Traumatic closed index extensor tendon rupture at the musclotendinous junction: a report of two cases

This report describes two cases of traumatic closed index extensor tendon rupture at the musclotendinous junction. Both patients were injured when their work gloves were caught in the revolving parts of machines, and both were treated surgically. One of the patients completely ruptured the index extensor digitorum communis (EDC) and the extensor indicis proprius (EIP) tendons at the musclotendinous junction of dorsal forearm. In this patient, the distal stump of the index EDC tendon was sutured to the middle EDC tendon in an end-to-side juncture. The other patient completely ruptured the EIP tendon and partially ruptured the index EDC tendon at the musclotendinous junction. In this patient, tendon transfer of the extensor digiti minimi (EDM) to the EIP tendon and plication of the index EDC tendon were performed. In both cases, surgical intervention enabled the patients to extend their index fingers almost normally; however, the former complained of inability to extend his index finger independently. Tendon transfer of the EDM in cases of index extensor tendon rupture at the musclotendinous junction is a good method to restore ability to independently extend the index finger. However, consideration should be given to anatomical variation in the little finger. The EDC tendon is sometimes absent leaving the EDM tendon as the only extensor tendon to the little finger.     

自发性伸指肌腱断裂临床分析

[目的]探讨自发性伸指肌腱断裂的病因，病理特点和治疗效果。[方法]本组病例12例，自发性拇长伸肌腱断裂8例，均采用食指固有伸肌腱转位修复。自发性环小指伸肌腱断裂3例，环指指伸肌腱远侧断端与中指伸指肌腱端侧编织缝合，食指固有伸肌腱移位修复小指固有伸肌腱。自发性中环小指肌腱断裂1例，冷冻异体伸指肌腱移植修复。[结果]所有病例术前均有类风湿关节炎史或桡骨远端骨折史，前者组织学检查显示以滑膜和肌腱慢性炎症伴局灶性坏死为主，后者以肌腱纤维断裂为主。所有病例治疗优良率达100％，未发生再次肌腱断裂。[结论]炎症侵蚀或骨折端磨损，是伸指肌腱自发性断裂的病理基础。食指固有伸肌腱转位重建拇长伸肌腱疗效确切，对多根伸指肌腱断裂可考虑行异体肌腱移植术。     

自发性手指伸肌腱断裂的修复重建

目的探讨不同部位手指伸肌腱自发断裂的治疗方案及其疗效。方法29例患者总结如下：伸肌腱Ⅰ区22例、中环小指伸肌腱Ⅵ区3例、拇长伸肌腱4例，修复重建后配合功能锻炼。结果Ⅰ区原位直接缝合修复，优良率100％；食指固有伸肌腱移位拇长伸肌腱，优良率85％；桡侧腕短伸肌腱修复中环小指伸肌腱Ⅵ区，优良率75％。结论伸肌腱自发断裂常伴有炎症侵蚀或骨折端磨损的病理基础，在伸肌腱Ⅰ区时首选原位直接缝合修复，无条件修复时可行远指间关节融合术；对于中环小指伸肌腱Ⅵ区及拇长伸肌腱断裂行相邻协同肌肌腱转位修复，疗效确切。     

可吸收锚钉修复伸指肌腱止点断裂的临床疗效观察

目的观察可吸收锚钉修复伸指肌腱止点断裂的临床疗效及安全性。方法对2009年1月至2011年6月收治的20例伸指肌腱止点断裂患者,采用可吸收锚钉修复伸指肌腱止点处断裂,分析临床效果及优缺点。结果随访6～24个月,未发生肌腱再次断裂及手指严重功能障碍。按照Dargen功能评定标准,优良率为95%。结论应用可吸收锚钉修复伸指肌腱止点断裂,操作简便、固定牢靠、疗效显著,值得推广使用。     

Transfer of either index finger extensor tendon to the extensor pollicis longus tendon

BACKGROUND:

Extensor pollicis longus (EPL) tendon ruptures have been treated succesfully with the transfer of the extensor indicis proprius (EIP) tendon. Situations exist in which, due to intraoperative observations, another tendon transfer may be considered preferable to the standard EIP transfer method.

OBJECTIVES:

To determine whether transfer of the extensor digitorum communis II (EDC II) tendon from the index finger to the EPL tendon, leaving the EIP tendon to the index finger intact, would serve as an equally efficient transfer and not adversely affect the function of the hand.

METHODS:

Two patients who had the EDC II tendon transferred to the ruptured EPL tendon, and two patients who had the EIP tendon transferred, were retrospectively reviewed. In each transfer type, one patient had suffered an EPL tendon rupture after a Colles’ fracture, and the other had rheumatoid arthritis. The rupture occurred on the non-dominant side in one patient in each transfer type. Each patient was examined and subjected to range of motion and power testing at least one year following surgery.

RESULTS:

All four patients showed a minimal extension lag with the lift off test, but there was no noticeable difference in range of motion, pinch grip and hand grip strength between the transfer types. Both EDC II transfer patients demonstrated an 8° to 15° loss of thumb interphalangeal joint flexion compared with the unoperated side; EIP transfer patients demonstrated less than a 5° loss. Three patients demonstrated a minor extension lag in the index finger and middle finger. Extension power of the thumb and index finger in all patients varied with wrist flexion and extension and ranged from 50% to 150% of the unoperated side.

CONCLUSIONS:

These case reports suggest that either index finger tendon may be successfully transferred in EPL tendon ruptures.     

经骨隧道加压缝合治疗手指伸肌腱止点断裂

目的探讨应用经骨隧道加压缝合治疗手指伸肌腱止点断裂的手术方法。方法对20例手指伸肌腱止点损伤所致锤状指畸形患者．用5ml注射器针头在末节指骨基底部横行钻一骨隧道,先用2／0两头带针肌腱吻合线将伸肌腱近断端按Kessler法缝合,然后将一针夹直后穿过骨隧道,如有撕脱骨折块,则将骨折块复位,对平关节面,拉紧肌腱吻合线打结,压紧骨折块,再将伸肌腱止点与指骨末节背侧软组织加强缝合1针。,术后用石膏耗外固定手指近侧指间关节屈曲45°、远侧指骨间关节轻微背伸位4~6周。结果20例木后切口愈合良好。15例患者随访6~24个月,无锤状指畸形发生。伸指0°、屈指指端过掌横纹8例;伸指受限-5°—-10°,屈指指端达掌横纹6例;伸指受限-20°,屈指指端离掌横纹1cm1例。根据Dargan功能评定法,优良率93．3％。结论本法操作简单,取材方便、便宜,能持续有效地内固定伸肌腱止点,值得临床推广应用。     

The treatment of Doyle types II and III mallet finger with the encircling fixation of a transplanted palmaris longus tendon

ObjectiveThis study aimed to investigate the clinical effect of the encircling fixation of a transplanted palmaris longus tendon in the treatment of Doyle types II and III mallet finger.MethodsThere were 115 cases of mallet finger deformity with Zone 1 extensor tendon rupture and defect. After debridement by first intention, the tendon bundles of the palmaris longus tendon were used to pass through the subcutaneous tunnel on the volar side of the base of distal phalanx, forming an encircling binding, crossing on the dorsal side. The tail of the tendon was then overlapped with the proximal extensor tendon and sutured. The finger extension position was fixed with plaster for four weeks. If the skin defect could not be closed directly, depending on the size of the skin defect, either a local turndown flap or a pedicled flap was used to cover the wound.ResultsThe patients were followed up for 3–12 months after the operation. According to Total Active Motion criteria, the clinical effect was excellent in 89 cases, good in 16 cases, acceptable in 7 cases, poor in 2 cases and inferior in 1 case. Conclusion: The treatment of Doyle types II and type III mallet finger with the encircling fixation of a transplanted palmaris longus tendon is simple and effective, with a low recurrence rate, few complications, and satisfactory results.     

Extensor quadriga: Pathomechanics and treatment

The extensor tendons to the index, long, ring and small fingers are motored by the common extensor digitorum communis muscle body. Effective function of this muscle can only occur if the gliding amplitude of each of its four extensor tendons is normal. As a corollary, limitation of the excursion of any of the individual tendons by adhesions at a fracture or tendon repair site, a fixed flexion contracture at the metacarpophalangeal joint, or by rupture, attenuation or laceration of a saggital band or juncturae tendinum, will result in reduction of the excursion of the adjacent extensor tendons. This pathological state has been termed the extensor quadriga because of its similarities to the analogous pathology affecting the flexor digitorum profundus system. Improper management of this clinical entity may lead to an abnormal pathomechanical kinematic chain imbalance. Early identification and treatment is critical to address this entity appropriately.     

Treatment of a zone III extensor tendon injury using a single relative motion with dorsal hood orthosis and a modified short arc motion protocol—A case report

Study DesignCase report.IntroductionZone III extensor tendon injuries are typically treated with early mobilization or by a period of immobilization followed by gradual motion. In both scenarios, the use of multiple orthoses is required.Purpose of the studyThis case report examines the effective use of a single, modified relative motion orthosis throughout the protected rehabilitation phase after a zone III extensor tendon repair.MethodsA patient with extensor tendon zone III laceration to his index finger (10th revision of the International Statistical Classification of Diseases and Related Health Problems s66.328) was treated using a single, relative motion with dorsal hood orthosis. The exercise protocol followed a modified immediate short arc motion program.ResultsFollowing laceration and complete rupture of the central slip, the patient regained full range of motion, strength, and function.DiscussionIt is becoming more common to use a relative motion flexion (RMF) orthosis to correct or improve extensor lag due to boutonniere deformity or stiffness after finger fractures. There is very little literature to support the use of the RMF orthosis after zone III extensor tendon repair. To produce a single orthosis that is useful through the entire protected phase of rehabilitation, the RMF orthosis is easily modified by addding a dorsal hood to create the relative motion dorsal hood orthosis (RMDH).ConclusionOur case report shows the successful treatment of a zone III extensor tendon repair using a single relative motion with dorsal hood orthosis and early active motion throughout the entire protected phase of rehabilitation.     

Traumatic Extensor Hood Rupture

We report a traumatic rupture of the extensor hood of the dominant middle finger in an elite boxer. Surgical repair of the extensor hood with the metacarpophalangeal joint (MCPJ) in 90° of flexion and immobilisation of the MCPJ in flexion for 4 weeks allowed successful return of function to an international level.     

Rupture of extensor tendon secondary to previously undiagnosed Kienböck disease

Abstract

We report three patients with an unusual pattern of rupture of the extensor tendon. All were found to have previously undiagnosed Kienböck disease. Radiographic study of the wrist is essential before treating any closed rupture of an extensor tendon. Lesions may be progressive and extend to adjacent tendons and should be treated urgently.     

Osseous destruction and rupture of the extensor tendon caused by sarcoidosis of the finger

We describe a woman with osseous destruction and rupture of the extensor tendon as a result of sarcoidosis in the left third finger with no evidence of systemic involvement. The tendon was repaired and she was successfully treated with prednisone.     

Concomitant Rupture of Extensor Pollicis Longus and Index Extensor Tendons following Distal Radius Plating—Report of Two Cases and Their Clinical Implication for Tendon Transfer Surgery

Extensor indicis proprius (EIP) tendon transfer is a standard operation for restoration of the thumb extension following rupture of extensor pollicis longus (EPL). In its standard form often the EIP is transferred to the EPL without inspection of the extensor tendons in the fourth compartment and it is retained in its anatomical fourth compartment. However, in a setting of EPL rupture in relation to the distal radius fracture (with or without fixation), concomitant injury to the extensor tendons to the index finger may result in failure of the transfer and even a loss of index finger extension (index finger drop) further complicating the reconstruction and resulting in immense patient dissatisfaction. We herein present two such rare cases to highlight this clinical scenario and how an awareness of this possibility and inspection of the extensor tendons to the index finger before EIP transfer allowed us to prevent this complication. In essence, if we know it, we can prevent it.     

Extensor pollicis brevis tendon can hyperextend thumb interphalangeal joint in absence of extensor pollicis longus:Case report and review of the literature

We are reporting a case of extensor pollicis longus tendon rupture which did not require tendon transfer owing to the ability of the intact extensor pollicis brevis(EPB) to fully hyperextend the thumb interphalangeal joint. The thumb metacarpophalangeal joint was also able to be fully actively extended by the EPB. Previous anatomical studies have demonstrated that the insertional anatomy of the EPB tendon is highly variable and sometimes inserts onto the extensor hood and distal phalanx, which is likely the mechanism by which our patient was able to fully extend the thumb interphalangeal joint. Despite the potential for the EPB to extend the IP joint of the thumb, virtually all previously reported cases of extensor pollicis longus(EPL) tendon rupture had deficits of thumb IP extension requiring tendon transfer. This case highlights the potential ability of the EPB tendon to completely substitute for the function of the EPL tendon in providing thumb IP joint extension.     

Closed rupture of the extensor digitorum longus tendon: A case report and biomechanical analysis of rupture mechanism

Closed subcutaneous rupture of the extensor digitorum longus tendon (EDL) has been rarely documented. We present a case report of a patient with closed subcutaneous rupture of EDL. To identify the site of tendon rupture, three-dimensional computed tomography (3D-CT) was performed. The 3D-CT (volume rendering) images indicated tendon rupture of EDL on the dorsal region of the left foot. To identify the mechanisms of EDL rupture we also performed a biomechanical study using three cadavers. The patient granted permission for submission of personal data for publication. From biomechanical findings, pressure of the EDL on the inferior extensor retinaculum was 4.9–10.7 times higher in plantar flexion than in dorsal flexion of the ankle. Therefore, we believe that EDL rupture occurred with a passive flexion force pressing onto the toe tip in the plantar flexion position of the ankle joint.     

Traumatic rupture of the extensor pollicis longus tendon

Rupture of the extensor pollicis longus tendon is rather rare, attributable in about half of all cases to rheumatoid arthritis affecting the wrist or to a Colles' fracture. In the remainder of cases, either a direct closed injury to the wrist or a hyperextension injury of the wrist is most often responsible. Far more unusual is a rotational injury which can cause complete avulsion of the EPL tendon at the musculotendinous junction. A delayed rupture is most probably caused by an avascular necrosis secondary to traumatic disruption of the mesotendon. Surgical correction of the injury is best accomplished by tendon transfer, using the extensor indicis proprius. Postoperative immobilization, hyperextension of the thumb, and adequate resting tension are all necessary to assure good return of function. Postoperatively, the patient may experience a slight decrease in extensor strength of the index finger which may or may not be accompanied by a minimal loss in extensor range.     

食指固有伸肌腱移位重建拇长伸肌功能及评价

目的评价采用食指固有伸肌腱移位重建拇长伸肌功能的临床疗效. 方法对1978年8月～2003年3月以食指固有伸肌移位重建拇长伸肌功能的46例患者进行随访、评价.其中男32例,女14例.年龄16～51岁,平均36岁.外伤陈旧性断裂24例,继发性断裂22例.病程2天～5个月,平均74天. 结果 41例获7个月～23年随访,平均9年3个月.术后拇指抬高丢失0～2.2 cm,平均1.8 cm;拇指屈曲丢失0～3 cm,平均1.6 cm;食指均能单独背伸,背伸丢失0～8度,平均5度.按SEEM评分标准:优29例,良10例,可2例,优良率达95%. 结论食指固有伸肌腱移位重建拇长伸肌功能是一种简便、有效的方法,采用SEEM评价标准使评价结果更加客观和合理.     

Delayed rupture of the thumb extensor tendon:A 5-year study of 18 consecutive cases

18 consecutive cases of delayed rupture of the extensor pollicis iongus tendon were recorded during 5 years; 4 were spontaneous, and 14 after distal radius fracture, most of which were undisplaced or only slightly displaced. 15 cases were operated upon with tendon transfers: 13 had extensor indicis pro-prius transfer, 1 transfer of the extensor carpi radialis Iongus, and 1 reoperated with the extensor communis to the little finger as a motor unit. Subjectively, nearly complete satisfaction was reported; all patients were able to elevate the thumb to the level of the palm and full independent index finger movements were noted.

In this 5-year-period 4,400 patients with distal radius fractures were treated, giving an incidence of delayed tendon rupture after distal radius fracture of 0.3 percent     

小指固有伸肌腱移位术后小指伸直障碍的防治

目的 探讨小指固有伸肌腱移位术后小指伸直障碍的应用解剖学依据及其防治方法。方法 针对小指伸肌腱行解剖学观察158例标本，并将伸向小指的指总伸肌腱束按生物力学分类为四型：即标准型、力线偏离度小型、力线偏离度大型及缺如型；针对术后小指伸直障碍，用腱间纤维联系切断术治疗3例，术中预防性治疗55例。结果 经1年以上随访，1989年8月－1996年间的54例病例中，3例术后发生小指伸直不全，经腱间纤维联系切断术后均治愈，此后，采用术中预防性治疗后未再发生小指伸直障碍。结论 小指固有伸肌腱移位术后小指伸直障碍与伸向小指的指总伸肌腱束的力线有关，按其类型分别采用腱间纤维联系切断术、腱短缩术及腱重建术，能够有效地防治小指伸直障碍的发生。     

Spontaneous rupture of extensor pollicis longus tendon with tophaceous gout infiltration

Introduction Spontaneous rupture of the extensor pollicis longus (EPL) tendon has been reported in the literature. Various mechanisms have been proposed to account for this problem, but gouty infiltration is a rare mechanism. Here we report a patient with a long-standing history of gout who presented with sudden loss of interphalangeal extension of the left thumb. Spontaneous rupture of the EPL tendon caused by gout was discovered.Materials and methods The successful treatment done involved surgical exploration and extensor indicis proprius tendon transfer. Postoperative thumb spica immobilization for 6 weeks was applied.Results Pathology disclosed urate crystals deposited within the ruptured EPL tendon. The functional recovery is satisfactory at the 1-year follow-up. Conclusion Spontaneous rupture of the EPL tendon caused by gout is rare. Successful treatment was done with surgical management. Life-long medical follow-up to prevent a repeated acute attack can lower the risk of a large amount of tophaceous gout infiltration in tendons and may possibly prevent acute spontaneous tendon rupture.