Extensor Digiti Minimi Tendon Research Articles

Novel Therapeutic Approach for Extensor Digiti Minimi Tendon Traction in Chronic Ulnar-Sided Wrist Pain Diagnosed as Triangular Fibrocartilage Complex Injury: A Case Report

Novel Therapeutic Approach for Extensor Digiti Minimi Tendon Traction in Chronic Ulnar-Sided Wrist Pain Diagnosed as Triangular Fibrocartilage Complex Injury: A Case Report

Extensor Tendon Rupture in Ulnar Impingement Syndrome: A Case Report

Ulnar impingement syndrome is caused by a shortened ulna impinging on the distal radius and causing a painful, disabling pseudoarthrosis. Vaughan-Jackson syndrome is characterized by a disruption of the digital extensor tendons, beginning on the ulnar side with the extensor digiti minimi (EDM) and extensor digitorum communis (EDC) tendon of the small finger. While ulnar impingement and Vaughan-Jackson syndrome are not uncommon, it is rare to observe the two conditions occurring simultaneously. We report a unique case of ulnar impingement syndrome presenting with Vaughan-Jackson syndrome, revealing that the degenerative changes from ulnar impingement syndrome can cause attrition rupture of the EDM and EDC tendon of the little finger. This entails increased clinical significance of ulnar impingement, because in addition to its potential to cause debilitating pain, there is also consequence of functional deficits if extensor tendon rupture were to occur due to progressive degenerative changes. The surgical management of distal radioulnar joint (DRUJ) arthritis arising from ulnar impingement may include various intra-operative techniques to prevent post-operative extensor tendon rupture.

Practical ultrasonographic technique to precisely identify and differentiate tendons and ligaments of the elbow at the level of the humeral epicondyles: anatomical study

ObjectivesTo develop a practical step-by-step technique to precisely identify and differentiate tendons and ligaments attaching to the humeral epicondyles, to confirm through gross anatomical study the accurate structure identification provided by this technique and to determine the frequency at which each structure can be identified in healthy volunteers.Materials and methodsFirst, ten fresh frozen cadavers (6 men, age at death = 58–92 years) were examined by two musculoskeletal radiologists and a step-by-step technique for the identification of tendons and ligaments at the level of humeral epicondyles was developed. Second, the accurate identification of structures was confirmed through gross anatomical study including anatomical sections on five specimens and layer-by-layer dissection technique on five others. Finally, 12 healthy volunteers (6 men, average age = 36, range = 28–52) were scanned by two radiologists following the same technique.ResultsAn ultrasonographic technique based on the recognition of bony landmarks and the use of ultrasonographic signs to differentiate overlapping structures was developed and validated through gross anatomical study. In healthy volunteers, most tendons and ligaments were identified and well-defined in ≥ 80% of cases, except for the extensor carpi radialis brevis and extensor digiti minimi tendons on the lateral epicondyle (having common attachments with the extensor digitorum communis) and the palmaris longus tendon on the medial epicondyle (absent, or common attachment with the flexor carpi radialis).ConclusionA step-by-step approach to the ultrasonographic assessment of tendons and ligaments at the humeral epicondyles allowed accurate identification of and differentiation among these structures, in particular those relevant to pathological conditions.

Prevalence of the extensor digitorum, extensor digiti minimi and extensor indicis tendons and their variations

We aimed to investigate tendon variations of the extensor digitorum (ED), extensor digiti minimi (EDM), and extensor indicis proprius (EIP) muscles. Our study was performed on 43 fetal cadavers (86 extremities), aged between 17 and 40 weeks of gestation. The number of ED tendons varied from three to six, proximal to the extensor retinaculum (ER), and from three to eight, distal to the ER. The ED most often had four tendons, both proximally and distally from the ER. The ED tendons of the fourth finger were observed to be most frequently duplicated. The most common juncturae tendinum (JT) was type 1 in the second intermetacarpal space (IMCS), type 2 in the third IMCS, and type 3r in the fourth IMCS according to von Schroeder classification. The number of EIP and EDM tendons varied from one to two and from one to five, respectively. The EIP double tendons inserted both into the ulnar and palmar sides of the extensor digitorum of the second finger, which had not been reported in the literature. In our study, 7% of hands had variant muscles. In 4.7% of hands, the extensor indicis et medii communis was observed, while the extensor medii proprius and the extensor digitorum brevis manus were observed in 1.2% and 1.2% of hands, respectively. Knowing the prevalence of the ED, EDM and EIP tendons and their variations in the fetal period should help to treat partial loss of hand function or injury after birth and to correct congenital hand deformities.

Arthroscopy of the distal radioulnar joint

The aim of the procedure is to visualize the proximal pouch of the DRUJ, the joint surfaces of the sigmoid notch and the ulnar head, the convexity of the ulnar head and the proximal ulnar side surface of the triangular fibrocartilage complex (TFCC). Arthroscopy of the distal radioulnar joint is applied for the evaluation of joint pathologies in ulnar-sided wrist pain, especially in cases without diagnostic findings in standard X‑rays and MRIs and arthroscopically assisted procedures. In vertical extension, two portals of the wrist are created on the dorsal side of the DRUJ between the extensor digiti minimi and extensor carpi ulnaris tendons. By insertion of asmall joint arthroscope via these portals visualization of the ulnar head, the sigmoid notch, the proximal pouch of the DRUJ and the proximal surface of the TFCC is accomplished. Arthroscopy of the DRUJ is ararely and not routinely performed procedure for the diagnosis and therapy of ulnar-sided wrist pain. It is technical demanding with aflat learning curve and anatomy-related obstacles. Acomplete view of the joint is not always accessible. Rare complications are injuries of the extensor digiti minimi tendon, as well as contusion or sectioning of the transverse branch of the dorsal branch of the ulnar nerve. In distinct cases, this procedure offers important additional information about the distal radioulnar joint. The procedure is especially valuable for the detection of proximal TFCC injuries that are missed otherwise.

The Relative Contribution to Small Finger Abduction of the Ulnar Versus Radial Slip of the EDM: Implications for Tendon Transfers.

The extensor digiti minimi (EDM) tendon is commonly divided into a radial slip (EDM-R) and an ulnar slip (EDM-U). To our knowledge, the degree to which each EDM slip concomitantly abducts the small finger with active extension has not been formally tested. This study sought to characterize the comparative contributions of finger abduction inherent to each slip of the EDM to observe the sequelae of active small finger extension following transfer of the contralateral slip. Eighteen fresh-frozen cadaveric hands were used in this study. Starting with the hand in resting position, a controlled traction of 10 N was applied to each slip of the EDM tendon. The range of small finger abduction with respect to the fixed ring finger was recorded utilizing infrared reflective markers tracked through the range of motion using a digital video camera. The mean abduction of the small finger when the radial slip of the EDM tendon was tested was 13.33° (95% confidence interval [CI]: 10.10°-16.55°), which was significantly different ( P ≤ .001) than small finger abduction produced by the ulnar slip of the EDM, with a mean of 23.72° (95% CI: 19.40°-28.04°). Given the fact that the ulnar slip of the EDM tendon is shown to be the major contributor of aberrant abduction with active small finger extension, as traction on this slip produces almost twice as much abduction as the radial slip, the EDM-U is the ideal donor graft with respect to tendon transfers of the EDM.

Extensor Digiti Minimi Transfer for the Treatment of an Unstable Metacarpophalangeal Joint in Thumb Polydactyly Without Thenar Atrophy.

Dear Sir, As treatments for the laxity of metacarpophalangeal (MCP) joint in hypoplastic thumb, joint capsular plication, free tendon graft or MCP arthrodesis have been performed [1]. In addition, transfer of abductor digiti minimi [2] or ring finger flexor digitorum superficialis [3] have been used to provide thumb opposition and restore MCP joint stability. In the present case, we used extensor digiti minimi (EDM) transfer to treat MCP joint instability due to ulnar collateral ligament laxity in a patient with thumb polydactyly without thenar muscle atrophy. An 11-year-old girl who was naturally right thumb polydactyly with floating ulnar thumb had a thumb plasty at the age of five. But she was bothered by an unstable MCP joint due to ulnar collateral hypoplasia (Fig. 1a). Six years later from primary operation, she underwent a second surgery to improve joint instability and outer appearance of the thumb. The MCP joint instability was corrected by an EDM transfer, which involved fasting the end of the transferred tendon to the ulnar side of the MCP joint at the bottom of proximal phalanx and at the metacarpal head (Fig. 2). At 10 months postoperatively, the appearance of the thumb was improved and the MCP joint was stable (Fig. 1b). The EDM transfer procedure was initially reported for restoration of thumb adduction in ulnar nerve paralysis [4], but MCP joint stability could be achieved by changing the distal tendon insertion as this case. We consider there are some advantages to this procedure: 1) the MCP joint achieves maximum stability in the opposite position, because the tension of the transferred EDM tendon increases with the increase in the angle of opposition, 2) the mobility of the MCP joint is not impaired, 3) the strength of side pinch could be increased by increasing the thumb adduction force. On the other hand, the disadvantages of this procedure include that this transfer would position thumb in extension and adduction, and a decrease in the extension force of the little finger. The former demerit barely mattered in actuality, because we think the tension of transferred EDM is not strong in the rest position.

Rice Body Tenosynovitis without Tuberculosis Infection after Multiple Acupuncture Procedures in a Hand.

Rice Body Tenosynovitis without Tuberculosis Infection after Multiple Acupuncture Procedures in a Hand.

Arthroscopy of the distal radioulnar joint

Insertion of a small joint arthroscope into the proximal and distal parts of the distal radioulnar joint (DRUJ) allows visualization of the proximal pouch of the DRUJ, the joint surfaces of the sigmoid notch and the ulnar head, the convexity of the ulnar head and the proximal ulnar-sided surface of the triangular fibrocartilage complex (TFCC). Evaluation of joint pathologies in ulnar-sided wrist pain, especially in cases without diagnostic findings in standard X-rays and MRI, suspected cartilage lesions without osteochondral changes (signs of osteoarthritis), undefined swelling of the DRUJ in suspected synovitis, removal of loose bodies and arthroscopical synovialectomy, suspected lesions of the deep part of the TFCC, respectively foveal avulsions, wear or superficial tears of the proximal TFCC and arthroscopic-assisted ulnar shortening. Significant changes of the local topographical anatomy, extensive scar formation, ulna plus variance, local infection or open wounds, affected sensibility in the area of the dorsal branch of the ulnar nerve, fractures of the sigmoid notch or the ulnar head, capsular tears causing effusion of irrigation fluid. In vertical extension of the wrist, two portals are created on the dorsal side of the DRUJ between the extensor digiti minimi and extensor carpi ulnaris tendons. Partial visualization of the ulnar head, the sigmoid notch, the proximal pouch of the DRUJ, and the proximal surface of the TFCC. Following isolated diagnostic arthroscopies immobilization of the wrist in a semicircular ulnar-sided cast for 1 week. No extensive load to the wrist for 4 weeks. Still rarely performed procedure for diagnosis and therapy of ulnar-sided wrist pain. Technically demanding with a flat learning curve and anatomy-related obstacles. A complete view of the joint is not always accessible. Rare complications are injuries of the extensor digiti minimi tendon as well as contusion or sectioning of the transverse branch of the dorsal branch of the ulnar nerve. In distinct cases this procedure offers valuable additional information about the distal radioulnar joint.

The prevalence of the extensor digiti minimi tendon of the hand and its variants in humans: a systematic review and meta-analysis.

The extensor digiti minimi (EDM) is frequently used in the case of an abduction deformity of the little finger. It is also considered as a main resource for tendon transfer. However, it shows many variations in the human hand, which include splitting into two or more slips and sending a slip to the fourth finger, named the extensor digiti minimi et quarti (EDMQ). The aim of this systematic review is to perform an evidence synthesis on the prevalence of the EDM and its variants. Twenty-six cadaveric studies met the inclusion criteria with a total of 2247 hands. Meta-analysis results yielded an overall pooled prevalence estimate (PPE) of the EDM of 99.7% and PPEs of 11.5, 77.6, 7 and 0.6% for the single-, double-, triple- and quadruple-slip EDM, respectively. For the single-slip EDM, the frequencies were such that Indians > Middle Eastern > Europeans > Japanese > North Americans. For the double-slip EDM, the frequencies were such that Japanese > North Americans = Europeans > Middle Eastern > Indians. No significance was found with regard to hand side. The true EDMQ prevalence was found to be at 7.3%, whereas its crude prevalence was 8%. This artilce offers reference values on the prevalence of the EDM and its variants, which are thought to be highly relevant to both anatomists and clinicians.

Triple Extensor Digiti Minimi Tendon: An Anatomic Variation

This case report describes an unusual variation of the extensor digiti minimi tendon discovered during extensor tendon repair in the emergency room. Knowledge of this variation may be helpful for the tendon transfers and tendon surgery that need tendon graft.

SPONTANEOUS RUPTURE OF THE LEFT EXTENSOR POLLICIS LONGUS-, EXTENSOR DIGITORUM- AND EXTENSOR DIGITI MINIMI TENDONS: A CASE REPORT

This case report describes a patient who experienced closed simultaneous rupture of the left extensor pollicis longus (EPL)-, extensor digitorum (ED) and extensor digiti minimi (EDM) tendons.

Modified Tajima technique for reconstruction of thumb opposition after median nerve palsy

Objective To introduce the application of extensor digiti minimi tendon transfer(modified Tajima technique)for functional reconstruction of thumb opposition following median nerve palsy.Methods Thumb opponenplasty was done in 11 cases of high median nerve injury with irreversible palsy.Modified Tajima technique was used to transfer the extensor digiti minimi tendon.The proximal band was anchored onto the extensor pollicis longus tendon at the metacarpal neck.The distal band was inserted in the medullary cavity of the proximal phalanx.Results The patients were follow-up for 4 to 38 months with an average of 18.5 months.Thumb opposition was restored in all 11 patients with 100％ success rate.The extension of the donor finger was not affected.Conclusion Modified Tajima method is a simple and reliable method to reconstruct thumb opposition function. Key words: Median nerve; Wounds and injuries; Tendon transfer; Thumb oppositional function

Accessory tendon slip arising from the extensor carpi ulnaris and its importance for wrist pain

The anatomical variations of the extensor carpi ulnaris (ECU) muscle can cause a functional impairment of the wrist and the little finger. The aim of this study was to determine the number, thickness and type of accessory tendon arising from the ECU. The presence of an accessory tendinous slip from the ECU muscle was examined in terms of gross appearance, size, shape, thickness, location and distribution in 54 cadaveric forearms. The accessory slips arising from the ECU muscle were observed in three specimens (5.6%) (two left, one right). These slips ran to the ulnar side of the extensor digiti minimi tendon, originated from the head of the ECU, and ended on the extensor apparatus of the fifth finger. The mean width of the tendinous slips was 1.4±0.01 mm. This anatomic variation of the ECU should be considered in diagnostic and surgical procedures involving the dorsum of the hand. Its clinical importance in the treatment of tenosynovitis and subluxation of joints is also stressed.

Restoration of active palmar abduction of the thumb in tetraplegia by tendon transfer of the extensor digiti minimi to abductor pollicis brevis

We describe a method to restore active palmar abduction of the thumb and report its functional impact in tetraplegia. At 54.2 (SD 42.8) months after cervical spinal cord injury (12 traumatic, 3 nontraumatic), the extensor digiti minimi (EDM) tendon was transferred to the abductor pollicis brevis (APB) through the interosseous membrane in 15 tetraplegic patients (age range 19-70 years) in addition to a mean 3.2 procedures to restore key pinch. According to International Classification, the operated upper extremities were in the OCu4 to OCu8 (1 patient X) group. The maximum distance between thumb and index finger tips during active or passive opening of the hand, maximum angle of palmar abduction, grip and key pinch strength, and active finger range of motion were measured. All patients were re-examined after 38.4 (SD 22.7) months. The active thumb-index opening increased significantly from 2.5 (SEM 1.0) cm before to 9.0 (SEM 0.8) cm after surgery. Nine patients without previous active opening of the first web space recovered a mean thumb-index opening of 9.1 (SEM 1.7) cm, whereas this distance increased by an average of 2.9 (SEM 0.8) cm in six patients who had active thumb index distance of 6.3 (SEM 1.6) cm before surgery. All but one patient were able to direct and coordinate key pinch and perform tasks using the restored APB function, including five patients whose EDM strength was rated as grade 3 before transfer. This EDM-to-APB transfer meets the theoretical requirements of architecture matching between donor and recipient muscles, the principles of tendon transfer, and our surgical expectations. We strongly recommend that an active EDM is transferred to the APB to restore opening of the hand and help in key pinch control in patients with tetraplegia.

Tendon impingement of the extensor digiti minimi: Clinical cases series and cadaveric study

The authors describe two unique clinical cases of closed extensor digiti minimi (EDM) tendon injuries after hyperflexion of the wrist with full finger flexion and one case of chronic tenosynovitis around the EDM tendon. All three cases were thought to be related to the bifurcation of the EDM tendon and synovial septum. Subsequently, variations in EDM tendons were investigated in 49 cadaveric hands with a focus on patterns of tendon bifurcation and their relationships with the surrounding synovial sheath. The EDM tendon was found to be bifurcated in 74% (n = 36) of hands and all of these hands contained a synovial septum. In 9 (25%) hands, the EDM tendon bifurcated proximal to the retinaculum, in 15 (42%), it bifurcated distal to the retinaculum, and in the other 12 hands (33%), the tendon bifurcated at the retinacular level. In 6 of the 15 hands with an infraretinacular bifurcation, the tendon was found to impinge on the synovial septum during passive flexion of the wrist with full finger flexion, and the mean distance between the synovial septum and the bifurcation point in these specimens was 0.6 cm (range, 0.4-0.7 cm), which was differed significantly from hands not showing impingement (P = 0.01). This study shows that distal bifurcation of the EDM tendon may lead to tendon impingement on the septum and suggests that this is a potential etiology of chronic tenosynovitis of the fifth compartment and of acute closed tendon injuries.

Correcting the persistently abducted little finger using a distally based extensor digiti minimi tendon

Correcting the persistently abducted little finger using a distally based extensor digiti minimi tendon

Traumatic Closed Index Extensor Tendon Rupture at the Musclotendinous Junction: A Report of Two Cases

This report describes two cases of traumatic closed index extensor tendon rupture at the musclotendinous junction. Both patients were injured when their work gloves were caught in the revolving parts of machines, and both were treated surgically. One of the patients completely ruptured the index extensor digitorum communis (EDC) and the extensor indicis proprius (EIP) tendons at the musclotendinous junction of dorsal forearm. In this patient, the distal stump of the index EDC tendon was sutured to the middle EDC tendon in an end-to-side juncture. The other patient completely ruptured the EIP tendon and partially ruptured the index EDC tendon at the musclotendinous junction. In this patient, tendon transfer of the extensor digiti minimi (EDM) to the EIP tendon and plication of the index EDC tendon were performed. In both cases, surgical intervention enabled the patients to extend their index fingers almost normally; however, the former complained of inability to extend his index finger independently. Tendon transfer of the EDM in cases of index extensor tendon rupture at the musclotendinous junction is a good method to restore ability to independently extend the index finger. However, consideration should be given to anatomical variation in the little finger. The EDC tendon is sometimes absent leaving the EDM tendon as the only extensor tendon to the little finger.

ACCESSORY EXTENSOR DIGITI MINIMI MUSCLE SIMULATING A SOFT TISSUE MASS DURING SURGERY: A CASE REPORT

During a wrist ganglion excision originating at the tendon sheath of the extensor carpi ulnaris muscle, a soft tissue mass was observed just radial and distal to the surgical field. Dissection of the mass revealed an accessory extensor digiti minimi muscle belly which joined the radial extensor digiti minimi tendon. The surgical impact is discussed.

Osteochondroma of the Capitate Causing Rupture of the Extensor Digiti Minimi: Case Report

Osteochondromas usually arise from the metaphyses of long bones. Involvement of the carpal bones is extremely rare. We report a case of an osteochondroma originating from the dorsal capitate in a 51-year-old man. Attritional rupture of the extensor digiti minimi tendon resulted from mechanical irritation as it coursed over the mass. Surgical excision of the mass with tendon transfer of the extensor digiti minimi was subsequently performed.