of the wrist in 22 patients, [8,9,12,13,18,19,20] suggesting nonspecific symptomatology. Thus, although wrist pain would be occasionally occurred as the prodromal symptom of closed tendon rupture, asymptomatic tendon rupture could occur in advanced Kienböck disease with collapsed lunate bone.…”

“…[1,2,3,4,5,6,7] On the other hand, although closed tendon ruptures of fingers are a well-known complication due to in advanced Kienböck disease, only 23 cases (extensor 18, flexor 5 cases) have been reported in the English literature. [8,9,10,11,12,13,14,15,16,17,18,19,20] In previous reports, all the closed tendon ruptures were caused by the protrusion of fragments of the lunate bone or a mass of ectopic bone, suggesting the closed tendon ruptures are attritional ruptures in advanced Kienböck disease. We present a rare occurrence of attritional extensor tendon rupture of the right fourth finger in a 69-year-old woman with Kienböck disease and review reports of similar cases.…”

Flexor Tendon Rupture Due to Previously Undiagnosed Kienböck Disease: A Case Report

“…1 Extensor tendon rupture is a rare sequelae of Kienböck's disease, with several authors reporting cases in the literature. [2][3][4] However, to our knowledge, there is no other reported case of flexor tendon rupture due to Kienböck disease.…”