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Lister's Tenderness (Drummer Boy's Palsy Extensor Pollicis Longus)

Exams and Signs

Historical Overview

In 1876, Duplay described spontaneous extensor pollicis longus (EPL) rupture.1 In 1896, Dums coined the term “drummer’s palsy,” in reference to drummers whose repetitive activity caused a rupture of the EPL tendon.2   

Description

  • Lister’s tenderness may result from trauma, often caused by repetitive drumming.
  • Lister’s tenderness, or EPL tendinopathy, is often documented in patients with rheumatoid arthritis (RA).2 

Pathophysiology

  • Lister’s tenderness can help to diagnose a fracture. 
  • Lister's tenderness can also be associated with RA, stenosing tenosynovitis or systemic lupus erythematosus.

Instructions

  1. Obtain an accurate and complete patient history. Ask the patient to rate on a scale from 1 to 10 how much pain s/he usually experiences in the affected hand and wrist
  2. Observe the wrist for swelling or bony irregularities3
  3. Palpate the wrist in the area of Lister’s tubercle
  4. Check for a rupture of the EPL tendon
  5. Examine the contralateral hand/wrist

Variations

  • In rare cases, a patient with Lister’s tenderness may present with triggering or snapping of the thumb.2 Lack of ability to extend and elevate the thumb may also be a sign of EPL tendinopathy.4
  • If RA is suspected, also check for sudden loss of active motion.5

Related Signs and Tests

  • Range of motion (ROM), active
  • Range of motion (ROM), passive
  • Scaphoid shift test3
  • Ultrasound
  • Magnetic resonance imaging (MRI)

Additional Information

Presentation Photos and Related Diagrams
Lister's Tubercle Tenderness Examination
  • The EPL tendon travels in the third extensor compartment. Lister's tubercle (arrow) acts as a fulcrum as the EPL changes direction. In this tight part of third compartment tenderness can occur secondary to tendonitis, trauma etc.
    The EPL tendon travels in the third extensor compartment. Lister's tubercle (arrow) acts as a fulcrum as the EPL changes direction. In this tight part of third compartment tenderness can occur secondary to tendonitis, trauma etc.
  • Direct palpation of the EPL at Lister's tubercle can elicit the tenderness associated with tendonitis.
    Direct palpation of the EPL at Lister's tubercle can elicit the tenderness associated with tendonitis.
Definition of Positive Result
  • A positive result occurs when pressure causes increased tenderness in the area of Lister’s tubercle.
Definition of Negative Result
  • A negative result occurs when pressure does not cause increased tenderness in the area of Lister’s tubercle. 
Comments and Pearls
  • Operative treatments for EPL tendon ruptures include primary repair, tendon graft, or tendon transfer.4
  • When examining children, be vigilant for an EPL rupture after a distal radius fracture.4
Diagnoses Associated with Exams and Signs
References
  1. Cigna E, Özkan Ö, Mardini S, et al. Late spontaneous rupture of the extensor pollicis longus tendon after corticosteroid injection for flexor tenosynovitis. Eur Rev Med Pharmacol Sci 2013;17(6):845-8. PMID: 23609371
  2. Kardashian G, Vara AD, Miller SJ, et al. Stenosing synovitis of the extensor pollicis longus tendon. J Hand Sur Am 2011;36(6):1035-8. PMID: 21636022
  3. Rayan G, Akelman E. The Hand: Anatomy, Examination and Diagnosis. Philadelphia: Lippincott Williams & Wilkins, 2012
  4. Song D, Evans R, Arneja JS. Delayed extensor pollicis longus tendon rupture following nondisplaced distal radius fracture in a child. Hand 2013;8(2):242-4. PMID: 24426928
  5. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012
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