Abstract
IntroductionThe aim of our study was the assessment of the mid-term outcome of patients treated with a pediculated extensor retinaculum flap for extensor carpi ulnaris (ECU) tendon subluxation including postoperative tendon stability control.Materials and methodsTwelve patients treated with an extensor retinaculum flap for symptomatic ECU tendon instability were retrospectively evaluated. Follow-up examinations included functional and radiologic assessment. The range of motion, grip strength, DASH score, PRWE score, Krimmer score and subjective satisfaction were recorded. A rotation-movie MRI was conducted before and after surgery to visualize tendon displacement.ResultsWrist extension was 65.8° (SD 10.0°), flexion 64.2° (SD 12.2°), radial deviation 15.8° (SD 6.0°), ulnar deviation 32.1° (SD 7.2°), pronation 82.5° (SD 9.4°) and supination 85.0° (SD 9.0°). Mean grip strength was 30.5 kg (SD 8.9 kg). Six patients presented an excellent, four a good, one a fair and one a poor result on the Krimmer score. The DASH and PRWE scores showed a mean of 24.2 (SD 25.1) and 32.2 (SD 29.4) points.MRI showed a dislocation (n = 7) or subluxation (n = 5) of the ECU tendon preoperatively. Five patients showed an unchanged displacement pattern postoperatively.ConclusionThe pediculated extensor retinaculum flap as a treatment for a symptomatic ECU instability shows good to excellent results and a high subjective satisfaction independent of postoperative ECU tendon displacement
Highlights
The aim of our study was the assessment of the mid-term outcome of patients treated with a pediculated extensor retinaculum flap for extensor carpi ulnaris (ECU) tendon subluxation including postoperative tendon stability control
The main finding of the study was that patients treated with a radially based extensor retinaculum flap for ECU tendon displacement showed a good to excellent function with a high satisfaction, grip strength and range of motion in comparison to the uninjured side
Good and excellent results could be achieved even if the ECU tendon showed further instability in the postoperative MRI investigations. This arises the question whether the instability is the main reason for complains or some other underlying problem, e.g. a potentially concomitant or subsequent irritating tendinosis or tenosynovitis, which is simultaneously treated intentionally or unintentionally
Summary
The aim of our study was the assessment of the mid-term outcome of patients treated with a pediculated extensor retinaculum flap for extensor carpi ulnaris (ECU) tendon subluxation including postoperative tendon stability control. Conclusion The pediculated extensor retinaculum flap as a treatment for a symptomatic ECU instability shows good to excellent results and a high subjective satisfaction independent of postoperative ECU tendon displacement. Extensor carpi ulnaris (ECU) tendon dislocation or subluxation can be one cause of ulnar-sided wrist pain. The extensor carpi ulnaris tendon is enclosed in an independent osteofibrous tunnel and stabilized by its sub-sheath. It prevents the tendon from subluxation out of the ulnar groove during a pronation–supination motion. Surgical treatment is necessary for patients suffering from chronic ECU tendon dislocation or subluxation and persistent pain
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