Vaughn Jackson Syndrome in Rheumatoid Arthritis: Wrist MRI Online Radiology Course
This case is from Dr Joe Thomas a senior consultant Rheumatologist who is also involved with our Spine Arthropathy and Spondyloarthropathy course and our upcoming Peripheral Arthropathy Course. Thanks to Dr. Binoy P S Specialist Hand Reconstructive Surgery and Microsurgery
- 44-year-old lady.
- Hx of rheumatoid arthritis.
- Presented with worsening right wrist pain and weakness of 5th finger.
Image above: Normal extensor tendons proximal to distal. EDM proximally appears as a single tendon (Pink arrow). Begins to separate (Blue arrow) an more distally consists of two tendon slips (Green arrows). Extensor digitorum communis (Orange arrow) and Extensor Carpi Ulnaris (Yellow arrow). EDC doesn’t overly the DRUJ.
Image above: Ruptured EDM (Blue arrow no tendon). EDM proximally appears as a single tendon (Pink arrow) and more distally consists of two tendon slips (Green arrows). Extensor digitorum communis (Orange arrow) displaced medially and Extensor Carpi Ulnaris (Yellow arrow) dislocated. Severe synovitis and erosions DRUJ (Red Arrow).
Ruptured EDM tendons and EDC to 4th finger. Adapted image courtesy of Dr Binoy P S Specialist Hand Reconstructive Surgery and Microsurgery
Extensor digiti minimi tendon rupture in Rheumatoid Arthritis. This combination has been named Vaughn Jackson Syndrome.
The EDM tendon may be single or a double tendon as demonstrated in this case and the dissection image below.
The anatomy of a double Extensor Digiti Minimi tendon is demonstrated below with Images and associated text adapted from Pawan Agarwal: Cadaveric study of the long extensor tendons of the finger over the dorsum of the hand. European Journal of Anatomy August 2011.
EDC= Extensor Digitorum Communis EI = Extensor Indicis.
- Vaughn Jackson Syndrome is the rupture of the Extensor Digiti Minimi Tendon in patients with Rheumatoid Arthritis.
- It's caused by attrition of the tendon by arthritic changes at the DRUJ where the distal ulna erodes the overlying EDM tendon.
- The importance of diagnosing it is that if left untreated the remainder of the extensor tendons will progressively migrate to the ulnar side and progressively rupture.
- In this patient there was also ulnar migration and rupture of the EDC tendon to the 4th finger.
1. Pawan Agarwal: Cadaveric study of the long extensor tendons of the finger over the dorsum of the hand. European Journal of Anatomy August 2011.
2. Vaughn-Jackson Syndrome Cody J. Sanderson et al Open Access Journal of Internal Medicine ISSN: 2638-5279 Volume 3, Issue 2, 2020, PP: 04-09.
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