Extensor Tendon Lacerations Workup

  • Author: Ginard I Henry, MD; Chief Editor: Joseph A Molnar, MD, PhD, FACS   more...
 
Updated: Jan 31, 2012
 

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. Bedside ultrasonography in the emergency department takes less time to perform than traditional wound exploration techniques or MRI.[10]

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.[11]

Proceed to Treatment & Management
 
 
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 Reconstructive Microsurgery, American Society for Surgery of the Hand, American Society of Plastic Surgeons, California Medical Association, Christian Medical & Dental Society, and National Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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, and Missouri State Medical Association

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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.

Nicolas (Nick) G Slenkovich, MD  Director, Colorado Plastic Surgery Center

Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society

Disclosure: Nothing to disclose.

Chief Editor

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

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

Disclosure: KCI, Inc. Honoraria Speaking and teaching; Integra Life Sciences Honoraria Speaking and teaching; Clincal Cell Culture Grant/research funds Co-investigator; KCI, Inc Wake Forest University receives royalties Other

Additional Contributors

The authors and editors of eMedicine 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

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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
AbbreviationFull NameInsertionFunctionOriginExt. Compartment
APLAbductor pollicis longusBase on thumb metacarpalAbduction of thumbProximal radius and ulna, interosseous ligamentI
EPBExtensor pollicis brevisBase of thumb proximal phalanxExtension of thumb proximal phalanxProximal radius and interosseous ligamentI
ECRL



ECRB



Extensor carpi radialis longus/brevisBase of metacarpal II



Base of metacarpal III



Extends and abducts handLateral epicondyleII
EPLExtensor pollicis longusDistal phalanx of thumbExtends thumb IP jointProximal ulnaIII
EDC



(4 tendons: II - V)



Extensor digitorum communisProximal and mid. phalanges of digits II-VExtends digits II - VLateral epicondyleIV
EIPExtensor indicis propriusExtensor hood of digit IIExtends digit IIProximal ulna and interosseous membraneIV
EDM (EDC)Extensor digitorum minimi (quinti)Proximal phalanx, digit VExtends digit VLateral epicondyleV
ECUExtensor carpi ulnarisBase of metacarpal VExtends and abducts handLateral epicondyle and proximal ulnaVI
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