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Distal intersection syndrome progressing to extensor pollicis longus tendon rupture: a case report with sonographic findings


The purpose of this case report is to describe the value of musculoskeletal ultrasound (US) in diagnosing both distal intersection syndrome (DIS) and rupture of the extensor pollicis longus (EPL) tendon in the same patient. A 38-year-old female presented for evaluation of a painful bump of unknown etiology on the dorsolateral aspect of her non-dominant wrist. US demonstrated tenosynovitis distal to Lister's tubercle of the EPL and extensor carpi radialis tendon sheaths, consistent with DIS. Immobilization therapy was employed, during which time the patient suffered rupture of the EPL tendon. Follow-up US examination confirmed this additional diagnosis. Characteristic US findings of DIS and EPL tendon rupture were observed. Surgical intervention was required and the patient recovered without complication. Although EPL rupture is relatively common in the literature, DIS is rare. This is the first known case of imaging-proven DIS progressing to EPL tendon rupture. This case underscores the value of US as a widely available, cost effective, and dynamic imaging modality for evaluation of wrist complaints.


Lo scopo di questo caso clinico è quello di descrivere l'utilità dell’ecografia (US) muscolo-scheletrica nella diagnosi della sindrome da intersezione distale (DIS) e della rottura del tendine estensore lungo del pollice (EPL) in uno stesso paziente. Il caso riguarda una donna di 38 anni, valutatain merito ad una tumefazione dolente di eziologia sconosciuta sulla superficie dorsolaterale del polso non dominante. L’ecografia dimostrava una tenosinovite distale al tubercolo di Lister della EPL e delle guaine tendinee dell’estensore radiale del carpo, coerente con la diagnosi di DIS. Tale lesione è stata trattata con immobilizzazione dell’arto, durante il quale la paziente ha subito rottura del tendine EPL. L’esame ecografico di follow-up ha confermato questa ulteriore diagnosi. L’ecografia ha quindi evidenziato reperti caratteristici della DIS e di rottura del tendine EPL, sulla base dei quali la paziente è stata sottoposta ad intervento chirurgico che è stato effettuato senza complicazioni, permettendo il recupero funzionale dell’arto. Anche se la rottura del EPL è relativamente comune nella letteratura, la DIS è rara. Questo è il primo caso a noi noto di imagingche dimostra la DIS con progressione verso rottura del tendine del EPL. Questo caso sottolinea il valore dell’ecografia come modalità di diagnostica di imaging dinamico,ampiamente disponibile ed economica per valutare le lesioni del polso.

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Correspondence to Ross Mattox.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Mattox, R., Battaglia, P.J., Scali, F. et al. Distal intersection syndrome progressing to extensor pollicis longus tendon rupture: a case report with sonographic findings. J Ultrasound 20, 237–241 (2017).

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  • Ultrasonography
  • Wrist
  • Tendons
  • Tenosynovitis
  • Overuse syndrome
  • Intersection syndrome