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Spontaneous Extensor Tendon Rupture in the Rheumatoid Wrist

Risk Factors and Preventive Role of Extended Tenosynovectomy

Hsueh, Jung-Hua MD; Liu, Wen-Chung MD; Yang, Kuo-Chung MD; Hsu, Kuei-Chang MD; Lin, Cheng-Ta MD; Chen, Lee-Wei MD, PhD

doi: 10.1097/SAP.0000000000000685
Clinical Papers
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Objective Spontaneous extensor tendon rupture is often seen in rheumatoid arthritis (RA) patients, but the risk factors are not clearly defined. We therefore collected the data of RA patients with previous extensor tendon rupture and those with tenosynovitis and analyzed the relationship between extended tenosynovectomy and spontaneous extensor tendon rupture.

Methods We retrospectively reviewed 17 spontaneous extensor tendon rupture episodes in 15 RA patients and 14 tenosynovitis episodes that required tenosynovectomy in 12 RA patients from 1997 to 2013. Correlations between the incidence of tendon rupture, X-ray findings, and clinical findings in the affected wrists before tendon rupture were analyzed statistically using the test for proportion.

Results The following parameters were significantly correlated with spontaneous extensor tendon rupture: disease duration longer than 8 years, persistent tenosynovitis longer than 1 year duration, and Larsen grade greater than 4 (P = 0.02, 0.03, and 0.01, respectively). Dislocation of the distal end of the ulna, carpal collapse, and the scallop sign on X-ray contributed to a higher spontaneous extensor tendon rupture rate among RA patients (P = 0.01, 0.05, and 0.03, respectively). Extended tenosynovectomy was performed on 14 wrists in 12 RA patients with persistent tenosynovitis longer than 6 months, and Larsen grade did not deteriorate in this group compared with those who did not undergo the surgery. No spontaneous extensor tendon rupture occurred following the surgery.

Conclusions Risk factors of spontaneous extensor tendon rupture included disease duration longer than 8 years, persistent tenosynovitis longer than 1 year, and wrist Larsen grade greater than 4. Dislocation of the distal end of the ulna, carpal collapse, and the scallop sign on X-ray indicated a higher probability of extensor tendon rupture. Rheumatologists should consult with hand surgeons promptly to preserve hand function before tendon rupture. Prophylactic extended tenosynovectomy surgery to prevent more severe damage of extensor tendon should be recommended in patients who had the above risk factors.

From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung; and †National Yang-Ming University, Taipei, Taiwan, Republic of China.

Received October 9, 2015, and accepted for publication, after revision November 9, 2015.

Conflicts of interest and sources of funding: none declared.

Reprints: Lee-Wei Chen, MD, PhD, Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China; National Yang-Ming University, Taipei, Taiwan, Republic of China, 386, Da-Zhong 1st Rd. Kaohsiung, Taiwan, Republic of China. E-mail: s19101037@gmail.com.

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