Extensor Pollicis Longus Tendonitis
Other Names
- Extensor Pollicis Longus Tendonitis
- Drummer's Wrist
- Drummer's Palsy
- Drummer boy palsy
- Drummer's Thumb
Background
- This page refers to extensor pollicis longus (EPL) tendonitis, sometimes called Drummer's Wrist
History
- Needs to be updated
Epidemiology
- Unknown, rare disease
- Limited to case reports
Introduction
General
- EPL tendonitis or drummer's wrist is an overuse injury resulting in tenosynovitis
- This is a rare disease poorly described in the literature
- May not be correctly diagnosed on initial presentation
- Patients present with pain and difficulty extending thumb
Associated Conditions
- EPL tendon rupture has been reported in associate with chronic tenosynovitis[2]
Anatomy of the Third Dorsal Compartment
- Contents: Extensor Pollicis Longus (EPL)
- It is located just medial to Lister's tubercle
Risk Factors
- Drumming/ drummer
- Case Reports
- Weight Lifting/ Rowing Machine[3]
- Ganglion Cyst[4]
- Rhematoid Arthritis
- History of Distal Radius Fracture
Differential Diagnosis
Differential Diagnosis Wrist Pain
- Fractures
- Dislocations
- Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
- Carpometacarpal Joint Dislocation
- Distal Radioulnar Joint Dislocation
- Lunate Dislocation
- Perilunate Dislocation
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
Clinical Features
History
- Diffuse dorsal wrist pain for several months
- Will eventually localize to the 3rd tendon compartment
- One case reported triggering of the thumb[5]
Physical Exam: Physical Exam Wrist
- Swelling and tenderness over the dorsal wrist
- Most notably in the area of Lister's tubercle, EPL tendon, wrist extensors
- Pain with passive flexion of the thumb IP joint
- Passive flexion of carpometacarpal, metacarpophalangeal joints not as painful
- Crepitus at listers tubercle may be a clue
Special Tests
- Needs to be updated
Evaluation
Radiographs
- Standard Radiographs Wrist
- Typically normal
MRI
- Findings
- Fluid accumulation surrounding the EPL tendon
- Not necessary for routine diagnosis
Ultrasound
- Role not clearly defined
- Findings should include peritendinous fluid
Classification
- Not applicable
Management
Nonoperative
- First line therapy[6]
- Cock Up Wrist Splint or Thumb Spica Splint
- NSAIDS
- Physical Therapy
- Third Dorsal Compartment of the Wrist Injection
Operative
- Indications
- Unknown, presumed refractory cases
- Technique
- EPL Tendon Release
- EPL Tendon Transposition
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play/ Work
- Needs to be updated
Prognosis and Complications
Prognosis
- Needs to be updated
Complications
- EPL Tendon Rupture
See Also
References
- ↑ Image courtesy of teachmeanatomy.info, "The Extensor Tendon Compartments of the Wrist"
- ↑ Adler L, Blazar P, Lee B. Acute attenuation of the extensor pollicis longus tendon: a case report. Clin Orthop 1997;345: 171–173.
- ↑ 3.0 3.1 Huang, Henry W., and Robert J. Strauch. "Extensor pollicis longus tenosynovitis: a case report and review of the literature." The Journal of Hand Surgery 25.3 (2000): 577-579.
- ↑ Satonaka, H., M. Tsujii, and A. Sudo. "Tenosynovitis of the extensor pollicis longus tendon caused by an intratendinous ganglion: a case report." Journal of Hand Surgery (European Volume) 39.6 (2014): 669-671.
- ↑ McMahon MS, Posner MA. Triggering of the thumb due to stenosing tenosynovitis of the extensor pollicis longus: a case report. J Hand Surg 1994;19A:623–625.
- ↑ Posner MA. Differential diagnosis of wrist pain: tendinitis, ganglia, and other syndromes. In: Peimer CA, ed. Surgery of the hand and upper extremity. New York: McGraw-Hill, 1996:837– 851.