Incomplete Avulsion Injury to a Solitary Extensor Pollicis Brevis After Volleyball Training-A Rare Case Report and Review of the Literature

排球訓練造成單獨伸拇短肌腱未完全性撕脫損傷－罕見病例報告和文獻回顧

吳宗翰(John Chung-Han Wu) ； 林有德(Yu-Te Lin) ； 李哲雄(Che-Hsiung Lee)

《臺灣整形外科醫學會雜誌》 31卷1期 (2022/03) Pp. 64-72

摘要

Background: Isolated rupture or damage to the extensor pollicis brevis tendon is extremely rare with limited case reports, most of which are associated with extensor pollicis longus or abductor pollicis longus injuries. These injuries are often related to thumb trauma, athletic training, work-related trauma, or complications of steroid injection for de Quervain's Tenosynovitis. Aim and Objectives: We present a rare case of tethered damage to a solitary extensor pollicis brevis and describe the patient's clinical presentation, diagnostic process, treatment course, and outcome. Materials and Methods: An 18-year-old girl presented with disability of left thumb extension following direct impact by a spiked volleyball three months prior. The volleyball struck the patient's thumb causing hyperflexion and resulted in severe pain and swelling over the patient's left thumb metacarpal phalangeal joint. After six weeks of spica splinting, active extension of her left thumb was still limited so ultrasound was performed. Ultrasound showed tenosynovial edema while no gross tear or rupture in the extensor pollicis brevis tendon was noted. These findings were compatible with tenosynovitis so rehabilitation was arranged. Three weeks later, however, weakness of metacarpal phalangeal joint extension was still noted, so tendon transfer was discussed and agreed upon. Results: Extensor indicis proprius to extensor pollicis brevis tendon transfer surgery was performed 9 months post her initial injury. The whole surgery was performed under wide-awake local anesthesia no tourniquet technique via three small incisions on the dorsal hand. Although the continuity of the extensor pollicis brevis was intact during exploration, the distal tendon appeared tethered and lax with fibrous-like strands. After successful tendon transfer surgery, the patient's thumb extension was restored and she has been followed up at our clinic for 2 years without any functional limitations. Conclusion: We described an extremely rare case of solitary extensor pollicis brevis tendon injury resulting in limitation of thumb extension. Ultrasound may be a helpful tool in visualization while surgical management by extensor indicis proprius tendon transfer is the treatment of choice to achieve adequate restoration of extensor function to the thumb.

關鍵字

extensor pollicis brevis ； incomplete avulsion injury ； extensor indicis proprius transfer

並列摘要

背景：單獨的伸拇短肌腱斷裂或損傷極為罕見，文獻中的病例報告也不多。其中大多數與伸拇長肌或拇外展肌損傷有關。這些損傷通常與拇指外傷、運動訓練、工作相關外傷或狄奎凡氏症腱鞘炎注射類固醇相關併發症有關。目的及目標：我們介紹了一個罕見的單獨性伸拇短肌未完全性撕脫損傷病例，並描述了患者的臨床表現、診斷過程、治療方式及結果。材料及方法：一名18歲的女性在三個月前被排球直接撞擊後，產生了左手拇指伸展不全。排球擊中了患者的左手拇指，導致過度屈曲，並造成患者左手拇指掌指關節劇烈疼痛和腫脹。在使用六週的拇指固定型副木後，病患左手拇指的伸展仍然受限，因此進行了超音波檢查。超音波顯示出伸拇短肌腱腱鞘水腫，但未發現伸拇短肌腱明顯撕裂或斷裂。影像學報告與腱鞘炎相符，因此安排了復健治療。然而，三週後，病患仍然注意到左手拇指掌指關節伸展無力，因此在討論過後，病患同意了進行肌腱轉移手術。結果：病患在受傷9個月後，接受了伸食指肌至伸拇短肌肌腱轉移手術。整個手術沒有使用止血帶並且在病患清醒且局部麻醉之下，通過手背上的三個小切口完成。雖然在探查過程中，伸拇短肌的肌腱是有連續性的，但遠端肌腱已鬆弛並摻雜許多纖維狀股線，似乎經過了拉扯及幾乎造成斷裂的損傷。肌腱轉移手術完成後，病患左手姆指伸直功能已恢復，手部活動也並沒有任何限制，病患已在我們門診追蹤長達2年。結論：我們描述了一個極其罕見的病例，因為單獨的伸拇短伸肌腱未完全性撕脫損傷而導致拇指伸展受限。超音波是一個良好的視覺化肌腱輔助診斷工具，而伸食指肌至伸拇短肌肌腱轉移手術，是讓拇指伸展功能恢復的治療方法之一。