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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

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.


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.

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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


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

(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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