Chronic Lacerations of Extensor Tendons

35 Chronic Lacerations of Extensor Tendons

Angela A. Wang and Michelle Gerwin Carlson

History and Clinical Presentation

A 66-year-old right hand dominant man sustained a deep laceration to the dorsum of his right wrist when a plate glass mirror fell on it. He was evaluated at a local emergency room and was informed he would need surgery, but he wanted to be treated at another institution. Seventeen days later, he presented to the office with the complaint that he could not lift his fingers.

Physical Examination

A well-healed 5-cm transverse laceration is noted on the dorsum of the right wrist just proximal to the edge of the extensor retinaculum. The patient lacked active extension of the index, long, and ring fingers at the metacarpophalangeal joints, as well as the thumb. In addition, he had a lack of extension of the wrist radially. The abductor pollicis longus, extensor pollicis brevis, and the small finger extensors were intact. Sensation in the distribution of the superficial radial nerve was intact (Fig. 35–1).

PEARLS

Ultimate results are closely tied to postoperative care and rehabilitation. Careful attention to good splinting and controlled mobilization of the repaired tendon will yield better function when the tendon healing is complete.

PITFALLS

The ruptured tendon must be repaired under the proper tension. Although tendon reconstruction under excessive tension is to be avoided, the surgeon must fix the tendon at the proper length to provide adequate power. It should also be noted that repairs usually loosen over time.

Diagnostic Studies

Radiographs of the right wrist were negative for bony pathology. No foreign bodies were present.

Figure 35–1. The patient under anesthesia preoperatively, with the wrist supported. Note the laceration on the dorsum of the wrist, and the lack of extension of the digits.

Differential Diagnosis

Extensor tendon laceration

Rheumatoid arthritis synovitis

Nerve injury

Diagnosis

Laceration of the Second, Third, and Fourth Dorsal Compartments of the Right Wrist, Late

Extensor tendon lacerations or ruptures that are treated in a delayed fashion may not be amenable to primary approximation and repair. Most tendon laceration and ruptures are best treated acutely; if this is not possible, the patient should be told that tendon reconstruction might be necessary. In cases of multiple tendon injuries, emphasis should be placed on recovering independent wrist and thumb extension, and mass extension of the fingers.

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