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Extensor Tendon Lacerations Workup

  • Author: Ginard I Henry, MD; Chief Editor: Joseph A Molnar, MD, PhD, FACS  more...
 
Updated: Feb 16, 2016
 

Diagnostic Procedures

Bedside ultrasonography is more sensitive and specific than physical examination for detecting tendon lacerations. In one study, sensitivity, specificity, and accuracy of US were 100%, 95%, and 97%, respectively. A cadaveric study by Defzuli et al indicated that dynamic US has a sensitivity and specificity of 100% in detecting lacerations of the extensor tendons of the fingers and thumb, along with a positive predictive value of 1.0, and that static US has a sensitivity, specificity, and accuracy of 85%, 89%, and 88%, respectively.[11]

Bedside ultrasonography in the emergency department takes less time to perform than traditional wound exploration techniques or MRI.[12]

A 3-view x-ray of the hand, wrist, or forearm must be performed on all but the most benign extensor tendon laceration injuries to rule out foreign bodies or bony injury. Also, in all blunt trauma cases, radiographs are used to evaluate for possible fractures or dislocations.

For diagnosis of partial tears, which are especially common in rheumatoid patients, ultrasonography and MRI have been investigated but demonstrate a low sensitivity of 0.33 and 0.27, respectively.[13]

 
 
Contributor Information and Disclosures
Author

Ginard I Henry, MD Assistant Professor of Surgery, Section of Plastic Surgery, Medical Student Faculty Coordinator, University of Chicago Pritzker School of Medicine; Plastic Surgeon, Weiss Memorial Hospital

Ginard I Henry, MD is a member of the following medical societies: American Medical Association, American Society for Surgery of the Hand, American Society of Plastic Surgeons, American Society for Reconstructive Microsurgery, California Medical Association, Christian Medical and Dental Associations, National Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

David W Chang, MD, FACS Associate Professor, Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas Medical School at Houston

Disclosure: Nothing to disclose.

Chief Editor

Joseph A Molnar, MD, PhD, FACS Medical Director, Wound Care Center, Associate Director of Burn Unit, Professor, Department of Plastic and Reconstructive Surgery and Regenerative Medicine, Wake Forest University School of Medicine

Joseph A Molnar, MD, PhD, FACS is a member of the following medical societies: American Medical Association, American Society for Parenteral and Enteral Nutrition, American Society of Plastic Surgeons, North Carolina Medical Society, Undersea and Hyperbaric Medical Society, Peripheral Nerve Society, Wound Healing Society, American Burn Association, American College of Surgeons

Disclosure: Received grant/research funds from Clinical Cell Culture for co-investigator; Received honoraria from Integra Life Sciences for speaking and teaching; Received honoraria from Healogics for board membership; Received honoraria from Anika Therapeutics for consulting; Received honoraria from Food Matters for consulting.

Additional Contributors

Anthony E Sudekum, MD Consulting Staff, Department of Plastic Surgery, St John's Mercy Health Center of St Louis

Anthony E Sudekum, MD is a member of the following medical societies: American College of Surgeons, American Society for Surgery of the Hand, Missouri State Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, D Glynn Bolitho, MD, PhD, FACS, FRCSC, FCS(SA), to the development and writing of this article.

References
  1. Calabro JJ, Hoidal CR, Susini LM. Extensor tendon repair in the emergency department. J Emerg Med. 1986. 4(3):217-25. [Medline].

  2. Lattanze LL, Lam J. Extensor tendon injuries. Trumble TE, Budoff JE. Hand Surgery Update IV. Rosemont: American Society for Surgery of the Hand; 2007.

  3. Kleinert HE, Spokevicius S, Papas NH. History of flexor tendon repair. J Hand Surg Am. 1995 May. 20(3 Pt 2):S46-52. [Medline].

  4. Baratz ME, Schmidt CC, Hughes TB. Extensor tendon injuries. Green DP, Hotchkiss RN, Pederson WC, Wolfe SW. Green's Operative Hand Surgery. 5th ed. Philadelphia, Pa: Elsevier; 2006. Vol 1: 187-218.

  5. Herndon JH. Tendon injuries--extensor surface. Emerg Med Clin North Am. 1985 May. 3(2):333-40. [Medline].

  6. Al-Qattan MM. Conservative management of partial extensor tendon lacerations greater than half the width of the tendon in manual workers. Ann Plast Surg. 2015 Apr. 74 (4):408-9. [Medline].

  7. Rockwell WB, Butler PN, Byrne BA. Extensor tendon: anatomy, injury, and reconstruction. Plast Reconstr Surg. 2000 Dec. 106(7):1592-603; quiz 1604, 1673. [Medline].

  8. Doyle JR, Botte MJ. Surgical Anatomy of the Hand and Upper Extremity. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003.

  9. von Schroeder HP, Botte MJ. Anatomy of the extensor tendons of the fingers: variations and multiplicity. J Hand Surg Am. 1995 Jan. 20(1):27-34. [Medline].

  10. Young CM, Rayan GM. The sagittal band: anatomic and biomechanical study. J Hand Surg Am. 2000 Nov. 25(6):1107-13. [Medline].

  11. Dezfuli B, Taljanovic MS, Melville DM, Krupinski EA, Sheppard JE. Accuracy of High-Resolution Ultrasonography in the Detection of Extensor Tendon Lacerations. Ann Plast Surg. 2016 Feb. 76 (2):187-92. [Medline].

  12. Wu TS, Roque PJ, Green J, Drachman D, Khor KN, Rosenberg M, et al. Bedside ultrasound evaluation of tendon injuries. Am J Emerg Med. 2012 Jan 11. [Medline].

  13. Swen WA, Jacobs JW, Hubach PC, Klasens JH, Algra PR, Bijlsma JW. Comparison of sonography and magnetic resonance imaging for the diagnosis of partial tears of finger extensor tendons in rheumatoid arthritis. Rheumatology (Oxford). 2000 Jan. 39(1):55-62. [Medline].

  14. Sakuma Y, Ochi K, Iwamoto T, et al. Number of ruptured tendons and surgical delay as prognostic factors for the surgical repair of extensor tendon ruptures in the rheumatoid wrist. J Rheumatol. 2014 Feb. 41(2):265-9. [Medline].

  15. Brzezienski MA, Schneider LH. Extensor tendon injuries at the distal interphalangeal joint. Hand Clin. 1995 Aug. 11(3):373-86. [Medline].

  16. Izadpanah A, Izadpanah A, Sinno H, Williams B. Pediatric boutonniere deformity after blunt closed traumatic injury. Pediatr Emerg Care. 2011 Nov. 27(11):1069-71. [Medline].

  17. Froehlich JA, Akelman E, Herndon JH. Extensor tendon injuries at the proximal interphalangeal joint. Hand Clin. 1988 Feb. 4(1):25-37. [Medline].

  18. Hall B, Lee H, Page R, Rosenwax L, Lee AH. Comparing three postoperative treatment protocols for extensor tendon repair in zones V and VI of the hand. Am J Occup Ther. 2010 Sep-Oct. 64(5):682-8. [Medline].

  19. Makhlouf VM, Deek NA. Surgical treatment of chronic mallet finger. Ann Plast Surg. 2011 Jun. 66(6):670-2. [Medline].

  20. Gelb RI. Tendon transfer for rupture of the extensor pollicis longus. Hand Clin. 1995 Aug. 11(3):411-22. [Medline].

  21. Pechlaner S, Hussl H, Kerschbaumer F. Atlas of Hand Surgery. 2nd ed. Stuttgart: Thieme; 2000. 565.

  22. Woo SH, Tsai TM, Kleinert HE, Chew WY, Voor MJ. A biomechanical comparison of four extensor tendon repair techniques in zone IV. Plast Reconstr Surg. 2005 May. 115(6):1674-81; discussion 1682-3. [Medline].

  23. Newport ML, Williams CD. Biomechanical characteristics of extensor tendon suture techniques. J Hand Surg [Am]. 1992 Nov. 17(6):1117-23. [Medline].

  24. Soni P, Stern CA, Foreman KB, Rockwell WB. Advances in extensor tendon diagnosis and therapy. Plast Reconstr Surg. 2009 Feb. 123(2):727-8. [Medline].

  25. Sharma JV, Liang NJ, Owen JR, Wayne JS, Isaacs JE. Analysis of relative motion splint in the treatment of zone VI extensor tendon injuries. J Hand Surg Am. 2006 Sep. 31(7):1118-22. [Medline].

  26. Mowlavi A, Burns M, Brown RE. Dynamic versus static splinting of simple zone V and zone VI extensor tendon repairs: a prospective, randomized, controlled study. Plast Reconstr Surg. 2005 Feb. 115(2):482-7. [Medline].

  27. Russell RC, Jones M, Grobbelaar A. Extensor tendon repair: mobilise or splint?. Chir Main. 2003 Feb. 22(1):19-23. [Medline].

  28. Howell JW, Merritt WH, Robinson SJ. Immediate controlled active motion following zone 4-7 extensor tendon repair. J Hand Ther. 2005 Apr-Jun. 18(2):182-90. [Medline].

  29. Newport ML, Tucker RL. New perspectives on extensor tendon repair and implications for rehabilitation. J Hand Ther. 2005 Apr-Jun. 18(2):175-81. [Medline].

  30. Chow JA, Dovelle S, Thomes LJ, et al. A comparison of results of extensor tendon repair followed by early controlled mobilisation versus static immobilisation. J Hand Surg [Br]. 1989 Feb. 14(1):18-20. [Medline].

  31. Crosby CA, Wehbe MA. Early motion after extensor tendon surgery. Hand Clin. 1996 Feb. 12(1):57-64. [Medline].

  32. Crosby CA, Wehbe MA. Early protected motion after extensor tendon repair. J Hand Surg [Am]. 1999 Sep. 24(5):1061-70. [Medline].

  33. Evans RB. Immediate active short arc motion following extensor tendon repair. Hand Clin. 1995 Aug. 11(3):483-512. [Medline].

  34. Ip WY, Chow SP. Results of dynamic splintage following extensor tendon repair. J Hand Surg [Br]. 1997 Apr. 22(2):283-7. [Medline].

  35. Sylaidis P, Youatt M, Logan A. Early active mobilization for extensor tendon injuries. The Norwich regime. J Hand Surg [Br]. 1997 Oct. 22(5):594-6. [Medline].

  36. Bruner S, Wittemann M, Jester A, Blumenthal K, Germann G. Dynamic splinting after extensor tendon repair in zones V to VII. J Hand Surg Br. 2003 Jun. 28(3):224-7. [Medline].

  37. Carl HD, Forst R, Schaller P. Results of primary extensor tendon repair in relation to the zone of injury and pre-operative outcome estimation. Arch Orthop Trauma Surg. 2007 Feb. 127(2):115-9. [Medline].

  38. Purcell T, Eadie PA, Murugan S, et al. Static splinting of extensor tendon repairs. J Hand Surg [Br]. 2000 Apr. 25(2):180-2. [Medline].

 
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Extensor system of the hand. Note the juncturae tendineae that interconnect the extensor digitorum communis (EDC) tendons.
The extensor tendons of the wrist and hand are divided into 6 compartments at the dorsal wrist, each containing specific tendons.
Depiction of sagittal bands, lateral bands, and the relationship of the ligamentous structures.
Both the intrinsic muscle and the extensor digitorum communis (EDC) tendon dynamically contribute to the extensor system of the digits.
Extensor retinacular system.
Regions of the dorsum of the hand have been divided up into extensor zones to further describe the location of an extensor tendon laceration. Defining a laceration per zone area enables better communication and relates to the complexity of the needed repair.
Primary closure of thumb extensor tendon laceration with the figure-of-8 technique.
Kirchmayr tendon laceration repair suture technique.
Four common core and epitenon tendon repair suture techniques.
Swan-neck deformity.
Boutonniere deformity.
Fight bite.
Table. Extensor Tendons of the Hand
Abbreviation Full Name Insertion Function Origin Ext. Compartment
APL Abductor pollicis longus Base on thumb metacarpal Abduction of thumb Proximal radius and ulna, interosseous ligament I
EPB Extensor pollicis brevis Base of thumb proximal phalanx Extension of thumb proximal phalanx Proximal radius and interosseous ligament I
ECRL



ECRB



Extensor carpi radialis longus/brevis Base of metacarpal II



Base of metacarpal III



Extends and abducts hand Lateral epicondyle II
EPL Extensor pollicis longus Distal phalanx of thumb Extends thumb IP joint Proximal ulna III
EDC



(4 tendons: II - V)



Extensor digitorum communis Proximal and mid. phalanges of digits II-V Extends digits II - V Lateral epicondyle IV
EIP Extensor indicis proprius Extensor hood of digit II Extends digit II Proximal ulna and interosseous membrane IV
EDM (EDC) Extensor digitorum minimi (quinti) Proximal phalanx, digit V Extends digit V Lateral epicondyle V
ECU Extensor carpi ulnaris Base of metacarpal V Extends and abducts hand Lateral epicondyle and proximal ulna VI
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