Failed Reconstruction of the Extensor Pollicis Longus in a Patient with a Major Variation of the Extensor Indicis Proprius Tendon: A Case Report

Abstract

Tendon transfer with extensor indicis proprius (EIP) has been performed widely for reconstructing ruptures of the extensor pollicis longus because of its simplicity and clinical outcome. We experienced a rerupture of the extensor pollicis longus restored by incorrect tendon transfer because of a major unrecognized variation in the anatomy of the EIP. Surgeons should perform such transfer with a detailed knowledge of the possible anatomical variations to avoid such serious complications.

Pointing in a different direction: a case of bilateral absence of extensor indicis

“…Clinically, absence of the EI tendon results in significant consequences, as it is the tendon most commonly used for reconstruction of the extensor pollicis longus (EPL) and abductor pollicis longus (AbPL) tendons [17,21]. Spontaneous rupture of the EPL tendon, occurring most frequently in patients with rheumatoid arthritis but also secondary to direct trauma and distal radial fracture, results in decreased capacity for extension at the interphalangeal and metacarpophalangeal joints of the thumb [17,21]. Tendon transfer of the EI is the current gold standard for efficacious EPL reconstruction, although extension deficits of the index finger, as well as loss of pinch strength, have been noted following EI resection [17].…”

“…Spontaneous rupture of the EPL tendon, occurring most frequently in patients with rheumatoid arthritis but also secondary to direct trauma and distal radial fracture, results in decreased capacity for extension at the interphalangeal and metacarpophalangeal joints of the thumb [17,21]. Tendon transfer of the EI is the current gold standard for efficacious EPL reconstruction, although extension deficits of the index finger, as well as loss of pinch strength, have been noted following EI resection [17]. Cases in which only one extensor tendon to the index finger can be located necessitate alternative sources of graft transfer, most commonly palmaris longus.…”

“…Because the index finger receives the ED tendon as well as the EI tendon, it should maintain the ability to extend if the EI tendon is removed [11,14]. It is critical, therefore, to be aware of variations of the EI muscle, especially those that involve absence of its tendon to evaluate patients prior to tendon transfer surgery [13,17]. We report a case of bilateral absence of the EI muscle-tendon unit and bilateral presence of an additional tendon slip arising from ED to the second digit.…”