Thumb Extensor Tendon (EPL) Rupture

Thumb Extensor Tendon (EPL) Rupture
July 29, 2017

Dr. Vikas Gupta being one of the best hand and shoulder specialists is also equally adept at diagnosing the problems that seem to be troubling the patient. Sharing his introspections about EPL rupture he calmly states, “The damage to the extensor tendon, around the bony prominence at the back of the wrist called Lister’s tubercle, when it extends to the thumb is referred to as EPL rupture. This Extensor Pollicis Longus enables the thumb to extend and move towards the index finger in a kind of hitchhike position and when certain causes such as a fracture in the wrist or presence of rheumatoid arthritis damage this tendon, the thumb fails to extend and perform normal functional movements.

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Presently designated as the head of hand and shoulder department at Max Healthcare, Dr. Gupta is not new to this field. He has a background of more than 25 years of experience and above 6000 surgeries to his credit. Asserting about the rupture he states, “When patients approach us with problems in their thumb we immediately seek to detect if there has been a rupture in the EPL. We ask the patient to place their hand on the table and then observe whether they are able to lift their thumb or not and diagnostically confirm the presence of EPL rupture with help from x-rays of wrist and thumb and ultrasound reports.”

“Here we need to understand clearly that after this tendon has ruptured it is not possible to repair them directly as the ends till then have already frayed. Patients usually bear this problem unaware that their thumb tendon may have ruptured and keep using their thumb and hand. It is only when the problem starts to interfere with the performance of other tendons and interrupts functioning that the patients seek medical advice and repair. We take up the repair of this tendon either by tendon graft or tendon transfer in an outpatient surgery.”

The patient should consult our medical team >>click here for appointment

FAQ – Thumb Extensor Tendon (EPL) Rupture

The extensor tendon that extends to the thumb is called the EPL i.e. Extensor Pollicis Longus. This long tendon runs on the back of the wrist and around a bony prominence which is referred to as Lister’s Tubercle. Being in a narrow and tight tunnel that confines it, the EPL enables the straightening of the end joint of the thumb and initiates its pulling in the thumb towards the index finger.
When the EPL becomes damaged in the tunnel at the wrist because of various causes making the thumb unable to extend completely it is referred to as a rupture in the EPL.
There are two reasons why the EPL may rupture- If the wrist has sustained a fracture at the end of the radius bone the EPL tendon may receive poor supply of blood in the tunnel and trigger off rupture of the EPL after weeks or months of the wrist fracture. If the patient is suffering from Rheumatoid Arthritis then the tendon is potentially damaged from the inflammation of the joint beneath and also from a condition known as tenosynovitis that harms the tendons from the rheumatoid process.
The signs that mark the presence of EPL rupture may be-
  • Occasional pain at the wrist
  • The end joint of the thumb fails to straighten
  • Working and posture of the thumb becomes abnormal
  • The thumb does not lift when the hand is placed flat on a table
  • A ping sensation
After examining the movement of the thumb intrinsically an X-Ray of hand and wrist is done to confirm the rupture. For the final conclusive diagnosis an ultrasound may also be used.
Tendon repair directly is not an alternative as the ends of the tendons already wear off with the rupture. Surgical intervention is taken up when other tendons become affected and the patient is unable to perform normally with the thumb and the hand. The treatment techniques vary from tendon graft (tendon from somewhere else in the body is taken and placed between the two ends) to tendon transfer (take another extensor tendon and replace it to perform the function of the ruptured tendon).
Surgery is the first step towards provision of relief but there are certain precautions and recommendations that should be followed diligently for an effective recovery thereafter. These precautions include splint wearing for a period of few days and then diligent exercise routine to improve strengthening and mobility in the thumb without any pressure on it. The splint is usually removed after six weeks of surgery.
Complications in EPL ruptures are rare after surgery as their repair is taken up by safe and effective procedures yet they may face some unforeseen risks. These complications are-
  • Infection in the cut made for surgery
  • Tenderness in the scar
  • Lack of grip strength
  • Numbness in the thumb
  • Repair techniques may fail to provide relief or may become loose and pull apart
  • A very rare chronic regional pain syndrome
  • ‘CRPS’ may affect the hand
The hand starts to feel a little better after 3 to 5 weeks and the patient can start making a full fist after 6 weeks. After 7 weeks the patient can start to hold and sustain it too and start with light activities but not activities heavier than lifting a kettle thereby resuming normal office work. The patient is allowed to resume driving after 8 weeks, permission to resume heavy work after 10 weeks and to go back to playing sports activities after 12 weeks.
Posted in Condition & Treatments by admin