Concept: Extensor pollicis longus muscle
A previous ultrasound study showed inflammation around the extensor pollicis longus tendon and surrounding structures at 6 weeks after manipulation, with or without pin fixation, and immobilization for distal radius fracture. Ultrasound examination after plating of distal radius fracture followed by early active mobilization of the wrist showed a short-lived inflammatory response, evident at 2 weeks but not at 6 weeks, around the extensor pollicis longus tendon (26 wrists examined) and flexor pollicis longus tendon (18 wrists examined). Early active mobilization of the wrist appears to limit the duration of inflammation around these tendons.
Volar plates positioned at, or distal to, the watershed line have been shown to have a higher incidence of attritional rupture of the flexor pollicis longus (FPL). In this study, we aimed to evaluate the effect of wrist extension and volar tilt on the contact between the plate and the FPL tendon in a cadaver model. We hypothesized that, following volar plate application, loss of native volar tilt increases the contact between the FPL and the plate at lower degrees of wrist extension.
Rupture of the flexor pollicis longus tendon is a major complication after volar locking plate fixation of distal radius fracture. This study used ultrasonography to assess the flexor pollicis longus tendon and intermediate tissue. The study assessed 27 patients (28 wrists) who underwent removal of the volar locking plate. Before plate removal, radiography and ultrasonography were performed to assess the relation between the flexor pollicis longus tendon and the volar locking plate. Intraoperatively, the authors evaluated the intermediate tissues between the flexor pollicis longus tendon and the distal volar margin of the plate. Preoperative and intraoperative findings were compared. Intraoperative findings were strongly related to the distance between the flexor pollicis longus tendon and the volar locking plate on ultrasonography. The sensitivity of ultrasonography in detecting thin, membrane-like intermediate tissue through which the plate was visible was 95%, and the specificity was 89% if the distance between the flexor pollicis longus tendon and the plate was less than 0.7 mm. Compression of the flexor pollicis longus tendon was seen in 11 cases (39.3%), and this finding suggested the presence of thin, membrane-like intermediate tissue. The study results showed that ultrasonography could be used to identify the type of intermediate tissue between the flexor pollicis longus tendon and the volar locking plate. [Orthopedics. 201x; xx(x):xx-xx.].
Closed tendon ruptures of the thumb that require secondary reconstruction can affect the extensor pollicis longus (EPL), extensor pollicis brevis (EPB) and flexor pollicis longus (FPL) tendons. Treatment of rupture of the EPB tendon consists of refixation to the bone and temporary transfixation of the joint. In the case of preexisting or posttraumatic arthrosis, definitive arthrodesis of the thumb is the best procedure. Closed ruptures of the EPL and FPL tendons at the wrist joint cannot be treated by direct tendon suture. Rupture of the EPL tendon occurs after distal radius fractures either due to protruding screws or following conservative treatment especially in undisplaced fractures. Transfer of the extensor indicis tendon to the distal EPL stump is a good option and free interposition of the palmaris longus tendon is a possible alternative. The tension should be adjusted to slight overcorrection, which can be checked intraoperatively by performing the tenodesis test. Closed FPL ruptures at the wrist typically occur 3-6 months after osteosynthesis of distal radius fractures with palmar plates and are mostly characterized by crepitation and pain lasting for several weeks. They can be prevented by premature plate removal, synovectomy and carpal tunnel release. For treatment of a ruptured FPL tendon in adult patients the options for tendon reconstruction should be weighed up against the less complicated tenodesis or arthrodesis of the thumb interphalangeal joint.
Isolated neuropathy of the superficial branch of the radial nerve (SBRN) is a rarely recognized pathology. It was initially described by Wartenberg in 1932. Various causes have been published. We report a case of an unusual injury of the SBRN at the wrist, never been previously reported in the literature. A 40-year-old woman presented with pain and paresthesia over the area of the lateral aspect of the wrist, thumb and first web two months after a blunt trauma of the left forearm. After failure of conservative treatment, surgical exploration found a neuroma of one branch of the SBRN. No distal nerve stump was found. Neuroma resection was performed and the nerve was transposed and embedded into the flexor pollicis longus muscle. With a six months follow-up, the result was satisfactory.