EPL rupture prodrome: Case series and review of the literature

Abstract

Extensor pollicis longus (EPL) tendinopathy is relatively uncommon condition which is often associated with nondisplaced distal radius fractures. If left untreated, it can progress to EPL rupture. Conversely, timely recognition and management of EPL tendinopathy may mitigate the risk of progression to EPL rupture, thereby avoiding the need for surgical reconstruction.After obtaining IRB approval, we conducted a chart review of EPL tendinopathy patients receiving care between December 2009 and February 2024. During the study period, prophylactic EPL decompression was performed on 44 patients. In each case, preoperative tendinopathy pain was alleviated, and none of the patients went on to EPL rupture during the follow-up period. Timely recognition and intervention of EPL tendinopathy will provide pain relief, less discomfort with EPL motion and may prevent impending EPL rupture with diagnosis and decompression of the third dorsal compartment in appropriately selected patients. This paper outlines a set of physical examination maneuvers to aid practitioners in diagnosing EPL tendinopathy and describes operative technique for decompressing the third compartment.