Abstract / Summary
Background/Objectives: Combined closed post-traumatic avulsion of the extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB) tendons is exceptionally rare. We describe a case and review the literature, with particular attention to rehabilitation. Methods: We reviewed reports of closed traumatic ECRL or ECRB rupture or avulsion, including osteotendinous avulsion and avulsion fracture. We excluded open injuries and inflammatory or degenerative tendon disorders. Results: A 26-year-old man sustained forced wrist hyperflexion in a motorcycle accident and could not actively extend his wrist. Initial radiographs showed no fracture, and posterior interosseous nerve palsy was suspected. Preserved finger extension with the wrist supported and focal tenderness at the second and third metacarpal bases suggested tendon injury. Magnetic resonance imaging (MRI) confirmed avulsion and proximal retraction of both tendons. Direct suture-anchor reinsertion was performed 21 days after injury. After surgery, a structured staged protocol was implemented, including early finger motion and progressive active wrist motion at 4 weeks, and passive motion and specific strengthening exercises at 8 weeks, with progressive task-specific loading. At 15 weeks, the patient had returned to work as a bricklayer without pain and near-normal wrist motion. Grip strength was 99.2% of the contralateral side. Published reports generally report favorable outcomes after anatomical repair but provide less detail on specific rehabilitation. Conclusions: Combined ECRL and ECRB avulsion can mimic posterior interosseous nerve palsy even when radiographs are negative. Early diagnosis, as in this case, documents recovery after subacute repair and staged rehabilitation, but a single case cannot establish the optimal treatment or rehabilitation schedule.