Current conceptsOpen Extensor Tendon Injuries
Section snippets
Anatomy and Classification
At the level of the forearm, the extrinsic extensor tendons can be divided into deep and superficial groups based on the relative position of their muscles bellies. The superficial group includes the extensor carpi radialis longus and brevis (ECRL and ECRB), the extensor digitorum communis (EDC), the extensor digiti minimi (EDM), and the extensor carpi ulnaris (ECU) muscles. The deep group includes the abductor pollicis longus (APL), the extensor pollicis brevis (EPB), the extensor pollicis
Evaluation and Diagnosis
The extensor tendons are a superficial structure in the dorsum of the hand and distal forearm such that any open wound to these areas should raise suspicion of an underlying tendon injury. Loss of the normal resting cascade of the fingers with extension lag of 1 digit is suspicious for extensor tendon injury, and each component of the 6 compartments should be tested individually. Zone I lacerations at the DIP joint cause extensor lag (ie, open mallet finger at that joint with the ability to
Treatment
Patients with open tendon injuries should be carefully assessed in the emergency department, with the extent noted of soft tissue and bony involvement and appropriate radiographs taken. Tetanus prophylaxis should be updated. Most patients are given a dose of antibiotics in the emergency department and are often discharged with a course of oral antibiotics with the type and duration tailored to the nature and mechanism of the injury. A careful neurovascular examination should be documented as
Rehabilitation of Open Extensor Tendon Repairs
Historically, rehabilitation after repair of extensor tendon lacerations consisted of static orthosis fabrication followed by gradual mobilization.16 However, interest in the use of early motion protocols in extensor tendon repairs is increasing. Koul et al17 published a retrospective case series on 21 repairs in 8 patients with complex extensor tendon and soft tissue injuries treated with single-stage reconstruction followed by an early active motion protocol. Those authors reported average
Complications
Loss of motion is the most common complication of extensor tendon injury and may include residual extensor lag and/or loss of flexion. Patients with multiple extensor tendon injuries, segmental loss, or concomitant soft tissue injury should be counseled that loss of motion is likely. Extensor tenolysis, along with possible joint contracture release and flexor tenolysis, may be considered if the patient lacks satisfactory motion after 6 months despite compliance with hand therapy. Re-rupture
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Cited by (17)
Extensor Tendon Injuries
2021, Plastic Surgery - Principles and PracticeAcute tendon injuries
2019, Orthopaedics and TraumaCitation Excerpt :Ranging from 5-0 distally (zone I-III) to a 3-0 or even 2-0 proximal. Partial injuries do not need to be repaired as long as more than 50% of the tendon is intact.35 The general posture of the hand must be observed as this can be an indication of tendon injury.
Two-stage extensor tendon graft using the Paneva-Holevitch procedure: A new technique
2018, Hand Surgery and RehabilitationCitation Excerpt :Extensor tendons on the dorsum of the hand are superficial and particularly vulnerable to trauma [1].
Hand Injuries
2018, Abernathy's Surgical Secrets: Seventh EditionThe optimal orthosis and motion protocol for extensor tendon injury in zones IV-VIII: A systematic review
2017, Journal of Hand TherapyCitation Excerpt :Studies were excluded if they investigated degenerative conditions, traumatic injury involving structures other than the extensor tendons, or postoperative conditions involving structures in addition to the extensor tendons, as those conditions could all independently affect length and quality of recovery.4 In addition, studies investigating distal extensor tendon injuries (zones I-III) were excluded because the rehabilitation protocols for those injuries are different from proximal injuries.4 Articles examining extensor tendon injuries in the thumb were similarly excluded.4
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