The dynamic or static protocol used in injuries to zones iv is used. This can sometimes appear to be flexor pollicis longus function when actually it is the relaxation of the extensor pollicis longus. Flexor pollicis longus lacerations, operative techniques in. At surgery, a dorsal blocking cast is applied with the wrist in 20 of flexion, the mcp and ip joints in 15 of flexion, and the carpometacarpal cmc joint in palmar abduction. Repeat 10 times flexor pollicis longus repair weeks 46.
Jan 23, 2015 the extensor pollicis longus muscle begins at the ulna and the interosseous membrane, a tough fibrous tissue that connects the ulna and the radius in the lower arm. Its principal attachments are from the anterior surface of the radius to the anterior surface of the distal phalanx of the thumb. The tendons of the extensor pollicis brevis and abductor pollicis longus form the radial border of the anatomic snuffbox. This oblique direction is so that it can pull the thumb up and back, as if trying to hitchhike. First, wrist hyperextension resulted in contraction forces at the middle third of the ulnar shaft at the insertion sites of the extensor carpi ulnaris and extensor pollicis longus.
If you are a member and have already registered for member area and forum access, you can log in by clicking here. Flexor pollicis longus washington university in st. Epl laceration medical billing and coding forum aapc. Dos do continue to wear your splint at night and when going out in crowded places e.
Assisting the abductor pollicis longus in facilitating thumb movements are the extensor pollicis brevis muscle and the extensor pollicis longus muscle. Because the flexor pollicis longus flexes the elbow, wrist, and thumb joints, it is stretched by extending the elbow, wrist, and thumb. Because of its ability to pronate the forearm, the stretch position should include full forearm supination as well figure 7. A rare case is reported in which the accessory extensor pollicis longus was discovered during dorsal wrist surgery.
The flexor pollicis longus originates from the anterior surface of the radius and the interosseous membrane insertion. Palpate the tendon on the ulnar aspect of the anatomic snuffbox over the dorsal aspect of the hand. The extensor pollicis longus muscle begins at the ulna and the interosseous membrane, a tough fibrous tissue that connects the ulna and the radius in the lower arm. Abductor pollicis longus painsignssymptomscausestreatment. He described a 36yearold female cane maker who had fallen and injured her right hand. Lateral side of base of proximal phalanx of thumb action. A survey of extensor pollicis longus tendon injury at the time of distal radius fractures.
Continue with hand therapy, emphasizing increased motion, swelling management, maintenance of tendon excursion and scar tissue management. It arises from the lateral part of the dorsal surface of the body of the ulna below the insertion of the anconeus, from the interosseous membrane, and from the middle third of the dorsal surface of the body of the radius passing obliquely downward and lateralward, it ends. The morphology of this tendon corresponds with four previously reported cases. Closed rupture of the extensor pollicis longus epl tendon was first described by duplay 1 in 1876. The tendon of epl is located over the back of the wrist, where it bends through a tunnel, adjacent to a slight prominence of bone. Dec 14, 2012 flexor and extensor tendon laceration vs. Andrews unit in a total of 216 thumbs over 18 years in an attempt to reduce the rupture rate from the initial high level of 17%. They originate at different carpal bones and distally attach to the thumb. The unusual suspects flexor pollicis longus muscle of the. Flexor pollicis longus lacerations, operative techniques.
Delayed flexor pollicis longus tendon rupture following. Subcutaneous rupture of the extensor pollicis longus tendon. Description o tendon part of the muscle that attaches the muscle to bone. Ultrasound evaluation following deep forearm laceration sirlyn. Tendons in the wrist include the flexor tendons that bend the fingers and wrist flexor digitorum profundus and superficialis, flexor pollicis longus, flexor carpi radialis and ulnaris, palmaris longus and the extensor tendons that extend the fingers and wrist extensor digitorum, extensor indicis, extensor digit minimi, abductor pollicis. Late rupture is one of several possible complcations after traumatic partial laceration of the fpl tendon 1 posttraumatic fpl tendon ruptures must be differentiated from mannerfelt syndrome, referring to attrition rupture of the fpl tendon caused by bony spurs at the scaphoid or in the carpal tunnel, a typical complication in rheumatoid arthritis. Jan 15, 20 radial deviation of the thumb is typical with a laceration of the extensor pollicis longus. To view all forums, post or create a new thread, you must be an aapc member. Jun 26, 2018 a 3view xray 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. Pdf late rupture of flexor pollicis longus tendon 10. Also, in all blunt trauma cases, radiographs are used to evaluate for possible fractures or dislocations. The abductor pollicis longus muscle is one of three muscles in the forearm that facilitate the movements of the thumb. Dequervains stenosing tenovaginitis is a common condition.
Anatomic variants such as an accessory extensor pollicis longus muscle within the third extensor compartment 55 can also predispose to the condition. The abductor pollicis longus muscle is innervated by the posterior interosseous nerve, which is a continuation of the deep branch of the radial nerve after it passes through the supinator muscle. Stenosing tenosynovitis extensor pollicis longus rotator. Discontinuation of narcotics is expected, continue with tylenol and ibuprofen as needed. The extensor pollicis longus or extensor pollicis longus muscle, latin. Tendon lacerations in the wrist occur when the tendons in the forearm that pass through the wrist joint and into the hand experience a traumatic cut.
This muscle is located between the two muscles which facilitate flexion of the thumb, namely the flexor pollicis brevis and the abductor pollicis. Position the thumb metacarpalphalangeal joint in extension. Recently, we reexamined data from our earlier studies and found that the rate of rupture after repair in zone 2 is twice as common as after zone 1 fpl repairs. The abductor pollicis longus lies immediately below the supinator and is sometimes united with it. If youve forgotten your username or password use our password reminder tool. Nov 04, 2014 the abductor pollicis longus muscle is one of three muscles in the forearm that facilitate the movements of the thumb. Jul 24, 2019 the abductor pollicis longus muscle which along with two other muscles helps with motion of the thumb. Extends distal phalanx of thumb at carpometacarpal and interphalangeal joints innervation. Abductor pollicis longus muscle an overview sciencedirect. Extends distal phalanx of thumb at carpometacarpal and interphalangeal joints. Orthopedic surgery for flexor tendon lacerations treatment. Primary repair of the flexor pollicis longus tendon plastic. Surgical exposure of the flexor pollicis longus tendon. Extensor pollicis brevis radiology reference article.
Along with abductor pollicis longus it passes through the 1 st extensor compartment of the wrist. Dec 10, 2005 a rare case is reported in which the accessory extensor pollicis longus was discovered during dorsal wrist surgery. The extensor pollicis longus muscle receives innervation from the posterior interosseous nerve c7 and c8 which is the continuation of the deep branch of the radial nerve. Left thumb volar laceration with flexor pollicis longus laceration, digital nerve, radial ulnar digital nerve lacerations with resultant stiffness, ip contracture, dysfunction of the flexor pollicis longus, and persistent paresthesias ulnar greater than radial, digital nerves. Once a tendon is lacerated, it has a tendency to retract, making location of the proximal end difficult. The sheath secretes a fluid that lubricates the tendon. It usually also has a small attachment to the medial epicondyle of the humerus figure 4 note.
Deep laceration of the forearm with tendon or nerve involvement. Flexor retinaculum and tubercles of scaphoid and trapezium insertion. Complete laceration of the extensor pollicis longus just proximal to the joint with retraction of the proximal stump well towards the wrist and at the index laceration noted to be tendon injury, but laceration of a branch of the radial nerve here. Next, onehanded standing positions results in compression forces through the rotation center axis of the forearm from the radial head to the distal ulna nakamura et al. It is much larger than the extensor pollicis brevis, the origin of which it partly covers and acts to stretch the thumb together with this muscle.
Injury classification into anatomical zones and the evaluation of the. Extensor pollicis longus tendinitis description extensor pollicis longus tendinitis is characterized by pain in the back of the wrist from inflammation of a tendon sheath covering or strain of one of the tendons to the thumb, the extensor pollicis longus epl. Given a particular point of laceration and knowledge of the epl attachments, the position of the lacerated tendon can be determined. Rupture of the extensor pollicis longus epl tendon has been. This is necessary in order to continue to protect the repaired tendon in your hand.
The others are the extensor pollicis brevis and extensor pollicis longus. While abductor pollicis brevis and adductor pollicis, both attached to the extensor pollicis. Revisiting spontaneous rupture of the extensor pollicis longus tendon. Flexor and extensor tendon lacerations by chevahlyan dozier 2. In human anatomy, the extensor pollicis longus muscle epl is a skeletal muscle located dorsally on the forearm.
Subcutaneous rupture of the extensor pollicis longus. A series of changes of primary treatment of divisions of the flexor pollicis longus tendon were carried out in the st. Jul 09, 2015 the flexor pollicis longus muscle has its origin at the anterior side of the radius and the interosseous membrane, sometimes also at the medial epicondyle of the humerus. Posterior surface of middle of ulna and interosseous membrane insertion. The flexor pollicis longus muscle tendon unit produces thumb interphalangeal joint flexion. Pollicis meaning in the cambridge english dictionary. The prodrome of extensor pollicis longus tendonitis and. Extensor pollicis longus definition of extensor pollicis. The deep group belongs to the abductor pollicis longus apl, extensor pollicis. The long flexors to the fingers were involved in 38 per cent. Posterior interosseous nerve c7 and c8, the continuation of the deep branch of the radial nerve arterial supply. Radial deviation of the thumb is typical with a laceration of the extensor pollicis longus.
Along with extensor pollicis longus, it is responsible for extension of the thumb. Pdf late rupture of flexor pollicis longus tendon 10 years. The flexor pollicis longus muscles moves through the hand as a tendon. Flexor pollicis longus lacerations flexor pollicis longus lacerations cook, paul a nappi, james f. The thenar musculature consists of four muscles, named abductor pollicis brevis, adductor pollicis, flexor pollicis brevis, and opponens pollicis. Nondisplaced or minimally displaced distal radial fractures can produce tears of the extensor pollicis longus epl tendon, typically distal to the extensor retinaculum 56,57 where the. The custom splint should be worn with all activities, but may be removed for bathing and. Rupture of the extensor pollicis longus epl tendon. We report the case of a complete rupture of flexor pollicis longus tendon in a 30year oldman 10 years after open reduction and internal fixation of a distal radius fracture with a volar buttress.
The flexor pollicis longus or flexor pollicis longus muscle, latin. Posterior interosseo u s nerve c7 and c8, the contin u ation of the deep branch of the radial nerve c7, c8 arterial supply. The flexor pollicis longus fpl is structurally and functionally quite different from the flexor tendons of the other fingers. The flexor pollicis longus is a muscle of the anterior forearm and hand. Wrist and hand level at or distal to wrist muscle side code code flexor carpi radialis flexor carpi ulnaris palmaris longus right na s56. It was possible, eventually, by strengthening the sutures and including the fingers in the. The mechanism and associated injuries, the location of injury, the interval until reconstruction, and. Nonsurgical treatment by corticosteroid injection has significantly improved the management of this disease. The abductor pollicis longus muscle which along with two other muscles helps with motion of the thumb. Fashion a removable shortarm thumb spica splint holding the wrist in 30 degrees of extension, thumb cmc joint in full radial abduction and extension, mcp joint in neutral, and ip joint in neutral to slight hyperextension.
Delayed flexor pollicis longus tendon rupture following sharp. Located on the radial side of the palm, they form together the ball of the thumb known as the thenar eminence. Because the fpl generated greater force than all the other thumb tendons, fpl dysfunction might cause serious impairment in thumb movement especially during the pinches and grasp. Attachments and actions of the flexor pollicis longus. Sonography of a rupture of the tendon of the extensor pollicis longus muscle. The mechanism and associated injuries, the location of injury, the interval until reconstruction, and patient requirements are important factors in selecting the method of reconstruction. Includes the extensor pollicis longus by hyperextending the interphalangeal joint and allowing it to relax. It lies in the same plane as the flexor digitorum profundus this muscle is unique to humans, being either rudimentary or absent in other primates. The flexor pollicis longus muscle has its origin at the anterior side of the radius and the interosseous membrane, sometimes also at the medial epicondyle of.
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