1007 - Dancing to ‘Never Can Say Goodbye’: A Case of How Vaughan-Jackson Syndrome Silenced the Extensors

Case Diagnosis: Complete tear of the extensor digitorum communis tendon contribution to the 4th and 5th digits due to Vaughan-Jackson Syndrome

Case Description: A 73 year old right hand dominant female initially presented to a hand surgery clinic with right hand pain and inability to open her ring and pinky finger for 2 weeks. MRI of the hand showed a complete tear of the extensor digitorum communis tendon contribution to the 4th and 5th digits, a complete tear of the extensor digiti minimi tendon at the level of the wrist, and moderate tenosynovitis of the 4th extensor compartment of the wrist. Given the non-traumatic nature of these findings, the patient was diagnosed with Vaughan-Jackson Syndrome.

Discussions: Vaughan-Jackson Syndrome is a progressive rupture of the extensor tendons of the fingers, usually in patients with rheumatoid arthritis. This rupture typically starts with the 5th digit with the extensor digiti minimi tendon and progresses radially to the 4th, 3rd, and sometimes 2nd finger at the EDC tendons. Patients present with pain and discomfort and their ADLs are affected. This presentation was even more frustrating for the patient, as her case of Vaughan-Jackson Syndrome was relatively sudden and she had no prior history of RA or other inflammatory diseases.

Conclusions: This case highlights a patient with sudden-onset Vaughan-Jackson Syndrome. After her diagnosis, hand surgery performed right EIP to 4th and 5th EDC tendon transfers, an extensive dorsal wrist 4th compartment tenosynovectomy, right middle finger EDC tendon centralization, and right wrist PIN neurectomy. Post-operatively, the patient presented to PM&R for OT, and a regimen was formulated to perform active and passive ROM, strengthening, stretching, and other modalities. The patient did OT for 4 months, and had near resolution of her symptoms, although still had some inability to extend the DIP joint of the 5th digit.