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.^[19]

Bedside ultrasonography in the emergency department takes less time to perform than traditional wound exploration techniques or MRI.^[8]

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.^[20]

Treatment & Management

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Media Gallery

Extensor system of the hand. Note the juncturae tendinae 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.

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Author

Ginard I Henry, MD Plastic, Reconstructive, and Hand Surgeon, Stonegate Plastic Surgery, Lakeland Health

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 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.

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

Extensor Tendon Lacerations Workup

Diagnostic Procedures

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