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Extensor carpi radialis longus and brevis rupture in a boxer.

Mundell T, Miladore N, Ruiter T - Eplasty (2014)

View Article: PubMed Central - PubMed

Affiliation: Oakland University William Beaumont School of Medicine, Rochester, MI.

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A 34-year-old man experienced rupture of his extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB) tendons after striking a heavy boxing bag... There have been limited reports in the literature demonstrating avulsion injuries of both the ECRL and the ECRB tendons... Three cases reported traumatic avulsion of both ECRL and ECRB tendons after high-energy injury, and one case of isolated ECRB avulsion by similar mechanism as our patient... Our case demonstrates a traumatic avulsion of both the ECRL and ECRB (Fig 1) and repair via suture anchor (Fig 4)... Patients taking fluoroquinolones, particularly ofloxacin, are at greatest risk of tendon rupture within the first month after taking the drug and are at increased risk of rupture if they are concomitantly taking a corticosteroid... Tendinitis is an independent risk factor associated with tendon rupture... There have been anecdotal reports of anabolic steroid use and creatine supplementation causing tendon rupture, although many questions remain... One report of weight-lifters showed no difference in collagen fibril structure under electron microscopy between those who used anabolic steroids and those who did not, while another study discovered a difference... Suture anchors were used to approximate the ECRL and ECRB tendons to the base of the second and third metacarpals, respectively... Suture anchors have various pullout strengths based on manufacturer and location, with mini suture anchors having pullout strength in metaphyseal porcine femur between 13 and 151 pounds of force... In general, suture anchors, especially when used in the hand, exceed pullout strength when compared to commonly used suture material by hand surgeons alone... In our patient, the enthesis was likely interrupted as the ECRL and ECRB were avulsed from the bone surface with little visible tendon attachment remaining on the bone surface... To facilitate effective healing, the tendons must be approximated closely to their bony insertions, which can be accomplished using interference screws or suture anchors... Our case demonstrates a rare injury, interesting imaging findings, and brings into question the most appropriate technique for surgical repair... Suture anchors demonstrate higher pullout strength when compared to suture alone; however, more studies are needed to understand exactly how the enthesis interface heals.

No MeSH data available.


Related in: MedlinePlus

Sagittal T2, right wrist demonstrating avulsed second dorsal compartment (arrow).
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Figure 3: Sagittal T2, right wrist demonstrating avulsed second dorsal compartment (arrow).

Mentions: There have been limited reports in the literature demonstrating avulsion injuries of both the ECRL and the ECRB tendons. Three cases reported traumatic avulsion of both ECRL and ECRB tendons1,2,3 after high-energy injury, and one case of isolated ECRB avulsion by similar mechanism as our patient.4 The most common mechanism of injury in acute tendon rupture is abrupt acceleration/deceleration5 secondary to their inherent viscoelastic properties. Our case demonstrates a traumatic avulsion of both the ECRL and ECRB (Fig 1) and repair via suture anchor (Fig 4). Magnetic resonance imaging reveals extensor pollicis longus crossing over an empty second dorsal compartment as well as evidence of avulsion from the base of the metacarpals (Figs 2 and 3).


Extensor carpi radialis longus and brevis rupture in a boxer.

Mundell T, Miladore N, Ruiter T - Eplasty (2014)

Sagittal T2, right wrist demonstrating avulsed second dorsal compartment (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4215591&req=5

Figure 3: Sagittal T2, right wrist demonstrating avulsed second dorsal compartment (arrow).
Mentions: There have been limited reports in the literature demonstrating avulsion injuries of both the ECRL and the ECRB tendons. Three cases reported traumatic avulsion of both ECRL and ECRB tendons1,2,3 after high-energy injury, and one case of isolated ECRB avulsion by similar mechanism as our patient.4 The most common mechanism of injury in acute tendon rupture is abrupt acceleration/deceleration5 secondary to their inherent viscoelastic properties. Our case demonstrates a traumatic avulsion of both the ECRL and ECRB (Fig 1) and repair via suture anchor (Fig 4). Magnetic resonance imaging reveals extensor pollicis longus crossing over an empty second dorsal compartment as well as evidence of avulsion from the base of the metacarpals (Figs 2 and 3).

View Article: PubMed Central - PubMed

Affiliation: Oakland University William Beaumont School of Medicine, Rochester, MI.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

A 34-year-old man experienced rupture of his extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB) tendons after striking a heavy boxing bag... There have been limited reports in the literature demonstrating avulsion injuries of both the ECRL and the ECRB tendons... Three cases reported traumatic avulsion of both ECRL and ECRB tendons after high-energy injury, and one case of isolated ECRB avulsion by similar mechanism as our patient... Our case demonstrates a traumatic avulsion of both the ECRL and ECRB (Fig 1) and repair via suture anchor (Fig 4)... Patients taking fluoroquinolones, particularly ofloxacin, are at greatest risk of tendon rupture within the first month after taking the drug and are at increased risk of rupture if they are concomitantly taking a corticosteroid... Tendinitis is an independent risk factor associated with tendon rupture... There have been anecdotal reports of anabolic steroid use and creatine supplementation causing tendon rupture, although many questions remain... One report of weight-lifters showed no difference in collagen fibril structure under electron microscopy between those who used anabolic steroids and those who did not, while another study discovered a difference... Suture anchors were used to approximate the ECRL and ECRB tendons to the base of the second and third metacarpals, respectively... Suture anchors have various pullout strengths based on manufacturer and location, with mini suture anchors having pullout strength in metaphyseal porcine femur between 13 and 151 pounds of force... In general, suture anchors, especially when used in the hand, exceed pullout strength when compared to commonly used suture material by hand surgeons alone... In our patient, the enthesis was likely interrupted as the ECRL and ECRB were avulsed from the bone surface with little visible tendon attachment remaining on the bone surface... To facilitate effective healing, the tendons must be approximated closely to their bony insertions, which can be accomplished using interference screws or suture anchors... Our case demonstrates a rare injury, interesting imaging findings, and brings into question the most appropriate technique for surgical repair... Suture anchors demonstrate higher pullout strength when compared to suture alone; however, more studies are needed to understand exactly how the enthesis interface heals.

No MeSH data available.


Related in: MedlinePlus