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Extensor Tendon Injuries Hand

From WikiSM

Other Names

  • Extensor tendon injuries of the hand
  • Extensor tendon laceration
  • Extensor tendon tear

Background

  • This page refers to traumatic extensor tendons injuries (ETI) of the hand and wrist

History

  • Needs to be updated

Epidemiology

  • One study estimated ETI represents 16.9% of orthopedic soft tissue injuries with an incidence of 17.9 per 100,000 population per year[1]

Introduction

Kleinert and Verdan zones of extensor tendon injuries[2]
The extensor compartments of the wrist[3]
The map of left-hand tendon lacerations isolated for each finger. The figure on the left shows the numbers of patients who had flexor tendon injuries according to flexor tendon zones. The figure on the right shows the numbers of patients who had extensor tendon injuries according to extensor tendon zones. Each finger was painted in its own color.[4]
Dissection of dorsum of hand and wrist showing the additional tendons. (ER: extensor retinaculum; EDM: extensor digitorum; EPL: extensor pollicis longus; EPB: extensor pollicis brevis; TI: tendinous interconnections; ∗: tendons of extensor digitorum; #: tendons of extensor indicis[5]

General

  • Generally a loss of ability to extend the affected digit, hand and/or wrist
  • Superficial, susceptible to injury
  • Most common finger is pointer/ index finger
  • Potential mechanisms are sharp object direct lacerations, burns, blunt trauma, bites, crush injuries, avulsions and deep abrasions

Pathoanatomy

  • Can affect MCPJ and/or PIPJ or DIPJ of hand
  • Zone 1: Traumatic flexion of DIPJ
  • Zone 2: Dorsal laceration or crush injury
  • Zone 5: Fight bite

Anatomy of the Extensor Tendons

Risk Factors

  • Unknown

Differential Diagnosis

Differential Diagnosis Finger And Hand Pain

Clinical Features

Closed rupture of the extensor digitorum communis of the right fourth digit as a result of Kienböck disease in a 69-year-old woman. Initial oblique (A) and lateral (B) clinical photographs 3 years prior to presentation at our hospital, showing apparent active extension lag of the fourth finger (arrowhead).[6]
A 35-year-old male who suffered from a knife injury to his extensor pollicis longus tendon. This case belonged to the most common patient and injury type.[4]

History

  • Need to carefully characterize the mechanism and position of hand at the time of injury
  • Pain or inability to extend a finger or the wrist

Physical Exam: Physical Examination Hand

  • Universally present with inability to extend at some point on dorsal finger, hand or wrist
  • Inspect for etiology (laceration, crush trauma, overuse, etc)
  • Zone 1: Loss of extensor mechanism at DIPJ (digits 2-4), IPJ (thumb)
  • Zone 3: Elson's Test can help confirm diagnosis
  • Evaluate for open/ closed injuries

Special Tests

Evaluation

Discontinuity of the 3rd finger extensor tendon. The proximal end shows 15 mm retraction with flexed MCP joint. No irregularity of the underlying cortex. No MCP joint effusion.[7]
Axial T1 weighted image at the level of the long MCP in a patient with pain following an injury. The central extensor tendon (arrow) is subluxed radially due to a defect in the ulnar sagittal band (arrowhead).[8]

Radiographs

Ultrasound

  • Normal findings
    • Typical fibrillar pattern of the tendons
  • Pathologic findings
    • Absence of tendon in physiologic site can suggest a complete rupture
    • Discontinuity or gap in the tendon
  • Benefits of US
    • Low cost, non invasive, sensitive
    • Can be used dynamically

MRI

  • Can accurately diagnose most tendinous and reticular injuries

MRI vs US

  • Swen et al found that US has better diagnostic value than MR in detecting partial extensor tendon tears[9]

CT

  • Role of CT to evaluate extensor tendons is limited

Classification

  • Zone 1: DIPJ
    • Injury to terminal extensor tendon distal to or at the DIPJ (digits 2-4) or IPJ (thumb) involving EPL
    • Sequelae: Mallet Finger
  • Zone 2: Middle Phalanx
    • Injury of tendon over middle phalanx (digits 2-4), or proximal phalanx thumb
  • Zone 3: PIPJ
  • Zone 4: Proximal Phalanx
    • Injury over the proximal phalanx (digits 2-4) or metacarpal of thumb (EPL, EPB)
  • Zone 5: MCPJ
    • Injury over MCPJ of digit (2-4) or CMCJ of thumb (EPL, EPB)
    • Sequelae: Fight Bite, Sagittal band rupture
  • Zone 6: Metacarpals
    • Injury over the metacarpal
    • Sequelae: Increased risk of neurovascular injury
  • Zone 7: Wrist
    • Injury at wrist joint
    • Surgical injury requiring repair of extensor retinaculum
  • Zone 8: Distal third of forearm
    • Disruption at the distal forearm
  • Zone 9: Muscle belly rather than tendon injury
    • Sequelae: High risk of neurologic injury, requires surgery

Management

Nonoperative

Operative

  • Indications
    • More than 50% of tendon structure is torn
    • Associated with extensive soft tissue damage, neurovascular lesions, contaminated wounds
  • Techniques
    • Incision & drainage: Open fracture involving joint, fite bite
    • Repair: tendon laceration >50%
    • Fixation: volar avulsion fracture
    • Reconstruction: tendon repair not possible
    • Central slip reconstruction

Rehabilitation and Return to Play

Rehabilitation

  • Needs to be updated

Return to Play

  • Needs to be updated

Prognosis and Complications

Prognosis

  • Needs to be updated

Complications

  • Neurovascular injury

See Also

Internal

External

References

  1. ↑ Clayton, Robert AE, and Charles M. Court-Brown. "The epidemiology of musculoskeletal tendinous and ligamentous injuries." Injury 39.12 (2008): 1338-1344.
  2. ↑ Colzani, Giulia, et al. "Traumatic extensor tendon injuries to the hand: clinical anatomy, biomechanics, and surgical procedure review." Journal of hand and microsurgery 8.01 (2016): 002-012.
  3. ↑ Image courtesy of teachmeanatomy.info, "The Extensor Tendon Compartments of the Wrist"
  4. ↑ 4.0 4.1 Tapan, Mehmet, et al. "Plastic and Reconstructive Surgery in the Wake of the Eid al-Adha: A Single-Center, Five-Year Investigation." Journal of Clinical Medicine 13.9 (2024): 2704.
  5. ↑ Nayak, Satheesha B., et al. "Variant superficial branch of radial artery along with supplementary tendons on the dorsum of the hand and their surgical implications." Case Reports in Surgery 2016.1 (2016): 9581759.
  6. ↑ Tomori, Yuji, Mitsuhiko Nanno, and Shinro Takai. "Closed rupture of extensor tendon resulting from untreated Kienböck disease: a case report and a review of the literature." Medicine 98.33 (2019): e16900.
  7. ↑ Case courtesy of Maulik S Patel, Radiopaedia.org, rID: 156001
  8. ↑ Image courtesy of radsource.us
  9. ↑ Swen, W. A. A., et al. "Comparison of sonography and magnetic resonance imaging for the diagnosis of partial tears of finger extensor tendons in rheumatoid arthritis." Rheumatology 39.1 (2000): 55-62.
Created by:
John Kiel on 16 August 2019 23:11:13
Authors:
Last edited:
9 August 2025 16:35:45
Categories:
Tendinopathies | Trauma | Finger | Hand | Wrist | Upper Extremity | Acute
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