Subcutaneous Rupture of the Extensor Pollicis Longus Tendon after Corticosteroid Injections for DeQuervain’s Stenosing Tenovaginitis

Abstract

DeQuervain's stenosing tenovaginitis is a common condition. Nonsurgical treatment by corticosteroid injection has significantly improved the management of this disease. The authors describe a case of subcutaneous rupture of the extensor pollicis longus tendon at the wrist, three months after two corticosteroid injections for DeQuervain's stenosing tenovaginitis. The etiological history has not found any trauma history of the wrist. The aim of our work is to draw attention to this rare complication and discuss its therapeutic management. Our functional results were excellent.

Effectiveness of Dextrose Prolotherapy for Rotator Cuff Tendinopathy: A Systematic Review

“…Recently there has been concern regarding subacromial corticosteroid injection for rotator cuff tendinopathies and its effects on tendon integrity, long‐term disease recurrence and progression, and effect on future surgical intervention . Corticosteroid is thought to cause cellular apoptosis and alteration in collagen synthesis, which ultimately weakens and can rupture tendons, reduce immunologic response, and reduce the success of future surgical repairs by delaying or inhibiting healing .…”

“…11,25,27,40 Due to the significant variation between the one-time single-site injection and repeat multisite injection protocols utilized, it is unknown whether patients receiving dextrose prolotherapy would continue to improve or maintain their improvements at 1 year as seen in Seven et al and Bertrand et al However, there is potential, based on the proposed mechanism of dextrose and results of repeat multisite injection protocols that patients may continue to improve or merely maintain their improvements at a 1-year follow-up, whereas patients with corticosteroid will have significant disease recurrence. 11,25,27,40 Recently there has been concern regarding subacromial corticosteroid injection for rotator cuff tendinopathies and its effects on tendon integrity, [41][42][43][44] longterm disease recurrence and progression, [41][42][43][44] and effect on future surgical intervention. 5,6,45 Corticosteroid is thought to cause cellular apoptosis and alteration in collagen synthesis, which ultimately weakens and can rupture tendons, 41,45 reduce immunologic response, 41,45 and reduce the success of future surgical repairs by delaying or inhibiting healing.…”

A Literature Review on De-Quervains Tenosynovitis

“…It is truly in its phylogenetic infancy, as its separation from the ABL, a fact sharply noticed in standard anatomy books. Occasionally it is absent, being represented only by a tendinous ligaments passing from the radial styloid to the base of the 1st phalanx of the thumb [16,17] . EPL its origin from ½ dorsal sides of the radius, the membrane introsseous and the insertion is at base of the proximal phalanx 826 of the thumb.…”

“…There is the stenosis of the 1 st dorsal compartment is caused by the attritional force secondary the friction; the attritional force produce swelling and thickening of the extensor retinaculum of the 1 st dorsal compartment the narrowed fibro osseous canal, resulting in the pain and decreased motions [5,17] . The histopathology of the de-quervain's disease generally does not involve inflammation but related instead to the thickening of extensor retinaculum [18] .…”

Functional Recovery Following an L-Lengthening Local Tendon Flap for Extensor Pollicis Longus Chronic Ruptures

“…arthritis, 11,12 the use of corticosteroids, 13,14 and in association with certain occupational activities. 15,16 Lister's tubercle is the most frequent site of an EPL rupture; it is thought to result from the poor vascular supply of the tendon at this point.…”