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Anatomy
Published in Peter Houpt, Hand Injuries in the Emergency Department, 2023
The extensors of the thumb form the borders of the anatomical snuff box. The m. extensor pollicis longus lies on the dorsal side of the thumb, inserts onto the distal phalanx and extends the IP joint. The m. abductor pollicis longus and m. extensor pollicis brevis are positioned on the radial side of the anatomical snuff box and provide abduction and extension of the first metacarpal, respectively. Positioned just ulnar to the anatomical snuff box are the two radial extensors of the wrist, the m. extensor carpi radialis longus and brevis, which insert at the base of the second and third metacarpal, respectively. The m. extensor carpi ulnaris is the most ulnar positioned tendon at the level of the wrist. It inserts onto the base of the fifth os metacarpal. The mm. extensor digitorum communis extend the fingers. The index finger has an additional extensor which is located on the ulnar side of the EDC; the m. extensor indicis proprius.
Radius and ulnar shaft
Published in Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou, Orthopaedic Trauma, 2014
The abductor pollicis longus and extensor pollicis brevis cross obliquely over the mid-dorsal radius, and must be mobilized proximally or distally following incision of their inferior and superior borders, to access the middle third. Distally, incising between extensor pollicis longus and extensor carpi radialis brevis provides direct access to the radius.
Examination of Pediatric Hand and Wrist
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Mohsina Subair, Satyaswarup Tripathy, Ranjit Kumar Sahu
Place palm up, fingers extended while examining flexors, palm down while examining extensors and test the action on the joint on which tendon inserts: Flexor digitorum profundus (FDP): Block the PIP joint flexion and ask the child to flex the DIP joint (Figure 7.11).Flexor digitorum superficialis (FDS): Hold the DIP joints of the other fingers in extension and ask the child to flex the PIP joint of the finger being tested. The FDPs of the little, ring, and middle fingers have a common belly and hence will be eliminated by blocking the DIPs of the other fingers leading to the isolated action of the FDS (Figure 7.11).Testing the FDS of the index finger: Ask the child to touch the pulp of the thumb with pulp of index finger. If FDS is normal, there will be hyperextension of the DIP joint and flexion at the PIP joint. If FDS is weak/absent, there will be flexion at the DIP due to FDP action (Figure 7.11).Flexor pollicis longus (FPL): Block the MCP joint of the thumb and ask the child to flex the interphalangeal (IP) joint of the thumb against resistance (Figure 7.11).Extensor digitorum communis (EDC): Keep the wrist on the table with the IP joints flexed (to eliminate intrinsic action) and ask the child to extend the MCP joint. Resistance can be applied proximal to the PIP joint (Figure 7.12).Extensor indicis proprius and extensor digiti minimi: Ask the child to make a fist to nullify the action of EDC and instruct the child to extend the index finger and little finger, respectively (Figure 7.12).Extensor pollicis longus: Ask the child to lift the thumb from the table (Figure 7.12).Abductor pollicis longus: Ask the child to abduct the thumb away from the hand.Extensor pollicis brevis: Ask the child to extend the MCP joint of the thumb against resistance.
Does proximal migration of the first metacarpal correlate with remaining pain after trapeziectomy?
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Ulla Molin, Kajsa Evans, Maria Wilcke
Radiologically, the thumb metacarpal migrates proximally towards the scaphoid to a varying degree after trapeziectomy. It has been proposed that maintenance of the scaphoid metacarpal distance and prevention of proximal migration of the thumb metacarpal is important for the functional outcome [5,6]. Different tendons (flexor carpi radialis (FCR), abductor pollicis longus (APL), extensor carpi radialis longus (ECRL)) are used as interposition to achieve stability of the thumb metacarpal and prevent migration. However, LRTI has not shown to prevent proximal migration better than simple trapeziectomy [7]. Although sparse, the available evidence suggest that subsidence of the thumb metacarpal does not affect clinical or subjective outcomes [8,9]. Accordingly, in our clinical experience, many patients with severe proximal migration report pain free, highly functional thumbs.
Chronic exertional compartment syndrome of the forearm
Published in The Physician and Sportsmedicine, 2019
Kunal Sindhu, Brian Cohen, Joseph A. Gil, Travis Blood, Brett D. Owens
The forearm contains four compartments. The dorsal compartment contains the abductor pollicis longus, extensor carpi ulnaris, extensor digiti minimi, extensor digitorum communis, extensor indicis, extensor pollicis brevis, extensor pollicis longus, supinator, and radial nerve. The lateral compartment or mobile wad contains the bracho-radialis, extensor carpi radialis brevis, and the extensor carpi radialis longus [32–34]. The superficial volar compartment contains the flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis, palmaris longus, and pronator teres. Finally, the deep volar compartment contains the flexor digitorum profundus, flexor pollicis longus, pronator quadratus, medial nerve, radial artery, and the ulnar nerve and artery [34,35,36], (Table 1).
Revision of trapeziometacarpal arthroplasty: risk factors, procedures and outcomes
Published in Acta Orthopaedica, 2019
The patients were divided into 3 groups based on the primary procedure: (1) trapeziectomy and LRTI with the abductor pollicis longus (APL) tendon either through a bone tunnel in the base of the metacarpal (LRTI + bone tunnel group) (Kaarela and Raatikainen 1999) or (2) LRTI with APL without a bone tunnel (a slip of the APL tendon weaved between the remaining APL tendon and flexor carpi radialis (FCR) tendon) (LRTI group) as described by Ceruso et al. (1991). The 3rd group consisted of simple trapeziectomy, partial trapeziectomy with interposition of palmaris longus tendon, LRTI with FCR (Weilby 1988), LRTI with extensor pollicis brevis, or total trapeziectomy and tendon interposition with the palmaris longus tendon without ligament reconstruction (Dell et al. 1978).