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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.
Motor Cortex Control of a Complex Peripheral Apparatus: The Neuromuscular Evolution of Individuated Finger Movements
Published in Alexa Riehle, Eilon Vaadia, Motor Cortex in Voluntary Movements, 2004
Marc H. Schieber, Karen T. Reilly, Catherine E. Lang
Comparing the extrinsic finger musculature of macaque monkeys to that of humans suggests that human muscles have evolved to provide a greater degree of independence in finger movements. As noted above, when instructed to move one finger alone, lesser motion of other, noninstructed digits occurs along with that of the instructed digit in both species. Quantitatively, however, humans move their fingers more individually than macaques.8 Part of this greater ability to individuate finger movements may result from the fact that humans have lost tendons to certain digits from multitendoned muscles. The human extensor indicis proprius (EIP), which extends only the index finger, is homologous to the macaque ED23, which extends both the index and middle fingers. The human EDQ, which extends only the little finger, is homologous to the macaque extensor digiti quarti et quinti (ED45),
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.
Immediate tendon transfer for functional reconstruction of a dorsal forearm defect after sarcoma resection
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Ryo Karakawa, Hidehiko Yoshimatsu, Yuma Fuse, Kenta Tanakura, Tomohiro Imai, Masayuki Sawaizumi, Tomoyuki Yano
A 75-year-old female suffered from soft tissue sarcoma on the dorsal aspect of the right forearm (Figure 1(a)). Surgical wide resection followed by immediate tendon transfer was planned. Surgical wide resection with a 1–2 cm margin, including the extensor compartment muscles (EDM, EDC, extensor indicis proprius (EIP), extensor carpi ulnaris (ECU), EPL, APL) and posterior interosseous nerve, was performed. The extensor carpi radialis longus (ECRL) and the extensor carpi radialis brevis (ECRB) were preserved (Figure 1(b)). Then, the planned tendon transfers were performed. The transfers of the FCR to the EDC and the EDM, and the PL tendon to the EPL were performed (Figure 1(d,e)). The skin defect was closed primarily. The resected mass was confirmed to be a UPS. The postoperative course was uneventful. The arm was immobilized with a wrist extension of 30° in a volar splint, and active flexion and passive extension exercises were started two weeks postoperatively. Active extension was allowed from three weeks after surgery. Within 32 months, the patient returned to normal activity with full fist motion, pinch of the thumb and little finger, DIP joint extension of 0°, PIP joint extension of 0°, MP joint extension of –10H°, thumb interphalangeal (IP) joint extension of 0°, and thumb MP joint extension of 10°. The MSTS score and the quick disabilities of the arm, shoulder and hand (DASH) score were 30 and 2.27, respectively (Figure 2, Supplementary Video 1).
Pull-in suture: a novel reconstruction technique for tendon avulsion injury at the musculotendinous junction associated with forearm open fracture
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Yuta Izawa, Yoshihiko Tsuchida, Hiroko Murakami, Tetsuya Shirakawa, Masahiro Nishida, Kentaro Futamura
A male patient aged 62 years, was injured when his right upper extremity was caught in a machine in the factory. He was diagnosed with a Gustilo–Anderson type 3B right forearm open fracture with a skin defect of 12 × 5 cm. Irrigation and debridement of the open wound were performed on the day of the injury. There was no neurovascular injury to the forearm. The EPL, EDC, extensor indicis proprius, EDM, and ECU tendons were pulled out at the musculotendinous junction and completely torn. On the second and third days after injury, osteosynthesis was performed for the forearm shaft fractures with a plate, and all of the ruptured tendons were reconstructed using pull-in sutures and soft tissue reconstruction with an anterolateral thigh flap. After the tendons repair surgery, strong tension to the tendons was avoided as much as possible, and only passive tenodesis-like motion was allowed for 3 weeks. Active and passive range of motion training was initiated 3 weeks postoperatively. The flap survived without any complications, and debulking surgery was performed 9 months after the injury (Figure 4). Two years after the injury, the TAM of the thumb and little finger was good, and the TAM of the index finger to the ring finger was excellent (Table 1). The wrist joint active palmar flexion and active dorsiflexion were 35° and 45°, respectively, and the DASH score was 21.6. Although mild restrictions in the skilled movement remained, the patient resumed his job as a sheet metal worker with no complaints (Figure 5).
Spontaneous rupture of the extensor pollicis longus tendon in a lacrosse player
Published in The Physician and Sportsmedicine, 2022
Jane-Frances Aruma, Paul Herickhoff, Kenneth Taylor, Peter Seidenberg
The patient was diagnosed with an attenuation EPL rupture of the right thumb with proximal retraction. A tendon transfer operation was therefore performed, in which the extensor indicis proprius (EIP) was surgically rerouted to reconstruct the ruptured EPL. A longitudinal skin incision was made just proximal to the anticipated location of the extensor retinaculum at the interval between the third and fourth extensor compartments. As expected, the EPL tendon was not visualized in its typical location. The EIP and extensor digitorum communis (EDC) to the index finger were isolated at this location and at a second skin incision proximal to the dorsal aspect of the index metacarpal head. A third small incision was made at the level of the dorsal thumb metacarpal where the distal aspect of the EPL tendon was identified. The EIP tendon was transected just proximal to the index finger sagittal bands so as not to render the EDC tendon unstable. The EIP was then retracted proximally through a subcutaneous tunnel rerouted dorsal to the extensor retinaculum and then passed subcutaneously distally to the thumb where it was repaired to the EPL using the Pulvertaft weave technique. Post-operatively, he was immobilized in a cast for 2 weeks. For 4 weeks thereafter, he was placed in a Volar plaster splint maintaining the thumb in retropulsion to protect the tendon transfer. This was followed by 8 weeks of physical therapy aimed at increasing active range of motion and strength of his thumb and wrist.