Scientific article
Stenosing Synovitis of the Extensor Pollicis Longus Tendon

https://doi.org/10.1016/j.jhsa.2011.02.004Get rights and content

There are only a few published cases of extensor pollicis longus (EPL) tenosynovitis in patients without rheumatoid arthritis. Even less common are cases of stenosing tenosynovitis of the EPL associated with triggering. This article presents 2 cases of EPL stenosing tenosynovitis with triggering of the thumb in the area of Lister's tubercle and addresses how to treat them.

Section snippets

Case 1

A 26-year-old, right-handed banker and avid drummer presented with a 4-week history of left wrist pain in the area of Lister's tubercle, as well as a painful snapping of his thumb with extension. His medical history reflected no illness or injury to the left upper extremity. The patient had already tried immobilization. Radiographs showed no abnormalities. Magnetic resonance imaging (MRI) performed at an outside institution was of poor quality and failed to define the diagnosis. A targeted,

Case 2

A 44 year-old, right-handed man presented with a history of a fall onto his left hand 1 month earlier. He complained of painful snapping along the dorsal radial side of the wrist during thumb extension. The patient also reported a remote history of a wrist fracture that had healed uneventfully without surgical intervention. Medical history was otherwise noncontributory. The snapping of the thumb was visibly apparent and initially thought to be the result of subluxation of the EPL tendon over

Discussion

McMahon and Posner4 in 1994 reported a case of snapping thumb secondary to tenosynovitis in the third extensor compartment. They used the term triggering instead of snapping, and attributed it to a normal-sized tendon compressed by a small third compartment near the Lister's tubercle. In our cases, the snapping was caused by an enlarged tendon within a normal-sized third compartment. In 1995, Lanzetta et al described a case of posttraumatic snapping thumb, using the term triggering, at the

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