국소 스테로이드 주사 후에 발생한 장무지신건 파열

Extensor Pollicis Longus Tendon Rupture Following Local Steroid Injection

  • 최윤석 (가톨릭대학교 의과대학 빈센트병원 성형외과학교실) ;
  • 김태형 (가톨릭대학교 의과대학 빈센트병원 성형외과학교실) ;
  • 임진수 (가톨릭대학교 의과대학 빈센트병원 성형외과학교실) ;
  • 전영준 (가톨릭대학교 의과대학 빈센트병원 성형외과학교실)
  • Choi, Yun Seok (Department of Plastic Surgery, The Catholic University of Korea College of Medicine) ;
  • Kim, Tae Hyung (Department of Plastic Surgery, The Catholic University of Korea College of Medicine) ;
  • Lim, Jin Soo (Department of Plastic Surgery, The Catholic University of Korea College of Medicine) ;
  • Jun, Young Joon (Department of Plastic Surgery, The Catholic University of Korea College of Medicine)
  • 투고 : 2005.08.19
  • 발행 : 2006.01.10

초록

Spontaneous extensor pollicis longus tendon rupture is commonly caused by attrition of the tendon from trauma or inflammatory processes. We experienced a patient with extensor pollicis longus tendon rupture after steroid injection, in which the rupture may have been caused by the effects of steroid itself as well as direct damage from the needle. A 51-year-old woman complained of inability to extend her right thumb at the first metacarpophalangal & interphalangeal joint level. The patient had a history of local steroid injection into the dorsal & radial side of wrist on two occations, and had no history of trauma or rheumatologic disease. After a physical examination of the patient, we decided to explore the wrist. The patient agreed with operation. Intraoperatively, an incision was made into the wrist and the proximal and distal ends of the ruptured extensor pollicis longus tendon were identified. The defect between the proximal and the distal end was measured to approach 8cm, and a palmaris longus tendon graft was performed. After three months of rehabilitation, the first metacarpophalangal & interphalangeal joint recovered the normal range of motion. Steroid injection has been widely used in various musculoskeletal disorders such as rheumatoid arthritis and osteoarthritis. However, inadvertent steroid injection into the extra or intra articular spaces may lead to tendon rupture. Steroids reduce tensile strength by decreasing tenocyte activity and collagen synthesis. Also, the physical effect of direct needle-stick injury into the mesotenon and blood vessels around the tendon may cause damage. In addition, hematoma and edema may increase pressure around the tendon and compromise blood supply, leading to tendon degeneration and subsequent rupture. When injecting steroid into an articular area, all physicians should have a complete understanding of the surrounding anatomy and always keep in mind the hazards of such procedures.

키워드

참고문헌

  1. Gray RG, Gottlieb NL: Intra-articular corticosteroid. Clin Orthop Relat Res 177: 235, 1983
  2. Wong MW, Tang YN, Fu sc Lee KM, Chan KM:Triamcinolone suppresses human tenocyte cellular activity and collagen synthesis. Clin Orthop Relat Res 421: 277, 2003 https://doi.org/10.1097/01.blo.0000118184.83983.65
  3. Straub LR, Wilson EH: Spontaneous rupture of extensor tendons in the hand associated with Rheumatoid arthritis. J Bone Joint Surg 38: 1208, 1956
  4. Engkvist O, Lundborg G: Rupture of the extensor pollicis longus tendon after fracture of the lower end of radius-a clinical and rnicroangiographic study. Hand 11: 76, 1976
  5. Hirasawa Y, Katsurni Y, Akiyoshi T, Tarnal K, Tokioka T:Oinical and rnicroangiographic studies on rupture of the extensor pollicis longus tendon after distal radius fracture. J Hand Surg 15: 51, 1990
  6. Kannus P, [ozsa L: Histopathological changes proceding spontaneous rupture of a tendon. J Bone Joint Surg 73: 1507, 1991
  7. Kim DK, Kim SH, Lee SH, Lee YH: Restoration of the spontaneous extensor pollicis longus tendon disruption by segmental palmaris longus tendon graft. J Korean Soc Plast Reconstr Surg 8: 167, 1981
  8. Charles H, William L: Restoration of the extensor pollicis longus tendon by an intercalated graft. J Bone Joint Surg 59: 412, 1977