Extensor-pollicis-longus or -brevis tendon rupture after corticosteroid injection

We present two cases and review possible rupture mechanisms. In case 1, the patient presented with a painful swelling on the dorsal side of her right first metacarpophalangeal joint. An orthopedic surgeon prescribed three local corticosteroid injections over 4 weeks, and the patient experienced a sudden loss of extension on the distal phalanx of her thumb 3 weeks after the last injection. Two days later, the proximal phalanx of the thumb lost its extension. Surgical exploration revealed that the extensor-pollicis-longus and extensor-pollicis-brevis tendons were completely severed. Both tendon ends had edematous necrosis with collagen degeneration. In case 2, the patient presented with ruptures of the extensor-pollicis-brevis tendon and the radial collateral ligament of her first metacarpal joint after receiving a local corticosteroid injection. In case 1, functional recovery was achieved by repairing the extensor-pollicis-brevis tendon and by transferring the extensor indicis proprius tendon to the extensor pollicis longus. In case 2, the patient was lost to follow-up and did not undergo surgery. Most physicians overlook local-corticosteroid-injection-induced tendon injuries. We hope that such patients will alert all physicians to the risk of tendon rupture associated with corticosteroid injections.
Source: Formosan Journal of Surgery - Category: Surgery Source Type: research