Spontaneous extensor pollicis longus (EPL) tendon rupture after ironing

Spontaneous tendon ruptures can occur rarely. Distal radius fractures, steroid applications and systemic diseases are mostly attributed to its etiology. In the treatment of spontaneous tendon ruptures, primary repair is not possible and tendon transfer is often required. The EPL tendon is the main extensor of the thumb. This muscle originates from the interosseous membrane, especially the dorsal part of the ulna. The EPL passes from the third dorsal extensor compartment ulnar to the Lister's tubercle before returning to the thumb. Since spontaneous tendon ruptures often occur due to degeneration, the defect is large in the area of the rupture. Therefore, spontaneous tendon ruptures are treated with tendon transfer rather than end-to-end repair. In this case report, we aimed to present a case of extensor indicis proprius (EIP) tendon transfer to our 64-year-old female housewife who was admitted to our clinic with a spontaneous rupture of the EPL tendon a resulting from excessive ironing in a short term. As a result of the examination and radiological evaluation of the patient who applied to our clinic with the complaint of inability to extend the thumb extension, a spontaneous EPL tendon rupture was diagnosed and surgical treatment was decided. While making a diagnosis of spontaneous tendon rupture, it was learned that the patient had no trauma and rheumatologic disease in her anamnesis. Ultrasound and magnetic resonance imaging (MRI) were used to confirm the diagnosis radiologically. The spontaneous EPL tendon rupture treatment was successfully provided by the transfer of the extensor indicis proprius (EIP) tendon. At the six month of follow-up after the surgical treatment, it was observed that the finger regained its former function. In elderly patients, repetitive, forceful finger movements for a long time may cause spontaneous tendon rupture. Long-term coercive thumb movement is a risk factor for EPL spontaneous tendon rupture.