The Thumb pp 177-197 | Cite as

Extensor Tendon

  • Young Ho LeeEmail author


The extensor tendon injuries in thumb more frequently occur than flexor tendon. The composite system of extensor mechanism with extensor retinacula structures and both extrinsic and intrinsic tendon may contribute to the difficult management. Thus, a thorough understanding of the anatomy and extensor mechanism is necessary to provide appropriate treatment. The diagnosis of extensor tendon injuries is often evident. But, open lesions should be surgically explored to identify the extent of the injury and prevent secondary ruptures. Various types of incisions can be used for open repair based on surgeon’s preference and the shape of the previous laceration. The strength of tendon suture is affected by the number of suture strands passing through the repair site, the suture diameter, the suture material properties, and the suture method. In case of segmental degeneration, it must be reconstructed. The transfer of extensor indicis proprius or tendon graft using the palmaris longus tendon is the most widely used for reconstructing the EPL. In complicated injury, radical debridement of all contaminated and devitalized tissue is mandatory and osseous structures and tendons must be provided with durable and healthy soft tissue coverage. Thus primary or delay flap surgery is often necessary.


Thumb Extensor Injury Suture 


  1. 1.
    de Jong JP, Nguyen JT, Sonnema AJ, Nguyen EC, Amadio PC, Moran SL. The incidence of acute traumatic tendon injuries in the hand and wrist: a 10-year population-based study. Clin Orthop Surg. 2014;6(2):196–202.CrossRefGoogle Scholar
  2. 2.
    Patillo D, Rayan GM. Open extensor tendon injuries: an epidemiologic study. Hand Surg. 2012;17(1):37–42.CrossRefGoogle Scholar
  3. 3.
    Doyle JR. Extensor tendons: acute injuries. In: Green DP, Hotchkiss RN, Pederson WC, et al., editors. Green’s operative hand surgery. 5th ed. New York: Churchill Livingstone; 1999. p. 195–1987.Google Scholar
  4. 4.
    Kleinert HE, Verdan C. Report of the committee on tendon injuries (International Federation of Societies for Surgery of the Hand). J Hand Surg Am. 1983;8(5 Pt 2):794–8.CrossRefGoogle Scholar
  5. 5.
    Strauch RJ. Extensor tendon injury. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SK, editors. Green’s operative hand surgery. 6th ed. New York: Churchill Livingstone; 2011. p. 165–8.Google Scholar
  6. 6.
    Henderson J, Sutcliffe M, Gillespie P. Epitendinous suture techniques in extensor tendon repairs—an experimental evaluation. J Hand Surg Am. 2011;36(12):1968–73.CrossRefGoogle Scholar
  7. 7.
    Henderson J, Sutcliffe M, Gillespie P. The tension band principle and angular testing of extensor tendon repairs. J Hand Surg Eur. 2001;36(4):297–302.CrossRefGoogle Scholar
  8. 8.
    Newport ML, Williams CD. Biomechanical characteristics of extensor tendon suture techniques. J Hand Surg Am. 1992;17(6):1117–23.CrossRefGoogle Scholar
  9. 9.
    Newport ML, Pollack GR, Williams CD. Biomechanical characteristics of suture techniques in extensor zone IV. J Hand Surg Am. 1995;20(3):650–6.CrossRefGoogle Scholar
  10. 10.
    Howard RF, Ondrovic L, Greenwald DP. Biomechanical analysis of four-strand extensor tendon repair techniques. J Hand Surg Am. 1997;22(5):838–42.CrossRefGoogle Scholar
  11. 11.
    Woo SH, Tsai TM, Kleinert HE, Chew WY, Voor MJ. A biomechanical comparison of four extensor tendon repair techniques in zone IV. Plast Reconstr Surg. 2005;115(6):1674–81.CrossRefGoogle Scholar
  12. 12.
    Lee SK, Dubey A, Kim BH, et al. A biomechanical study of extensor tendon repair methods: introduction to the running-interlocking horizontal mattress extensor tendon repair technique. J Hand Surg Am. 2010;35:19–23.CrossRefGoogle Scholar
  13. 13.
    Patel MR, Lipson L-B, Desai SS. Conservative treatment of mallet thumb. J Hand Surg Am. 1986;11:45.CrossRefGoogle Scholar
  14. 14.
    Schaller P, Baer W, Carl HD. Extensor indicis-transfer compared with palmaris longus transplantation in reconstruction of extensor pollicis longus tendon: a retrospective study. Scand J Plast Reconstr Surg Hand Surg. 2007;41(1):33–5.CrossRefGoogle Scholar
  15. 15.
    Chung US, Kim JH, Seo WS, et al. Tendon transfer or tendon graft for ruptured finger extensor tendons in rheumatoid hands. J Hand Surg Eur. 2010;35:279–82.CrossRefGoogle Scholar
  16. 16.
    Noorda RJ, Hage JJ, de Groot PJ, et al. Index finger extension and strength after extensor indicis proprius transfer. J Hand Surg Am. 1994;19:844–9.CrossRefGoogle Scholar
  17. 17.
    Lemmen MHM, Schreuders TAR, Stam HJ, Hovius SER. Evaluation of the restoration of the extensor pollicis function by transfer of the extensor indicis. J Hand Surg Br. 1999;24:46–9.CrossRefGoogle Scholar
  18. 18.
    Magnussen PA, Harvey FJ, Tonkin MA. Extensor indicis proprius transfer for rupture of the extensor pollicis longus tendon. J Bone Joint Surg Br. 1990;72:881–8.CrossRefGoogle Scholar
  19. 19.
    Stahl S, Wolff TW. Delayed rupture of the extensor pollicis longus tendon after nonunion of a fracture of the dorsal radial tubercle. J Hand Surg Am. 1988;13:338–41.CrossRefGoogle Scholar
  20. 20.
    Choi JC, Kim WS, Na HY, Lee YS, Song WS, Kim DH, Park TH. Spontaneous rupture of the extensor pollicis longus tendon in a tailor. ClinOrthop Surg. 2011;3(2):167–9.Google Scholar
  21. 21.
    Al-Rashid M, Theivendran K, Craigen MA. Delayed ruptures of the extensor tendon secondary to the use of volar locking compression plates for distal radial fractures. J Bone Joint Surg Br. 2006;88:1610–2.CrossRefGoogle Scholar
  22. 22.
    Zwetkow AN, Schibli SI, Canova MA, Mark GI, Sommer CH. Rupture of the extensor tendons: a complication following volar locking compression plate osteosynthesis of the distal radius. Br J Surg. 2005;92:900–18.CrossRefGoogle Scholar
  23. 23.
    Scheker LR, Langley SJ, Martin DL, et al. Primary extensor tendon reconstruction in dorsal hand defects requiring free flaps. J Hand Surg Br. 1993;18:568–75.CrossRefGoogle Scholar
  24. 24.
    Sundine M, Scheker LR. A comparison of immediate and staged reconstruction of the dorsum of the hand. J Hand Surg Br. 1996;21:216–21.CrossRefGoogle Scholar
  25. 25.
    Ulusal BG, Lin YT, Ulusal AE, et al. Free lateral arm flap for 1-stage reconstruction of soft tissue and composite defects of the hand: a retrospective analysis of 118 cases. Ann Plast Surg. 2007;58:173–8.CrossRefGoogle Scholar
  26. 26.
    Bevin AG, Hothem AL. The use of silicone rods under split thickness skin grafts for reconstruction of extensor tendon injuries. Hand. 1978;10:254–8.CrossRefGoogle Scholar
  27. 27.
    Cautilli D, Schneider LH. Extensor tendon grafting on the dorsum of the hand in massive tendon loss. Hand Clin. 1995;11:423–9.PubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Orthopedic SurgerySeoul National University HospitalSeoulSouth Korea

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