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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.
Brachial Plexus Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Janice He, Bassem Elhassan, Rohit Garg
The thumb can flex, extend, radially abduct and palmarly abduct. The flexor pollicis longus (median nerve) is the flexor at the thumb interphalangeal joint. The extensor pollicis longus (radial nerve) is the extensor at the interphalangeal joint and also allows the thumb to retropulse. Thumb radial abduction is primarily the action of the abductor pollicis longus (radial nerve) and adduction is the action of the adductor pollicis (ulnar nerve). The thenar muscles (median nerve) are responsible for thumb palmar abduction and opposition. These can all be tested by stabilizing the patient's wrist and asking the patient to move his or her thumb while providing resistance (Figures 12.13 and 12.14).
Upper Limb Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo
An accessory extensor pollicis longus may cause pain at the wrist (Beatty et al. 2000). Doubling and/or variable insertion of its tendon may limit the ability to extend the first digit (Masada et al. 2003; Sawaizumi et al. 2003; Türker et al. 2010), cause hyperextension of the first digit (Alsharif et al. 2017), or be mistaken for a ruptured tendon (Masada et al. 2003). Variation in the course of the extensor pollicis longus tendon can also cause tenosynovitis that may mimic intersection syndrome or de-Quervain’s disease (Rubin et al. 2011).
Biomechanical evaluation of the stability of extra-articular distal radius fractures fixed with volar locking plates according to the length of the distal locking screw
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Gyung-Hwan Oh, Hak-Sung Kim, Jung Il Lee
Distal radius fractures (DRFs) are a common injury encountered by orthopedic surgeons. Recently, an operative treatment using a volar locking plate (VLP) has emerged as a popular treatment for unstable DRFs. (Chung et al. 2009; Obert et al. 2013) However, the increased use of VLP has led to various postsurgical complications. Extensor tendon complications such as extensor tenosynovitis, extensor pollicis longus rupture, and extensor digitorum rupture after VLP fixation have been extensively reported. (Benson et al. 2006; Soong et al. 2011; Bentohami et al. 2014; Caruso et al. 2015; Azzi et al. 2017; Thorninger et al. 2017) These complications related to extensor tendons can occur due to inappropriate surgical technique (injury by depth gauge or drill bit) or dorsal protrusion of the distal screw.
Experiences with Osteoligamentoplasty According to Weiss for the Treatment of Scapholunate Dissociation
Published in Journal of Investigative Surgery, 2018
W. Petersen, J. Rothenberger, H. E. Schaller, A. Rahmanian-Schwarz, M. Held
The surgery was performed with an axillary plexus block. A longitudinal, s-shaped incision was placed dorsally with respect to the wrist, centered over Lister's tubercle as described by Weiss et al. [18] and shown in Figure 3. After a subcutaneous tissue dissection, the capsule between the second and the fourth compartments was incised longitudinally and taken down in either direction to expose the SL interval. The fourth and fifth extensor compartment was elevated along the ulnar. The extensor pollicis longus tendon and the radial wrist extensor tendon were transposed radially. This exposure provided an excellent visualization of the SL interval and previous arthroscopic findings of the SL dissociation with distinct instability were confirmed among all patients who participated in the study (Figure 4).
A case of total scaphoid titanium custom-made 3D-printed prostheses with one-year follow-up
Published in Case Reports in Plastic Surgery and Hand Surgery, 2020
After a review of the different surgical options (total scaphoid implant, proximal row carpectomy, 3- or 4-corner arthrodesis, or no surgery but completion of wrist denervation), the patient agreed to undergo a total scaphoid replacement with a custom-made 3D implant (Adler Ortho, Cormano, Italy). The implant had a titanium niobium nitride (TiNbN) coating to reduce its allergic potential and to improve its surface hardness. The surgical technique consisted of a dorsal approach between the extensor carpi radialis brevis and extensor pollicis longus. The wrist capsule with the radiocarpal dorsal ligament was cut in a T-shape with dissection from the radius and carpal bones so that the necrotic scaphoid was exposed and isolated.