Background:
Isolated rupture or damage to the extensor pollicis brevis tendon is extremely rare with limited case reports, most of which are associated with extensor pollicis longus or abductor pollicis longus injuries. These injuries are often related to thumb trauma, athletic training, work-related trauma, or complications of steroid injection for de Quervain’s Tenosynovitis.
Aim and Objectives:
We present a rare case of tethered damage to a solitary extensor pollicis brevis and describe the patient’s clinical presentation, diagnostic process, treatment course, and outcome.
Materials and Methods:
An 18-year-old girl presented with disability of left thumb extension following direct impact by a spiked volleyball three months prior. The volleyball struck the patient’s thumb causing hyperflexion and resulted in severe pain and swelling over the patient’s left thumb metacarpal phalangeal joint. After six weeks of spica splinting, active extension of her left thumb was still limited so ultrasound was performed. Ultrasound showed tenosynovial edema while no gross tear or rupture in the extensor pollicis brevis tendon was noted. These findings were compatible with tenosynovitis so rehabilitation was arranged. Three weeks later, however, weakness of metacarpal phalangeal joint extension was still noted, so tendon transfer was discussed and agreed upon.
Results:
Extensor indicis proprius to extensor pollicis brevis tendon transfer surgery was performed 9 months post her initial injury. The whole surgery was performed under wide-awake local anesthesia no tourniquet technique via three small incisions on the dorsal hand. Although the continuity of the extensor pollicis brevis was intact during exploration, the distal tendon appeared tethered and lax with fibrous-like strands. After successful tendon transfer surgery, the patient’s thumb extension was restored and she has been followed up at our clinic for 2 years without any functional limitations.
Conclusion:
We described an extremely rare case of solitary extensor pollicis brevis tendon injury resulting in limitation of thumb extension. Ultrasound may be a helpful tool in visualization while surgical management by extensor indicis proprius tendon transfer is the treatment of choice to achieve adequate restoration of extensor function to the thumb.

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