What are the signs and symptoms of extensor tendon rupture in rheumatoid arthritis (RA)?

Updated: Jun 11, 2021
  • Author: Michael Neumeister, MD, FRCSC, FACS; Chief Editor: Joseph A Molnar, MD, PhD, FACS  more...
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Commonly affected extensor tendons are the EPL, extensor digiti quinti, and extensor digiti communis. Multiple extensor tendon ruptures are usually initiated by attrition of a single tendon and progress in a radial manner, frequently beginning with the small finger extensor.

A retrospective study by Hsueh et al indicated that risk factors for spontaneous extensor tendon rupture in patients with RA of the wrist include RA of over 8 years’ duration, persistent tenosynovitis lasting for more than 1 year, and a Larsen score of over 4. [9]

EPL tendon rupture may not significantly affect the thumb interphalangeal (IP) joint extension, because this motion is controlled by the intrinsic muscles and by the EPL. In contrast, extension at the thumb MP joint is usually reduced, because the extensor pollicis brevis cannot compensate for deficient EPL function. To test for EPL tendon rupture, palpate the tendon at the wrist while the patient extends the thumb with the palm resting on a flat surface. Active testing may also reveal some weakness and pain at the site of rupture.

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