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Elbow/Forearm Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Vaikunthan Rajaratnam, Timothy Teo Wei Wen, Usama Farghaly Omar
Scars over the extension compartment of their elbow and forearm can indicate lesions to the extensor mechanism (Figure 13.10) and the superficial radial nerve. This is close to the extensor retinaculum over the wrist area especially in the middle and can be associated with the division of the extensor pollicis longus. Extensive scarring around the elbow joint in the extensor surface area can involve the radial nerve producing intractable pain along the superficial radial nerve territory.
Hands
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Synovitis – dorsal tenosynovectomy ± wrist joint synovectomy ± osteophyte excision. Complications include skin necrosis exposing tendons, haematoma and bowstringing if a strip of extensor retinaculum is not preserved.
The wrist
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Extensor tenosynovectomy and soft-tissue stabilization of the wrist may forestall further deterioration. Through a dorsal longitudinal incision the extensor retinaculum is exposed and carefully dissected but left attached at the radial side. The thickened synovium around the extensor tendons, as well as any bony protrusions on the back of the wrist, are removed. The preserved extensor retinaculum is then placed beneath the tendons to further reduce the risk of later tendon rupture.
Post-arthrolysis rehabilitation in a patient with wrist stiffness secondary to distal radio-ulnar fracture: A case report
Published in Physiotherapy Theory and Practice, 2023
Andrea Inglese, Sheila Santandrea
The pre-surgical evaluation suggested that both intra and extra-articular factors were the causes of stiffness; hence, it was decided to proceed with an open arthrolysis under brachial plexus block. The extensor tendons of the fingers and carpus were released from the adhesions detected at the level of the extensor retinaculum and parts of the capsule that had the fibrosis were removed. The ROM of the wrist was tested, and it was found to be limited by an impingement between scaphoid and radius. The osteophyte causing the impingement was removed, and a significant increase in wrist mobility was observed. Passive range of motion (PROM) was measured with the goniometer at the end of the surgical procedure to record the improvements achieved by arthrolysis: flexion was 70° while extension was 55° (Figure 4 B).
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.
Intratendinous ganglion in the extensor digitorum communis
Published in Case Reports in Plastic Surgery and Hand Surgery, 2020
Yoichi Sugiyama, Kiyohito Naito, Kenji Goto, Nana Nagura, Kazuo Kaneko
The developmental mechanism of an intratendinous ganglion is unclear, but Seidman and Margles mentioned that it secondarily develops after synovitis [7], and Senda et al. mentioned that chronic stimulation, such as friction with the extensor retinaculum and metacarpal bosses, is the cause [4]. In our patient, no metacarpal boss was noted, the development site was the distal extensor retinaculum, and outgrowth of the surrounding synovial membrane was noted during surgery, suggesting that the cause was synovitis. In previous case reports of intratendinous development of ganglion, repeated trauma-induced mucous degeneration of the tendon and infiltration of tendonitis-induced inflammatory synovial membrane into the tendon parenchyma were considered the causes [7,8]. Outgrowth of the synovial membrane around the tendon and the presence of aberrant synovial membrane tissue in the tendon tissue were noted in our patient, suggesting that development of synovial membrane-derived ganglion in the tendon tissue was the developmental mechanism.