Extensor Indicis Proprius Tendon Transfer Research Articles

Opponensplasty using the extensor indicis proprius tendon for severe carpal tunnel syndrome in 40 patients.

The aim of this study was to assess the clinical results after extensor indicis proprius opponensplasty in patients with carpal tunnel syndrome and severe thenar muscle atrophy. Forty patients who underwent this procedure during open carpal tunnel releases. The mean follow-up period was 17 months (range 10 to 36). Kapandji scores significantly improved from 5.5 before surgery to 9.6 at final follow-up. Thumb pronation angle also significantly improved from 111° before surgery to 149°. Side and pulp pinch strength significantly improved postoperatively, as well as DASH scores at final follow-up. In conclusion, the extensor indicis proprius tendon transfer technique represents a reliable opponensplasty procedure to achieve consistent results in patients with severe carpal tunnel syndrome.Level of evidence: IV.

Extensor Pollicis Longus Tendon Rupture after Non-Displaced Extra-Articular Distal Radius Fracture: A Case Report

Background: Spontaneous tendon rupture of hand is not frequent. These ruptures can occur after a fracture. Aim: We report a case of spontaneous rupture of extensor pollicis longus tendon, and describe the treatment. Case presentation: We report the case of a 63-year-old woman who had extensor pollicis longus tendon rupture after non-displaced extra-articular distal radius fracture, treated by wrist circular cast immobilization. Extensor indicis proprius tendon transfer was performed, with an excellent functional result. Conclusion: Extensor pollicis longus tendon rupture can occur after non-displaced extra-articular distal radius fracture. Its treatment by tendon transfer helps to restore function of hand.

Delayed presentation of extensor pollicis longus tendon injury treated using extensor indicis proprius tendon transfer

Spontaneous closed rupture of EPL tendon are frequently associated with rheumatoid arthritis, Colles fracture, sports related injury. In cases of delayed presentation direct tendon repair is not feasible and a tendon transfer is usually recommended. In this study we evaluated the results of extensor indicis proprius (EIP) to extensor pollicis longus (EPL) transfers for EPL ruptures. Four patients, (two male and two females); mean age 32 years (range 20 to 45 years) with EPL tendon rupture underwent EIP to EPL tendon transfer. The mean duration from rupture to surgery was 4.5 weeks (range 4 to 6 weeks). Range of motion of the metacarpophalangeal (MCP), interphalangeal joints (IP) of the thumb and index finger of the operated side was compared with the normal side. The results were scored using geldmacher scheme, for the thumb four functions were scored, the radial abduction angle, the elevation deficit, the opposition distance and flexion extension deficit of MP and IP joints. The mean follow-up period was 5 months. All the four patients were able extend the thumb at MCP joint and oppose the thumb to the MCP of little finger after mean follow up of 5 months. Based on the questionnaire, the results of tendon transfer scored by three (75%) patients was excellent and by one (25%) patient was good. Independent extension of the index finger of operated hand was possible in all 4 patients. The procedure of EIP to EPL tendon transfer provides excellent result for extension of thumb. It is a safe procedure.

Functional Recovery Following an L-Lengthening Local Tendon Flap for Extensor Pollicis Longus Chronic Ruptures

Extensor indicis proprius tendon transfer has been considered the reference standard technique for extensor pollicis longus (EPL) chronic ruptures, but relevant complications have been reported. We describe a new reconstructive technique for chronic EPL ruptures and assess functional recovery after this procedure. We observed 31 patients who fulfilled inclusion criteria an average of 6.8 months after treatment. An L-shaped local tendon flap was prepared by making a transverse incision to the middle of the tendon and then longitudinally toward the end of one of the tendon stumps. Absorbable suture was used to coapt the free ends and as a reinforcement suture. We used the total active motion scale to classify results. Total active motion in patients who completed the follow-up period was 89% of the normal side; 97% of patients returned to their previous employment. Surgical complications were infrequent and only one patient (3%) required surgery for extensor tendon adhesions. This technique permits reconstruction of the EPL tendon without the need for a tendon graft or tendon transfer. Therapeutic IV.

Factors affecting extension lag after tendon reconstruction for finger extensor tendon rupture due to distal radioulnar lesion

BackgroundAlthough extensor tendon rupture associated with distal radioulnar joint disorder is often encountered, its treatment has not yet been established. We report the postoperative results for reconstruction of finger extensor tendon rupture due to distal radioulnar lesion and analyse the factors affecting postoperative extension lag. MethodsWe examined 74 index, middle, ring, or little fingers with extensor tendon rupture of 34 hands. Primary diseases were rheumatoid arthritis in 24 hands and osteoarthritis in 10. Reconstruction methods included tendon graft in 45 fingers, extensor indicis proprius tendon transfer in 15, and end-to-side adjacent tendon suture in 14. At final postoperative follow-up ranging from 12 to 40 (mean: 18) months, we measured metacarpophalangeal (MCP) joint range of motion and extension lag and statistically evaluated the relationship between postoperative extension lag and several clinical factors. ResultsWe encountered no cases of re-rupture or worsening of finger flexion range after reconstruction. Mean postoperative active flexion of the MCP joint was 78.1 (range: 45–95) degrees. Mean postoperative extension lag was 10.3 (range: 0–50) degrees. We observed that postoperative extension lag was significantly larger in fingers associated with extensor tendon rupture in two or three additional fingers in the affected hand or in fingers of patients aged 80 years or over. The interval from rupture to reconstruction, reconstruction method, or arthritis type did not remarkably affect outcome. ConclusionsThis study uncovered that surgical intervention for extensor tendon rupture should be performed before three fingers become affected.

Failed Extensor Indicis Proprius Tendon Transfer for Extensor Pollicis Longus Tendon Rupture after Distal Radial Fracture

The known complications of distal radial fractures (DRFs) include tendon rupture, tendon lag, trigger finger, and tenosynovitis. Open reduction and locking plate fixation via the volar approach for treatment of an unstable DRF is becoming an increasingly popular method and has been reported to cause tenosynovitis of the extensor tendons, which leads to delayed extensor tendon rupture. The extensor pollicis longus (EPL) tendon is most commonly ruptured. Screw penetration of the dorsal radius cortex to the third compartment after internal fixation of a volar plate for Failed Extensor Indicis Proprius Tendon Transfer for Extensor Pollicis Longus Tendon Rupture after Distal Radial Fracture

Rupture of Both the Abductor Pollicis Longus and Extensor Pollicis Brevis Tendons after Steroid Injection for de Quervain Tenosynovitis

Rupture of Both the Abductor Pollicis Longus and Extensor Pollicis Brevis Tendons after Steroid Injection for de Quervain Tenosynovitis

A BLAUTH IIIB HYPOPLASTIC THUMB RECONSTRUCTED WITH A VASCULARISED METATARSO-PHALANGEAL JOINT TRANSFER: A CASE REPORT WITH 28 YEARS OF FOLLOW UP

We reconstructed the Blauth-IIIB hypoplastic right thumb of a 16-year-old girl with a vascularised metatarso-phalangeal (MTP) joint from her second toe combined with a dorsalis-pedis flap. Abduction was provided with an abductor policis long tendon advancement, and adduction, with an extensor indicis proprius tendon transfer. Opponoplasty was performed one year later using the flexor sublimis (IV) tendon. The transferred joint remained functional and non-osteoarthritic 28 years later. Radial and palmar abduction of the reconstructed thumb was 45 degrees and 75 degrees respectively. The index, middle, and ring fingers could oppose the thumb, however she grasped small objects between her index and middle fingertips. If a pollicisation using the index finger is not accepted, the reconstruction described here is one of the surgical options. However donor-foot morbidity is not negligible. Currently, we use a proximal-interphalangeal joint transfer with an opponoplasty using an abductor digiti minimi as a first choice, when planning a reconstruction of preserved hypoplasic thumb.

Early Free Active Versus Dynamic Extension Splinting After Extensor Indicis Proprius Tendon Transfer to Restore Thumb Extension: A Prospective Randomized Study

Transfer of the extensor indicis proprius tendon to the distal extensor pollicis longus (EPL) tendon is a standard operation to restore thumb extension. However, several postoperative hand therapy regimens exist. The previously described early dynamic extension splinting protocol has become our standard, and we now compare it with an early active protocol in a prospective randomized study. Twenty-one patients with a closed EPL tendon rupture in zones T4 and T5 were treated with an extensor indicis proprius tendon transfer and were randomly divided into 2 postoperative physical therapy regimens: one group (DY) was treated with a dynamic protocol using a rubber-band system, and the other group (AC) was allowed an early active thumb extension with limited flexion. All patients were evaluated for active range of motion (ROM) of the thumb and for grip and tip-pinch strength 3, 4, 6, and 8 weeks postoperatively. Long-term outcomes were not evaluated. Three weeks postoperatively, DY group patients demonstrated a significantly better active ROM in the interphalangeal joint than that of the AC group patients. DY group patients achieved 72% of contralateral joint active ROM compared with 49% of contralateral joint active ROM achieved in the AC group. However, no significant difference was found during further course of study resulting in a final mean interphalangeal joint active ROM of 69 degrees (range, 45 degrees to 110 degrees) in group DY and of 58 degrees (range, 40 degrees to 75 degrees) in group AC. The mean grip strength and tip-pinch strength did not differ significantly after 8 weeks with patients achieving 66% and 73%, respectively, of the contralateral side in group DY and 63% and 71%, respectively, of the contralateral side in group AC. Three complications--one due to rupture (DY group), one due to adhesion, and one due to inadequate joint motion secondary to poor tendon tensioning at the time of initial surgery (both AC group)--occurred during a 1-year follow-up. Considering the small group sizes, both regimens (dynamic vs early active) achieved comparable clinical results. The early active protocol does not have a notably higher complication rate but fails to accelerate rehabilitation. Therapeutic III.

EXTENSOR POLLICIS LONGUS TENDON RUPTURE AS A RESULT OF SCAPHOLUNATE DISSOCIATION: A CASE REPORT

A 39-year-old patient was presented with, to our knowledge, the first ever diagnosed case of extensor pollicis longus (EPL) tendon rupture as a result of scapholunate (S-L) dissociation. Arthroscopic findings showed that the dorsal aspect of the S-L ligament was ruptured and severe synovitis was revealed around the S-L joint. Direct observation revealed synovium at the rupture site of the EPL tendon. After careful resection of this synovium, an aperture in the S-L joint was observed. Thus, it was considered that the synovium in the S-L joint was connected to the rupture site of the EPL tendon, passing through the dorsal capsule of the S-L joint. The ruptured EPL tendon was reconstructed with extensor indicis proprius tendon transfer, and S-L dissociation was treated with a bone-retinaculum-bone autograft taken from the third dorsal compartment region.

Spontaneous rupture of extensor pollicis longus tendon with tophaceous gout infiltration

Spontaneous rupture of the extensor pollicis longus (EPL) tendon has been reported in the literature. Various mechanisms have been proposed to account for this problem, but gouty infiltration is a rare mechanism. Here we report a patient with a long-standing history of gout who presented with sudden loss of interphalangeal extension of the left thumb. Spontaneous rupture of the EPL tendon caused by gout was discovered. The successful treatment done involved surgical exploration and extensor indicis proprius tendon transfer. Postoperative thumb spica immobilization for 6 weeks was applied. Pathology disclosed urate crystals deposited within the ruptured EPL tendon. The functional recovery is satisfactory at the 1-year follow-up. Spontaneous rupture of the EPL tendon caused by gout is rare. Successful treatment was done with surgical management. Life-long medical follow-up to prevent a repeated acute attack can lower the risk of a large amount of tophaceous gout infiltration in tendons and may possibly prevent acute spontaneous tendon rupture.

Effects of extensor pollicis longus transposition and extensor indicis proprius transfer to extensor pollicis longus on thumb mechanics

Purpose: The spatial relationship of the extensor pollicis longus (EPL) to the thumb carpometacarpal (CMC) joint may be altered by its transposition from the third dorsal wrist compartment and by subcutaneous extensor indicis proprius (EIP) to EPL tendon transfer. Changes in tendon position could alter thumb function. This study examined changes in the EPL adduction moment arm after EPL tendon transposition from its extensor compartment or EIP transfer. Methods: The EPL adduction moment arm at the thumb carpometacarpal joint was determined under 4 tendon conditions: (1) intact extensor pollicis longus, (2) transposed extensor pollicis longus, (3) extensor indicis proprius to extensor pollicis longus tendon transfer through an extensor retinacular pulley, and (4) extensor indicis proprius tendon transfer through a subcutaneous route. Each tendon condition was tested in 2 wrist positions: neutral and 40° of flexion. Results: The wrist neutral/flexion moment arms for the 4 tendon conditions, in millimeters, were 9.2/7.3, 3.6/1.2, 8.3/5.1, and 4.8/1.0. Conclusions: EPL transposition produces a significant decrease of its adduction moment arm at the thumb CMC joint, an effect exacerbated by wrist flexion. The moment arm mechanics of the pulley and subcutaneous EIP tendon transfer resemble those of the intact and transposed EPL, respectively. Diminution of the adduction moment arm could impair thumb function, especially adduction.

Extensor indicis opposition transfer in the ulnar and median palsied thumb in leprosy

Twenty seven opponensplasties for ulnar and median paralysis in 25 leprosy patients were performed using extensor indicis proprius. An additional transfer of the radial half of flexor pollicis longus to extensor pollicis longus was done to stabilize the metacarpophalangeal joint of the thumb. The biomechanical aspects of extensor indicis proprius tendon transfer were studied and results evaluated using various anatomical and functional parameters. Extensor indicis proprius provides adequate strength to position the thumb. However, sometimes it does not reach its new insertion. There is no significant deficit at the donor site but in a few cases the index finger may lose its capability for independent extension and sometimes a proximal interphalangeal joint contracture may develop.

TENDON TRANSFER FOR RUPTURE OF THE EXTENSOR POLLICIS LONGUS

Reviewing the history and etiology of extensor pollicis longus tendon rupture shows the most compelling mechanism of rupture apparently is interruption of the tendon's vascularity secondary to hemorrhage and pressure, which causes the damaged tendon to be more susceptible to rupture secondary to late ischemic necrosis and attrition. Treatment options tried have included direct repair, tendon grafting, and tendon transfer. The authors recommend the extensor indicis proprius tendon transfer as the most predictable procedure to restore the original function of the EPL. This technique can be performed reliably, requires little postoperative re-education, and has few associated complications.

Index finger extension and strength after extensor indicis proprius transfer

We reviewed the long-term morbidity of the donor index finger following extensor indicis proprius tendon transfer in 34 patients with an average follow-up period of 8 years. An extension lag of the donor index was found to present in 24 patients. In all patients a reduced extension strength of the donor index finger was noticed, either measured dependently (with concurrent long finger extension) or independently (without long finger extension). Despite these findings, 30 of the patients described no limitations in their daily life activities. In nearly all patients the dependent extension strength was superior to the independent extension strength. To prevent an extension lag, the surgeon should avoid surgical trauma to the dorsal aponeurosis (“hood”) by sectioning the index tendon proximal to the hood.