A Study Of Arrangement Of The Extensor Tendons In The Hand

Background and Objective: Knowledge of normal anatomy of extensor tendons of forearm and hand, along withthe variations which can occur in this arrangement of tendons is necessary for anatomists as well as orthopedicsurgeons who deal with it. This knowledge is needed for anatomists for routine dissection of the cadaver forteaching, and for surgeons when they operating injured hand or diseased hand where tendon repair orreconstruction is needed. In this study we tried to document the arrangement of extensor tendons of medial fourfingers of human hand.Materials and Methods: By using 80 upper limb specimens of human cadaver, arrangement of extensor tendonsto the medial four fingers are studied from origin to insertion, including middle part of the tendons to observesplitting in the tendons. The tendons studied are extensor digitorum communis (EDC) with four tendons, namelyextensor digitorum communis index (EDCI), extensor digitorum communis longus (EDCL), extensor digitorumcommunis ring (EDCR), extensor digitorum communis small (EDCS), extensor indicis proprius (EIP) tendon, extensordigiti minimi (EDM) tendon. The special findings are photographed; all the findings are tabulated and analyzedstatistically.Results: The important findings are, EDCI is having single tendon in all the 80 specimens (100%). EDCS is absentin 22 specimens (27.5%), 13 right and 9 left limb specimens. EIP is absent in one right side specimen (1.25%). EIPis having double tendons in 10 specimens (12.5%) and triple tendons in 1 specimen (1.25%). EDM is havingdouble tendons in 60 specimens (75%).Conclusion: Many variations are seen in the arrangement of extensor tendons in this study. Variations areespecially seen in the tendons of EIP and EDM. EIP showed multiple tendons and it is absent in one limb, EDMalso had double tendons in 75% specimens.

Extensor Pollicis Longus Tendon Rupture with Concomitant Rupture of the Extensor Digitorum Communis II Tendon and Extensor Indicis Proprius after Volar Plating for Distal Radius Fracture

Extensor tendon rupture is well known complication following distal radius fracture after either conservative treatment or volar plating. However, there are not many reports in literature about concomitant ruptures of other extensor tendons. We report a case of delayed rupture of extensor pollicis longus (EPL), second extensor digitorum communis (EDC II), and extensor indicis proprius (EIP) tendons 4 weeks after volar plating for distal radius fracture. Due to the absence of EIP, EIP transfer was discouraged for EPL reconstruction. Thumb and index finger extension was restored by palmaris longus tendon graft for EPL and EDC II.

An Anatomic Study of the Extensor Tendons of the Human Hand

PURPOSE: Hands are the chief organs for physically manipulating the environment, using anywhere from the roughest motor skills to the finest, and since the fingertips contain some of the densest areas of nerve endings on the human body, they are continuously used organ with complex functions, and therefore, often gets injured. To prevent any functional loss, a detailed anatomical knowledge is required to have a perfect surgical treatment. Also it is necessary to have a thorough understanding of arrangements of the human extensor tendons and intertendinous connections when tenoplasty or tendon transfer is required. We performed a study of the arrangements of the human extensor tendons and the configuration of the intertendinous connections over the dorsum of the wrist and hand. METHODS: A total of 58 hands from Korean cadavers were dissected. The arrangements of extensor indicis proprius, extensor digitorum communis, and extensor digiti minimi tendons and intertendinous connections were studied. RESULTS: The most common distribution patterns of the extensor tendons of the fingers were as follows: a single extensor indicis proprius(EIP) tendon which inserted ulnar to the extensor digitorum-index(EDC-index); a single EDC-index; a single EDC-middle; a double EDC-ring; an absent EDC-little; a double extensor digiti minimi(EDM), a single EDC-index(98.3%), a single EDC-middle(62%), a double EDC-ring(50%), and an absent(65.5%) or a single (32.8%) EDC-little. A double(70.6%) EDM tendons were seen. Intertendinous connections were classified into 3 types: type 1 with thin filamentous type, type 2 with a thick filamentous type, and type 3 with a tendinous type subdivided to r shaped 3r type and y shaped 3y type. The most common patterns were type 1 in the 2nd intermetacarpal space, type 2 in the 3rd intermetacarpal space, and type 3r in the 4th intermetacarpal space. And in the present study, we observed one case of the extensor digitorum brevis manus(EDBM) on the boht side. CONCLUSION: A knowledge of both the usual and possible variations of the extensor tendon and the intertendinous connection is useful in the identification and repair of these structures.

Intratendinous Ganglion in the Extensor Digitorum Communis of the Hand: A Case Report

Ganglions are most common benign lesion of the hand and wrist. Although they usually arise from tendon sheaths, those originating within a tendon substance itself are rare. The etiology, pathogenesis and treatment of the intratendonous ganglion are not completely understood. We report a case of an intratendinous ganglion that developed in the extensor digitorum communis tendon of the hand and caused the extension limitation of the wrist. Treatments consisted of the intratendinous ganglion excision and meticulous tendon repair followed by tenosynovectomy.

Common Extensor Fasciotomy and Radial Nerve Decompression on Recurrent Lateral Epicondylitis

PURPOSE: This study was performed to evaluate the results after a combined surgical treatment of common extensor Fasciotomy & Radial nerve decompression in recurrent lateral epicondylitis patients. MATERIALS AND METHODS: We retrospectively reviewed the functional records of 6 cases of patients who were treated surgically from the February 2004 to June 2008. 2 cases had Radial tunnel syndrome, and The average duration from the time of diagnosis until operation was 23.5 months (7~38), the patients were given an average of 5.7 local steroid injections each, and they were followed up postoperatively for at least 1 year. We performed combined surgical treatment of common extensor Fasciotomy & Radial nerve decompression. The patients' pain intensity was evaluated by VAS score system before the operation, 6 months and 12 months after the operation. The objective assessment of the surgery was investigated according to the criteria by Roles and Maudsley. RESULTS: The grasping power of the lesion site was 11.7 before surgical treatment, 18.6 and 28.3 after 6 months and 12 months. The mean VAS score was 8.2 before surgical treatment, 4.2 and 1.3 after 6 months and 12 months, respectively. The mean Simple Elbow Test Score was 1.8 before operation, 7.0 and 10.3 after 6 and 12 months, respectively. In clinical evaluation by the Roles and Maudsley's Criteria, there were 3cases assessed as excellent and 3 cases assessed as good after 12 months of follow up. No recurrence was noted and all the patients returned to the occupational activity and the average duration was 4.5 months. CONCLUSIONS: The surgical treatment using common extensor fasciotomy and radial nerve decompression for recurrent lateral epicondylitis is considered to be one of the recommendable methods.

Effect of EMG-triggered Electrical Stimulation to Improve Arm Function in Patients with Chronic Hemiplegia

OBJECTIVE: The purpose of this study was to identify the effect of EMG-triggered electrical neuromuscular stimulation for recovery of hemiplegic arm function. METHOD: EMG-triggered electrical stimulation was applied to the extensor digitorum communis (EDC) of 8 chronic hemiplegics who showed no functional changes for more than 3 months. Stimulation was started when the amplitude of processed EMG signal from the same muscle exceeded the preset threshold. The therapeutic effect was evaluated by kinesiologic and clinical methods before and after 4 weeks. Quantitative EMG from EDC, excursion of second metacarpophalangeal joint, and functional measurements were used. We also evaluated cognitive and perceptual effect on recovery of arm function. RESULTS: Subjects treated with EMG-triggered electrical stimulation showed significant gain in amplitude of quantitative EMG and excursion sum during maximal exertion comparing to those of pre-treatment (p0.05). CONCLUSION: These results suggest that EMG-triggered electrical stimulation might be an effective therapeutic modality to improve motor function of the hemiplegic arm of chronic brain injured patients.