Brachioradialis Muscle Tendon Transposition in Extensor Pollicis Longus Reconstruction: Anatomical Study and a New Surgical Approach

Abstract

Background Complete extension of the thumb and activation of the extensor pollicis longus (EPL) tendon are fundamental to ensure maximum function. Many EPL repair techniques are described in the literature. Methods The authors present an alternative technique using the brachioradialis (BR) tendon. Thirty patients with injuries of the EPL tendon in zone 8 were studied. In all cases, neither direct suture repair nor traditional tendon transfer was possible. Results Thumb extension was restored in all patients with satisfactory extension recovery. All patients achieved excellent extension; good functional results were observed in 2 cases, and in 1 case satisfactory results were achieved using the Geldmacher assessment and the Kapandji assessment. The overall results were rated as excellent, good, fair, or poor according to the Quick Disabilities of the Arm, Shoulder, and Hand Scale. Discussion The BR tendon was suitable to treat all cases, in particular injuries occurring near Lister’s tubercle, due to its appropriate length for tenorrhaphy albeit with a short distal head.

Spontaneous rupture of extensor pollicis longus after distal radius fracture: a case report

“…The extensor indicis proprius is favored for its 5 cm excursion, fiber length, cross-sectional area, and relative muscle power, closely resembling the extensor pollicis longus and positioning it as an ideal therapeutic approach. 9 These findings align with the results of Al-Omari et al, who identified surgical tendon transfer of the extensor indicis proprius to the extensor pollicis longus as the most effective management, yielding favorable outcomes. 1…”

A case report of upper limb loss of substance: Use of functional gracilis free flap, brachioradialis transposition and bioglass for bone regeneration

“…General anesthesia was administered to transpose the tendon of BR pro EPL [ Fig. 3 ] using the Pulvertaft suture technique as in previous surgical interventions [5] , [6] and the flap was harvested [ Fig. 2 B].…”

“…The aforementioned flap is considered an optimal muscle to reconstruct the extensor digitorum communis muscle of the forearm (EDC) supplied with relevant pedicle and single motor nerve (obturator nerve) to regenerate motor skills and secure skin coverage regarding cutaneous loss of substance. In addition, we proposed the use of the Brachioradialis pro Estensor pollicis longus as a tendon transfer [5] , [6] .…”