Extensor Digitorum Communis Tendon Research Articles

Surgical procedures to improve hand function in tetraplegic patients: patient satisfaction and outcomes over a 20-year period.

The aim of the present study was to report our experience in the evolution in surgical strategy and patient satisfaction after upper limb reconstruction in tetraplegic patients. A total of 72 patients (114 upper limbs) underwent surgery between 1997 and 2017. Since April 2003, tenodesis of the extensor digitorum communis tendons was no longer performed because it limited wrist flexion, and two-stage operations to restore active grasp were replaced by one-stage procedures. In total, 34 patients (58 upper limbs) completed questionnaires about function and satisfaction at a mean follow-up of 14 years (range 4-24) since their first operation; 26 were satisfied, 30 would have the operation again and 31 benefitted from the surgery. Surgical procedures, such as tendon transfers, arthrodesis and tenodesis, can have a positive effect on patient-perceived function and satisfaction in the long term in most of these patients.Level of evidence: IV.

Atypical Cleft Hand: Surgical Technique for Grasping Improvement

Introduction: We present 6 cases of children with atypical cleft hand and discuss a surgical technique. Clinically, participants presented with a lack of pulp-to-pulp pinch due to metacarpophalangeal ligament insufficiency and difficulty grasping large objects because of the narrowed first web. Materials and Methods: Second metacarpal resection and Z-plasty, creating a wide first web. The second extensor digitorum communis tendon was transferred to improve the thumb metacarpophalangeal joint stability. Conclusions: The surgical technique presented in this paper did improve function in oligodactyly or type-IIA atypical cleft hand.

The Medial Triquetrohamate Portal: A New Portal in Wrist Arthroscopy. Anatomical Study.

Introduction Continuing advances in wrist arthroscopy and better understanding of carpal conditions have created the need to design new wrist access portals that facilitate the implementation of new surgical techniques. The aim of this study was to define and verify the safety of the medial triquetrohamate (MTH) portal. Description of the technique The MTH portal is located about 5-10 mm ulnar and 2-3 mm distal to the midcarpal ulnar portal, ulnar to the extensor digitorum communis (EDC) tendon of the fourth and fifth fingers, and radial to the extensor digiti quinti (minimi) (EDQ) tendon. Methods An anatomical study was performed on 15 upper limb specimens from 15 human cadavers. Iatrogenic injuries to potentially at-risk neurovascular and tendinous structures were assessed, and the distance from the portal to these structures was measured. Results There were no iatrogenic injuries to the structures at risk. Mean distances from the MTH portal to the EDC tendon of the fourth and fifth fingers and to the EDQ tendon were 4.67 ± 0.35 mm and 7.27 ± 0.18 mm, respectively. No differences were observed between the left and right wrists. The distance from the MTH portal to the dorsal sensory branch of the ulnar nerve was 15.07 ± 0.44 mm. The structure with the highest risk of injury was the EDC tendon of the fourth and fifth fingers, with a distance of less than 5 mm. Conclusions The MTH portal is safe, reproducible and facilitates the implementation of various techniques related to midcarpal pathology.

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.

Reconstruction of Hand Dorsum Defect Using Double Perforators-Based Anterior Interosseous Artery Island Flap: A Case Report and Description of a New Anterior Interosseous Artery Perforator.

The anterior interosseous artery (AIA) perforator flap is not commonly used in hand dorsum reconstruction compared with alternatives. However, it is a versatile flap with several advantages. Literature on the AIA perforator flap is based on the dorsal septocutaneous branch (DSB), which branches from the AIA and passes through fascia between the extensor pollicis longus (EPL) and extensor pollicis brevis muscles. In the described case, the authors reconstructed a hand dorsum defect in a 78-year-old man using an AIA perforator flap with double perforators supplied by the DSB and a new perforator branching from the distal than DSB. No complication was encountered, and the flap survived completely. A retrospective computed tomography review revealed the presence of the new perforator in 14 of 21 patients. Two types of new perforator were observed. One passed through the ulnar side of the extensor indicis proprius (EIP) muscle and penetrated fascia between the extensor digitorum minimi and extensor digitorum communis tendons, whereas the other passed between the EPL and EIP muscles. This report describes the anatomical location and clinical application of the new AIA perforators. The double perforators-based AIA flap provides a straightforward, reliable means of reconstructing hand dorsum defects.

Wide awake surgery for rupture of the lateral expansion of the long-finger extensor tendon: A case report

Spontaneous extensor digitorum communis (EDC) tendon rupture is uncommon but easily confusing injury that lead to functional impairment. There is no any strict first-line treatment for nonrheumatoid EDC tendon rupture. We report a kidney transplant recipient with spontaneous rupture of the lateral expansion of the long-finger extensor tendon treated by wide awake surgery. Surgical repair with wide-awake local anesthesia was performed to realign the tendon for the patient. Three months following surgery, the patient obtained a full pain-free range of motion of the hand without recurrent dislocation.

Rupture of the extensor digitorum communis tendon in extensor zone V due to plant thorn injuries: a report of two cases

Penetrating injuries due to a plant thorn in the hand may occur during outdoor activities. We experienced two patients with rupture of the extensor digitorum communis (EDC) tendon in extensor zone V caused by plant thorn injuries. Both patients, presenting with pain and swelling around the third metacarpophalangeal joint, had a history of penetrating injuries due to plant thorns. The injuries had been ineffectively treated with oral antibiotics. Plain radiographs showed soft tissue swelling without a foreign body and bony lesions. Enhanced magnetic resonance imaging confirmed a rupture of the EDC tendon at the third extensor zone V. Tendon ruptures were diagnosed 27 and 60 days after injury, respectively. A plant thorn injury in the hand can cause persistent synovitis around the tendon, and as a result, progress to tendon rupture. A magnetic resonance imaging examination may be helpful if symptoms do not improve for a prolonged period after plant thorn injury.

The MCP2 and the wrist plus two extensor compartments are the most affected and responsive joints/tendons out of the US7 score in patients with rheumatoid arthritis-an observational study

BackgroundThere is no international consensus on an optimal ultrasound score for monitoring of rheumatoid arthritis (RA) on patient-level yet. Our aim was to reassess the US7 score for the identification of the most frequently pathologic and responsive joint/tendon regions, to optimize it and contribute to an international consensus. Furthermore, we aimed to evaluate the impact of disease duration on the performance of the score.MethodsRA patients were assessed at baseline and after 3 and 6 months of starting/changing DMARD therapy by the US7 score in greyscale (GS) and power Doppler (PD). The frequency of pathologic joint/tendon regions and their responsiveness to therapy were analyzed by Friedman test and Cochrane-Q test respectively, including the comparison of palmar vs. dorsal regions (chi-square test). The responsiveness of different reduced scores and the amount of information retained from the original US7 score were assessed by standardized response means (SRM)/linear regression. Analyses were also performed separately for early and established RA.ResultsA total of 435 patients (N = 138 early RA) were included (56.5 (SD 13.1) years old, 8.2 (9.1) years disease duration, 80% female). The dorsal wrist, palmar MCP2, extensor digitorum communis (EDC) and carpi ulnaris (ECU) tendons were most frequently affected by GS/PD synovitis/tenosynovitis (wrist: 45%/43%; MCP2: 35%/28%; EDC: 30%/11% and ECU: 25%/11%) and significantly changed within 6 months of therapy (all p ≤0.003 by GS/PD). The dorsal vs. palmar side of the wrist by GS/PD (p < 0.001) and the palmar side of the finger joints by PD (p < 0.001) were more frequently pathologic. The reduced US7 score (GS/PD: palmar MCP2, dorsal wrist, EDC and ECU, only PD: dorsal MCP2) showed therapy response (SRM 0.433) after 6 months and retained 76% of the full US7 score’s information.No major differences between the groups of early and established RA could be detected.ConclusionsThe wrist, MCP2, EDC, and ECU tendons were most frequently pathologic and responsive to therapy in both early and established RA and should therefore be included in a comprehensive score for monitoring RA patients on patient-level.

Surgical treatment of sagittal band injuries and classification according to operative findings

PurposeThe indications for surgery in patients with acute closed sagittal band injuries are still undetermined. The purpose of this study was to classify the types of injuries based on intraoperative findings of patients who underwent surgery for sagittal injuries, and to present the treatment plans and surgical methods.MethodsTwenty-five patients who had undergone surgical exploration for closed sagittal band injuries between January 2011 and December 2020 were included in the study, comprising 17 patients with acute injuries (within 3 weeks), four patients with chronic injuries, and four patients who underwent surgery because symptoms did not improve in response to conservative treatment. Patients with laceration, fracture, and rheumatoid arthritis were excluded.ResultsSagittal band injuries were classified into two groups: superficial sagittal band (SSB) and proper sagittal band (PSB) injuries. SSB injuries were observed in 75.0% of spontaneous rupture cases and PSB injuries were observed in 66.7% of traumatic rupture cases. SSB injuries were observed in 83.3% of Rayan and Murray classification type II cases and PSB injuries were observed in 61.5% of type III cases (p=0.041). PSB injuries were present in all four patients who underwent surgery because conservative treatment failed.ConclusionWe successfully corrected sagittal band injuries with extensor digitorum communis tendon instability through surgical treatment. Sagittal band injuries can be classified into two types depending on the anatomical injury pattern; SSB and PSB injuries. The surgical method and treatment plan can be chosen based on this classification.

Stenosing tenosynovitis of the extensor digitorum tendons of the hand: clinical and sonographic features.

To describe the ultrasound (US) features of 18 patients with extensor digitorum communis stenosing tenosynovitis (EDCST). A retrospective search in the radiologic information systems of two separate Institutions was performed to identify all patients presenting EDCST between January 2010 and September 2019. A total of 18 patients (ten males and eight females; mean age, 57.4years) were identified and included. Sonographic examinations were retrospectively reviewed by two senior radiologists to assess morphologic changes and power Doppler activity of the extensor retinaculum (ER) and of the extensor digitorum communis (EDC) tendons and sheath. The presence of dynamic impingement between the EDC and the ER was evaluated using video clip records. At the ultrasound, all patients (18/18; 100%) presented thickening of both the ER and EDC tendons associated with EDC tendon sheath effusion. Power Doppler hyperemia of the ER was inconstant and observed in 11 cases (11/18; 61.1%) as tendon sheath effusion observed in 16 cases (16/18; 88.9%). A cyst located inside the EDC of the index finger was observed in three of these patients (3/18; 17%). Dynamic examination showed impingement of the EDC against the ER during active tendon extension in all patients (18/18; 100%). Four of these patients (4/18; 22%) underwent surgery allowing diagnosis confirmation and release of EDCST, while the remaining fourteen patients (14/18; 78%) were either treated conservatively or using US-guided steroid injection. US findings of EDCST include thickening of the ER and EDC tendons, EDC tendon sheath effusion, and in some cases presence of an EDC intratendinous cyst. Impingement of the EDC tendons against the ER is well demonstrated using dynamic US.

Biomechanical Study Comparing Pulvertaft, Double Side-to-Side, and Locking Side-to-Side Tendon Suture Techniques

In this study, we present a single-sided locking side-to-side (STS) suture technique as a possible alternative for the Pulvertaft weave in tendon transfers. The aim of the study was to compare the biomechanical characteristics of the single-sided locking STS reconstruction with Pulvertaft and double-sided nonlocking STS reconstructions. Twenty-four human cadaveric extensor digitorum communis tendons and 24 flexor digitorum superficialis tendons were randomly assigned to 1 of 3 groups, resulting in a total of 8 flexor tendons and 8 extensor tendons per group: Pulvertaft, double-sided nonlocking STS, and single-sided locking STS reconstructions. Load to failure was measured with a tensile testing machine. Increase in cross-sectional area was used as a measure of bulkiness at the reconstruction site. In extensor tendons, single-sided locking STS reconstructions showed a higher load to failure than Pulvertaft reconstructions, whereas no difference was found in load to failure between single-sided locking and double-sided nonlocking STS reconstructions. In flexor tendons, single-sided locking STS reconstructions showed a higher load to failure than Pulvertaft reconstructions. However, load to failure of single-sided locking STS reconstructions was less than double-sided nonlocking STS reconstructions. In both extensor and flexor tendons, the percent increase in cross-sectional area at the reconstruction site was higher in Pulvertaft reconstructions than single-sided locking STS reconstructions, whereas no difference was found between single-sided locking STS and double-sided nonlocking STS reconstructions. Single-sided locking and double-sided nonlocking STS reconstructions are suitable alternatives to the Pulvertaft technique for tendon transfers owing to a higher strength and less bulkiness. Because load to failure of both STS reconstructions did not differ in extensor tendon transfers, the single-sided locking STS reconstruction seems especially suitable for extensor tendon transfers. This study provides anatomical evidence that the single-sided locking STS reconstruction yields a higher strength and is less bulky than the Pulvertaft reconstruction in tendon transfers.

Multiple Huge Tendinous Xanthomas with Normal Lipid Profiles in All Extremities

Xanthomas are grayish-yellow masses composed of lipid-filled foamy histiocytes and are usually accompanied by familial hypercholesterolemia or some other disease associated with dysfunctional lipid metabolism. Here, we report a case of multiple huge tendinous xanthomas with normal lipid profiles involving all extremities. These masses were large enough to cause pain, dysfunction of extremities, and cosmetic compromise and the condition was accompanied by cerebrotendinous xanthomatosis. Due to the presence of many masses in all extremities, a two-stage operation was planned with a time gap of several months. At 1-month follow-up visits after first and second surgeries, although extension of the left middle finger was poor as a result of sacrificing the 3rd extensor digitorum communis tendon, no problems such as wound dehiscence, hematoma formation, or infection at operative sites were noted.

A Reconstructive Extensor Tendon Centralization Technique for Sagittal Band Disruption.

Sagittal band injuries may result in extensor digitorum communis (EDC) tendon instability and may require operative treatment for symptomatic loss of extension, pain, and snapping at the metacarpophalangeal joint (MCPJ). Operative methods vary according to the source of donor tissue, as well as the anchor point of attachment. We present a surgical technique that diminishes tension of the repair with MCPJ flexion. Twenty-two EDC tendon stabilization procedures were performed between 2006 and 2017 using a tendon flap method. The selection criteria for this group of patients included completely dislocating extensor tendons with persistent complaints of pain and decrease in finger extension despite at least a 6-week conservative treatment attempt. All subjects underwent surgical treatment for tendon centralization using a distally based tendinous flap from the EDC sutured to the adjacent finger volar plate. A mathematical model was developed to analyze repair tension at 30, 60, and 90 degrees of MCPJ flexion calculating the flap length difference of 2 attachment points: deep transverse metacarpal ligament versus adjacent volar plate. Centralization was maintained in all digits with no evidence of subluxation at final postoperative evaluation. Clinical symptoms of pain and weakness resolved in all patients. Mathematical modeling provided evidence that translation of the anchor point of reconstructed flap to the volar plate of the adjacent finger resulted in lower tensile forces when compared with attachment at the intermetacarpal ligament. This optimized forces on reconstructed tendon flap experienced during MCPJ flexion.Level of Evidence: Level IV-therapeutic, case series.

Characterization of the extensor digitorum communis tendon using high‐frequency ultrasound shear wave elastography

Hand tendon injuries caused by various accidents are common in emergency departments. The assessment of tendon properties is crucial for evaluating the effectiveness of therapy or rehabilitation during recovery after hand injuries. Many recent studies have indicated that the shear wave velocity (SWV) of tendons is related to their stiffness. However, measurement of SWV of hand tendon is still a challenge because the small size of tendon and the limitation of existing ultrasound systems for detecting fast SWV. We propose a high-frequency ultrasound (HFUS) elastography system using an external vibrator to measure the SWV of the extensor digitorum communis (EDC) tendon. First, animal studies were performed by measuring the SWV and stress of porcine tendons using the proposed HFUS elastography and materials testing systems respectively. In the human experiment, SWVs were measured during hand extension and flexion. The applied stress from a finger during the movements was recorded synchronously by using a load cell. The experimental results reveal that a favorable linear correction (R2 of 0.96) was obtained between tendon SWV and stress in animal studies. In the human (hand) EDC tendon experiments, the SWV increased with the extension and flexion of the hand. The SWV of the EDC tendon was in the range of 20 to 135m/s as the applied force from the finger of a healthy human increased to 50% maximal voluntary contraction. All the experimental results show that the proposed HFUS elastography system can be used to characterize the EDC tendon and has potential use for evaluating tendon stiffness during recovery after hand injures.

Surgical Stabilization of the Extensor Tendon Dislocation in Non-Rheumatic Hand

Treatment of traumatic sagittal band injury and subluxation of the extensor tendon at the metacarpophalangeal joint is often conservative but can also require surgical intervention if conservative treatment fails. A technique is presented using an extensor digitorum communis (EDC) tendon slip to stabilize the dislocated extensor tendon.

Management of extensor digitorum communis enlargement in a patient with scleroderma-polymyositis overlap syndrome

Overlap syndrome is a very rare condition defined by the coexistence of two connective tissue diseases in the same patient. We describe our experience with the surgical treatment of extensor digitorum communis involvement in the context of this infrequent disorder. A 42-year-old female with scleroderma-polymyositis overlap syndrome presented to our department with a suspected right-hand flexor tenosynovitis. Physical examination, imaging, and electromyographic studies demonstrated, however, an enlargement of the extensor digitorum communis tendons with an extension deficit of the fingers. Conservative management was unsuccessful, so we performed surgery to shorten the extensor tendons of the second, third, and fourth fingers of the right hand. The patient recovered hand mobility and her finger extension improved. She continues to maintain 160° extension of the metacarpophalangeal joints and is able to make a complete fist with her hand 18 months after surgery. Level of evidence: Level V, therapeutic study.

Tether Creation Between the Second and Third Extensor Digitorum Communis for Third Extensor Tendon Subluxation at the Metacarpophalangeal Joint.

We developed a substitution technique for a sagittal band reconstruction for subluxation of the third extensor tendon at the metacarpophalangeal joint. Through this procedure, we attempted to supply a tether between the second and third extensor digitorum communis (EDC) tendons. A half-slip of the second EDC was interlaced to the third EDC tendon at the level of the third metacarpal head with the metacarpophalangeal joint in full flexion position; this ensured that the interlace of the graft serves as a direct stabilizer against ulnar subluxation. A key advantage of our procedure is the strong and reliable interlace of the graft that does not require postoperative immobilization and allows unprotected motion protocol.

Transfer of the triceps brachii to the finger and thumb extensors: Anatomical study and report on one case

Our aims were to study the anatomical feasibility of triceps brachii long head (TBLH) transfer to the extensor digitorum communis (EDC) and extensor pollicis longus (EPL) tendons through a medial route, and to report on its first clinical application. Dissections were conducted on 10 fresh-frozen cadaver specimens. Using a posteromedial approach, the TBLH was separated from the remaining triceps and extended distally with a fascia lata strip. This strip was then tunneled through a medial route and secured distally to the EDC and EPL tendons. The transfer tenodesis effect during elbow extension was assessed with metacarpophalangeal (MCP) joint motion of the thumb and index finger, and the distance between the thumb and index finger tips (TI distance). This transfer was performed in an eight-year-old boy with incomplete recovery of a right brachial plexus birth palsy; preoperatively, shoulder and elbow functions were recovered as well as active gripping distally, but he had no active wrist or finger extension. With the trapeziometacarpal and radiocarpal joints stabilized, 90° elbow extension provided a mean extension of the thumb and index finger MCP joints of 34 ± 5° and 90 ± 11°, respectively, with a mean TI distance of 116 ± 16 mm. Twelve months after surgery, the boy had full active MCP joint extension, independent from elbow extension. Transferring the TBLH to the EDC and EPL tendons is anatomically feasible. Larger clinical studies will be needed to assess more adequately its functional outcomes.

Mechanics of MetacarpophalangealJoint Extension.

It is a common belief that extension of the metacarpophalangeal (MCP) joint of the finger is achieved via the sagittal bands acting as a sling or lasso to attach the extensor tendon to the base of the proximal phalanx. The aim of this study was to test the hypotheses that (1) division of the sagittal bands reduces extension force or torque of the MCP joint, and (2) division of the extensor tendon distal to the sagittal band will not affect the extension force or torque of the MCP joint. Ten cadaver limbs were secured to a jig to allow for testing of the extension force of the MCP joints of the index, middle, and ring fingers. A 1-kg load was applied to the forearm extensor digitorum communis tendon and the extension force was measured with the MCP joint positioned at 0° (neutral extension) and again at 45° flexion. These measurements were repeated after the sagittal bands were divided in 15 specimens; in the other 15 specimens, the extensor tendon was divided just distal to the sagittal bands. After sagittal band division, extension force was similar in the 2 groups (0.11 N reduction after division with the MCP joints in neutral and 0.14 N in 45° flexion). There was significantly less extension force after division of the extensor tendon in both joint positions (0.95 N reduction after division in neutral extension and 0.66 N in 45° flexion). The sagittal bands do not primarily extend the MCP as a sling or lasso. The extensor tendon continuation to the extensor hood and middle phalanx is the major extension motor. The MCP joint is extended by the torque generated by the extensor tendon passing the joint carrying a force and possessing an extension moment arm. This principle should be correctly understood in the literature to ensure that clinical decisions related to injury and/or repair of the extensor tendon and sagittal bands are based on a sound understanding of their mechanics.

Sagittal band reconstruction in the index finger using a modified Elson technique.

The Elson technique is a rigid reconstruction method for a hypoplastic or absent sagittal band in the treatment of chronic extensor digitorum communis (EDC) tendon dislocation. We performed a modified procedure based on the Elson technique for reconstruction of the radial sagittal band in case involving the index finger. We investigated the postoperative outcomes of chronic EDC dislocation after treatment with the original and modified Elson technique. We examined five fingers of five patients (2 males and 3 females) with a mean age of 41 years. The chronic EDC tendon dislocation was due to an old trauma, or a spontaneous or congenital condition involving the index in two, middle in two, and ring finger in one patient. Sagittal band reconstruction was performed using the modified Elson technique for the index finger and the original technique for the other fingers. The mean duration of postoperative follow-up was 58 months. Clinical findings such as pain and discomfort at metacarpophalangeal flexion associated with the tendon dislocation, range of motion (ROM), and disabilities of the arm, shoulder and hand were evaluated. We also examined postoperative recurrence and subjective patient evaluation. All cases achieved pain-free stability of the EDC tendon with no recurrence, and full ROM was maintained at the latest examination after surgery. The postoperative subjective evaluation by the patients was "very satisfied" in four fingers and "neutral" in one finger. We demonstrated our modified Elson technique for the treatment of chronic extensor tendon dislocation of the index finger.