Elsevier

The Journal of Hand Surgery

Volume 40, Issue 2, February 2015, Pages 391-397
The Journal of Hand Surgery

Current concepts
Open Extensor Tendon Injuries

https://doi.org/10.1016/j.jhsa.2014.06.136Get rights and content

The extensor tendons in the dorsum of the hand lie relatively superficially, making open injuries to the extensor mechanism a common source of morbidity. These injuries can range from simple clean lacerations to complex open injuries associated with severe skin and soft tissue loss. Although many advances in the treatment of tendon injuries focused on the flexor tendon, the extensor tendon has begun to receive more attention in recent literature. Knowledge of modern repair techniques and rehabilitation protocols may improve patient outcomes. This Current Concepts article summarizes the treatment of open extensor tendon injuries with a focus on the recent literature.

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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