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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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