S.M. Ali, , and D. OFarrell
Mid Western Regional Orthopaedic Hospital, Croom, Limerick, Republic of Ireland
Introduction Extensor tendon rupture is commonly seen after trauma or in association with diseases like rheumatoid arthritis or Kienbock’s disease. Here, we describe a case of extensor tendon rupture caused whilst playing the Ulileann pipe (traditional Irish musical pipes).
Case report Thirty four-year-old male right handed carpenter by occupation, presented to injury clinic complaining of an inability to extend his left middle finger, swelling and mild pain on the dorsal aspect of hand for 3 weeks. His symptoms started suddenly after playing the Uileann pipes at a music festival. He experienced a popping sensation on the dorsum of the hand and was unable to continue playing.
On examination a flexion deformity of the left middle finger .
Treatment He had exploration of the dorsal aspect of his hand, which showed a complete tear of the extensor tendon distal to his wrist, the edges of which were retracted leaving a gap of more than 4 cm. A graft was obtained from palmaris longus and the tendon was sutured with Ethibond suture. The wrist was immobilized in a cast for a short period of four weeks and then a physiotherapy/rehabilitation programme was started. Three months after surgery, he could fully extend the middle finger and was back to his occupation as a carpenter. He has also recently returned to playing music.
Discussion Extensor tendon injuries are divided into different zones from I to VIII.1 (I) Injury at DIPJ, (II) injury at MP, (III) injury at PIPJ, (IV) injury at PP, (V) injury at MPJ, (VI) injury at MC, (VII) injury at distal retinaculum, (VIII) injury at distal forearm/wrist. This injury was in zone VI, which has a better prognosis for the following reasons: 1. It is unlikely to be associated with joint injuries. 2. Decreased tendon area in this zone lessens the potential of adhesion formation. 3. Increased subcutaneous tissue in this zone lessens the potential for adhesion. 4. Greater tendon excursion in this zone. 5. Complex tendon imbalances are less likely to occur in this zone. Rupture of the extensor tendon whilst playing the Uileann pipes is a rare mechanism of injury. The main cause of rupture of the middle finger tendon is because this finger is under more stress, compared to other fingers. Besides the degenerative conditions of the tendon, such as rheumatoid arthritis, the other common reported causes of extensor tendon rupture are lacerations of the hand, fractures, during surgical procedures (SauveKapandji/Darrach procedureWada T, 1997)5, a rare disease Kienbock’s disease (Murase T, 1997, Yoshid 1990) and Secreetan’s disease (peritendinous fibrosis). In 1901, 11 cases were reported by Henri Secreetan).3 and 4
There are many different treatment options described in the literature.1 and 2 For this case, we used palmaris longus tendon graft, which achieved a favorable result and the patient was back at work within 12 weeks of injury.
In conclusion, ultrasound is beneficial in identifying the injury in delayed presentation for pre-operative planning. Early mobilization will help in achieving a good out come.
Injury Extra Volume 36, Issue 5 , May 2005, Pages 101-103.