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

Concomitant Rupture of Extensor Pollicis Longus and Index Extensor Tendons following Distal Radius Plating—Report of Two Cases and Their Clinical Implication for Tendon Transfer Surgery

Extensor indicis proprius (EIP) tendon transfer is a standard operation for restoration of the thumb extension following rupture of extensor pollicis longus (EPL). In its standard form often the EIP is transferred to the EPL without inspection of the extensor tendons in the fourth compartment and it is retained in its anatomical fourth compartment. However, in a setting of EPL rupture in relation to the distal radius fracture (with or without fixation), concomitant injury to the extensor tendons to the index finger may result in failure of the transfer and even a loss of index finger extension (index finger drop) further complicating the reconstruction and resulting in immense patient dissatisfaction. We herein present two such rare cases to highlight this clinical scenario and how an awareness of this possibility and inspection of the extensor tendons to the index finger before EIP transfer allowed us to prevent this complication. In essence, if we know it, we can prevent it.

Traumatic index extensor tendon attenuation mimicking closed tendon rupture: two case reports

Background While some traumatic closed index extensor tendon ruptures at the musclotendinous junction have been previously reported, closed index extensor tendon pseudorupture due to intertendinous attenuation is exceedingly rare with only one case report of a gymnastics-related sports injury in the English literature. Herein, we report two non-sports injury related cases of traumatic index extensor tendon attenuation mimicking closed tendon rupture, including the pathological findings and intraoperative video of the attenuated extensor indicis proprius tendon. Case presentation A 28-year-old man and a 30-year-old man caught their hands in a high-speed drill and lathe, respectively, which caused a sudden forced flexion of their wrists. They could not actively extend the metacarpophalangeal joints of their index fingers. Intraoperatively, although the extensor indicis proprius and index extensor digitorum communes tendons were in continuity without ruptures, both tendons were attenuated and stretched. The attenuated index extensor tendons were reconstructed either with shortening by plication or step-cut when the tendon damage was less severe or, in severely attenuated tendons, with tendon grafting (ipsilateral palmaris longus) or tendon transfer. Six months after the operation, the active extension of the index metacarpophalangeal joints had recovered well. Conclusions Two cases of traumatic index extensor tendon attenuation were treated successfully by shortening the attenuated tendon in combination with tendon graft or transfer. We recommend WALANT (wide-awake local anesthesia and no tourniquet) in the reconstruction surgery of index extensor tendon attenuation to determine the appropriate amount of tendon shortening or optimal tension for tendon grafting or transfer. Intraoperative voluntary finger movement is essential, as it is otherwise difficult to judge the stretch length of intratendinous elongation and extent of traumatic intramuscular damage affecting tendon excursion.

Rupture of Extensor Pollicis Longus Tendon Caused by Scaphoid Nonunion Advanced Collapse Wrist

We report the case of a 69-year-old male patient with extensor pollicis longus (EPL) tendon rupture associated with a scaphoid nonunion advanced collapse (SNAC) wrist. He could not actively extend the left thumb interphalangeal joint and visited our institution for an examination. Plain X-rays revealed advanced stage SNAC and an enlarged soft tissue shadow owing to dorsal ridge growth. The patient was diagnosed with EPL tendon subcutaneous rupture due to SNAC. During surgery, the EPL tendon was found to be absent, a proximal-type scaphoid nonunion was detected, and bone growth to the dorsal part of the dorsal ridge was observed. Considering that the EPL tendon rupture was associated with the bone growth, we performed scaphoid lunate advanced collapse (SLAC) reconstruction and extensor indicis proprius tendon transfer which needed a revision tendon surgery afterward. To the best of our knowledge, EPL tendon ruptures caused by SLAC or SNAC are considered rare and have not yet been reported.

A Simple and Quick Tendon Transfer Technique to Restore Thumb Extension.

Extensor pollicis longus (EPL), the long extensor tendon for the thumb, is one of the commonest tendon to rupture and require treatment. In case of closed rupture of EPL, direct repair is usually not possible, requiring tendon reconstruction to restore function. Traditionally, extensor indicis proprius (EIP) tendon is transferred under general or regional anaesthesia through two (or more) incisions. The author proposes and demonstrates that it is possible to carry out this transfer through one short incision under local anaesthesia with good outcome and minimal complications.

Simultaneous Opponensplasty and Free Gracilis Muscle Flap for Thenar Reconstruction after Arteriovenous Malformation Resection

We report the case of a thenar eminence arteriovenous malformation presenting with continuous growth and pain that was treated with surgical excision after embolization. Extracapsular resection compromised thenar muscles which function was reconstructed with extensor indicis proprius transfer for opposition and abduction, and neurotized free gracilis muscle flap for opposition and adduction, as well as thenar eminence reconstruction.