Arch Hand Microsurg.  2022 Dec;27(4):311-314. 10.12790/ahm.22.0046.

Rupture of the extensor digitorum communis tendon in extensor zone V due to plant thorn injuries: a report of two cases

• Jang MG
• Heo YM
• Shin WJ

• KMID: 2536218
• DOI: http://doi.org/10.12790/ahm.22.0046

Abstract

Penetrating injuries due to a plant thorn in the hand may occur during outdoor activities. We experienced two patients with rupture of the extensor digitorum communis (EDC) tendon in extensor zone V caused by plant thorn injuries. Both patients, presenting with pain and swelling around the third metacarpophalangeal joint, had a history of penetrating injuries due to plant thorns. The injuries had been ineffectively treated with oral antibiotics. Plain radiographs showed soft tissue swelling without a foreign body and bony lesions. Enhanced magnetic resonance imaging confirmed a rupture of the EDC tendon at the third extensor zone V. Tendon ruptures were diagnosed 27 and 60 days after injury, respectively. A plant thorn injury in the hand can cause persistent synovitis around the tendon, and as a result, progress to tendon rupture. A magnetic resonance imaging examination may be helpful if symptoms do not improve for a prolonged period after plant thorn injury.

Keyword

Plant thorn; Extensor digitorum communis tendon; Magnetic resonance imaging; Rupture

Figure

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  Fig. 1. (A) In a photograph, swelling around the third metacarpophalangeal joint of the right dorsal hand was observed. (B) A lateral radiograph showed mild swelling of the dorsal hand without residual foreign material. (C) Sagittal magnetic resonance imaging (MRI) (enhanced T1 fat-suppressed) showed subcutaneous edema and rupture with retraction of the extensor digitorum communis (EDC) tendon at the dorsal aspect of the third metacarpal head. (D) Axial MRI (enhanced T1 fat-suppressed) showed fluid collection and disappearance of the EDC tendon. (E) Intraoperatively, a nearly complete rupture of the third EDC tendon was confirmed. (F and G) Photographs showed recovery of the range of motion at the final follow-up.

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  Fig. 2. (A) Swelling of the left dorsal hand was observed in a photograph. (B) T1 sagittal magnetic resonance imaging (MRI) showed rupture of the extensor digitorum communis (EDC) tendon at the dorsal aspect of the left third metacarpal head. (C) Axial MRI (enhanced T1 fat-suppressed) showed fluid collection and disappearance of the EDC tendon. Infectious arthritis was also suspected because diffuse synovial thickening and enhancement at the third metacarpophalangeal joint was found. (D) Intraoperatively, an approximately 2-mm foreign body was found in a hypertrophied synovium of the ruptured third EDC tendon. (E) The necrotic tissues, including the dorsal joint capsule, were debrided. (F) The ruptured tendon was directly repaired.

Reference

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