Traumatic extensor hood rupture.
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ABSTRACT:
SUBMITTER: Loosemore MJ
PROVIDER: S-EPMC2686793 | biostudies-other | 2009 Jun
REPOSITORIES: biostudies-other
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Project description:BACKGROUND:While some traumatic closed index extensor tendon ruptures at the musclotendinous junction have been previously reported, closed index extensor tendon pseudorupture due to intertendinous attenuation is exceedingly rare with only one case report of a gymnastics-related sports injury in the English literature. Herein, we report two non-sports injury related cases of traumatic index extensor tendon attenuation mimicking closed tendon rupture, including the pathological findings and intraoperative video of the attenuated extensor indicis proprius tendon. CASE PRESENTATION:A 28-year-old man and a 30-year-old man caught their hands in a high-speed drill and lathe, respectively, which caused a sudden forced flexion of their wrists. They could not actively extend the metacarpophalangeal joints of their index fingers. Intraoperatively, although the extensor indicis proprius and index extensor digitorum communes tendons were in continuity without ruptures, both tendons were attenuated and stretched. The attenuated index extensor tendons were reconstructed either with shortening by plication or step-cut when the tendon damage was less severe or, in severely attenuated tendons, with tendon grafting (ipsilateral palmaris longus) or tendon transfer. Six months after the operation, the active extension of the index metacarpophalangeal joints had recovered well. CONCLUSIONS:Two cases of traumatic index extensor tendon attenuation were treated successfully by shortening the attenuated tendon in combination with tendon graft or transfer. We recommend WALANT (wide-awake local anesthesia and no tourniquet) in the reconstruction surgery of index extensor tendon attenuation to determine the appropriate amount of tendon shortening or optimal tension for tendon grafting or transfer. Intraoperative voluntary finger movement is essential, as it is otherwise difficult to judge the stretch length of intratendinous elongation and extent of traumatic intramuscular damage affecting tendon excursion.
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Project description:This report aimed to present a case of wrist-tendon rupture and to discuss a rare complication after corticosteroid injection. A 67-year-old woman had difficulty extending her left-thumb interphalangeal joint several weeks after a palpation-guided local corticosteroid injection. Passive motions remained intact without sensory abnormalities. Ultrasound examination showed hyperechoic tissues at the site of the extensor pollicis longus (EPL) tendon at the wrist level and an atrophic EPL muscle stump at the forearm level. Dynamic imaging demonstrated no motion in the EPL muscle during passive thumb flexion/extension. The diagnosis of complete EPL rupture, possibly due to inadvertent intratendinous corticosteroid injection, was therefore confirmed.
| S-EPMC10001071 | biostudies-literature
Project description:A case of traumatic hallux varus due to avulsion fracture of the lateral side of the base of proximal phalanx was reported. The lateral instability of the first metatarsophalangeal joint was believed to be due to the disruption of adductor hallucis function. It was successfully managed by minimally invasive extensor hallucis brevis tenodesis.
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Project description:PurposeTo investigate the difference between sonographic findings in extensor pollicis longus tendons rupture and other finger tendons rupture in patients sustaining hand and wrist trauma.MethodsTwenty-four patients who presented with signs and symptoms clinically suspicious for tendon injury and surgically confirmed tendon rupture were included in this study. We analyzed 6 sonographic features: discontinuity of the tendon, pseudomass formation, decreased echogenicity of the tendon, retraction of the ruptured tendon, fluid collection within the tendon sheath, and the motion of the tendon. We compared the sonographic features of ruptured extensor pollicis longus tendons with the other ruptured finger tendons.ResultsDiscontinuity of the tendon was the most common sonographic findings and retraction of the ruptured tendon was the second most common findings. Fourteen of 16 cases with a dynamic study on sonography showed loss of normal motion of the tendon. Pseudomass formation was the second most common feature in ruptured extensor pollicis longus tendons, in contrast to the other ruptured finger tendons (p < 0.05).ConclusionUsing ultrasonography, detection of discontinuity of the tendon, retraction of the ruptured tendon, and limitation of tendon motion could be very helpful for diagnosing a tendon rupture in hand and wrist trauma. Pseudomass formation could be more specific for diagnosing extensor pollicis longus tendon ruptures compared with other finger tendons.
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Project description:The purpose of this case report is to describe the value of musculoskeletal ultrasound (US) in diagnosing both distal intersection syndrome (DIS) and rupture of the extensor pollicis longus (EPL) tendon in the same patient. A 38-year-old female presented for evaluation of a painful bump of unknown etiology on the dorsolateral aspect of her non-dominant wrist. US demonstrated tenosynovitis distal to Lister's tubercle of the EPL and extensor carpi radialis tendon sheaths, consistent with DIS. Immobilization therapy was employed, during which time the patient suffered rupture of the EPL tendon. Follow-up US examination confirmed this additional diagnosis. Characteristic US findings of DIS and EPL tendon rupture were observed. Surgical intervention was required and the patient recovered without complication. Although EPL rupture is relatively common in the literature, DIS is rare. This is the first known case of imaging-proven DIS progressing to EPL tendon rupture. This case underscores the value of US as a widely available, cost effective, and dynamic imaging modality for evaluation of wrist complaints.
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Project description:Traumatic subarachnoid hemorrhage (SAH), a common finding following head trauma, is usually a benign condition with a favorable outcome, seldom requiring surgical intervention. Unlike nontraumatic aneurysmal SAH, most cases of traumatic SAH occur in the sulci of the cerebral convexities, and only rarely arise at the base of the brain. Basal traumatic SAH can be life-threatening and is primarily associated with rupture of vertebrobasilar arteries. We herein present a rare case of basal traumatic SAH resulting from rupture of the posterior communicating artery (PCoA). A 77-year-old male was taken to the emergency department in a semicomatose state. Upon arrival at emergency room, the patient had a Glasgow coma scale (GCS) score of 6 (E1M3V2), and the neurologic examination demonstrated no focal neurologic deficit. Although the trauma history was evident from abrasions and bruising on the face and chest, brain computed tomography (CT) demonstrated basal SAH, which is typical for nontraumatic aneurysmal SAH. Subsequent digital subtraction angiography (DSA) disclosed a traumatic rupture at the mid-portion of right PCoA and ongoing extravasation of contrast media. Despite emergent trapping of the right PCoA by endovascular surgery, the patient's clinical condition only minimally improved. The patient remained bed-ridden with stuporous mentality and persistent hydrocephalus. To the best of our knowledge, this is the first reported case of basal traumatic SAH originating from rupture of the PCoA. This case demonstrates that a meticulous vascular workup is mandatory for every patient with basal SAH, even though a trauma history is clear.
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Project description: Not available
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Project description:Thoracic trauma is commonly encountered in daily clinical practice; however, blunt thoracic trauma in patients with congenital cystic adenomatoid malformation (CCAM) is rare. CCAM rupture denotes a broad spectrum of manifestations on imaging and may be misdiagnosed as many other conditions. Consequently, this leads to inaccurate treatment and poor patient outcomes. We report the case of a girl with the initial diagnosis of a cavitary lung lesion that was likely a traumatic pulmonary pseudocyst or CCAM. The patient received medical therapy for 20 days; however, her condition did not improve. Subsequently, she underwent right lower lobectomy. Ruptured CCAM was confirmed during surgery and with histopathology. No complications occurred postoperatively, and the patient made a good recovery.
| S-EPMC9989401 | biostudies-literature
Project description:BackgroundAlthough chest trauma happens very often, accompanying tricuspid valve injuries occur rarely and may be manifested by scarce symptoms and signs. Pericardial rupture with cardiac herniation is even a bigger rarity. Transthoracic echocardiography plays a key role in the diagnosis of valve injuries but is of limited value in cardiac herniation.Case presentationWe present the case of 58-year-old man who experienced severe chest trauma in a car accident. Symptoms of right heart failure occurred 10 years after the injury, due to the loss of tricuspid leaflet support caused by the rupture of tendinous chords with significant tricuspid regurgitation. Intraoperatively, old posttraumatic pericardial rupture into left pleura was also found, with partial cardiac herniation and pressure of the edge of pericardium on all left-sided coronary arteries simultaneously. The patient was successfully operated and is free of symptoms 4 years later.ConclusionsThis case emphasizes the importance of timely diagnosis and underlines a mechanism that leads to delayed rupture of the tricuspid valve apparatus. Repeated echocardiography in all patients who experienced chest trauma could be of great importance. Also, given the limited value of echocardiography in posttraumatic pericardial rupture and cardiac herniation, cardiac computed tomography should be performed.
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Project description:A male in his 40s presented to the trauma center via air ambulance after colliding with a cement wall at highway speeds. Cross-sectional imaging revealed a right ventricular pseudoaneurysm, confirmed by echocardiography. He was taken emergently to the operating room where he was found to have a pericardial laceration, hemopericardium and a right ventricular rupture, which was primarily repaired. Postoperatively, the patient was transferred to intensive care and after 34 days in the hospital was ultimately discharged home.
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