How is extensor tendon rupture in rheumatoid arthritis (RA) treated?

Updated: Jan 11, 2019
  • Author: Michael Neumeister, MD, FRCSC, FACS; Chief Editor: Joseph A Molnar, MD, PhD, FACS  more...
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Answer

Significant deformity or functional loss is an indication for repair by end-to-end repair, tendon graft, or tendon transfer to avoid flexion contraction. [2, 7] Tendon transfer with the extensor indicis proprius or extensor carpi radialis longus is the preferred method. [2] No deficit in independent index finger motion or wrist extension results using these tendons. Furthermore, this transfer avoids the complication of adhesion formation that can occur with tendon grafts. End-to-end repair is usually not possible because of the delay that frequently occurs between the time of the injury and the time the patient presents for treatment.

Extensor tendon rupture due to RA also frequently affects the small finger, causing extensor lag at the MP joint. Loss of extensor digiti quinti function reduces small finger extension at the MP joint by 30-40°. Any greater loss usually indicates the extensor digiti communis tendon has also been affected. The Vaughn-Jackson lesion is a sign of loss of extension in the little and ring fingers due to rupture of these tendons at the distal ulnar head, which can result from caput ulna syndrome.

Small finger extension can be tested by having the patient extend the small finger while the index, middle, and ring fingers are held in flexion. A small finger extensor tendon rupture from RA should be repaired early, because this defect generally leads to multiple tendon ruptures. Repair is usually accomplished by attaching the distal tendon end to an adjacent extensor tendon. [2] Dorsal tenosynovectomy and removal of bony spicules that may have worn down the tendon are also required to eliminate the ultimate cause.


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