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Rerouting extensor pollicis longus tendon transfer.

Julie Colantoni Woodside¹, Randip R Bindra¹

¹Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL; Department of Orthopaedic Surgery, Griffith University and Gold Coast University Hospital, Gold Coast, Australia.

The Journal of Hand Surgery

|March 10, 2015

Summary

Radial nerve palsy causes thumb dysfunction. A novel technique reroutes the extensor pollicis longus (EPL) tendon through the first dorsal compartment, restoring thumb extension and radial abduction with a single transfer.

Keywords:

Extensor pollicis longus radial nerve palsy tendon transfers

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Area of Science:

Orthopedic Surgery
Hand Surgery
Reconstructive Surgery

Background:

Radial nerve palsy results in significant loss of thumb extension and radial abduction.
Existing tendon transfer methods for radial nerve palsy have limitations, including potential thumb adduction and compromised donor tendon length.

Purpose of the Study:

To describe a novel technique for rerouting the extensor pollicis longus (EPL) tendon through the first dorsal compartment.
To restore both thumb extension and radial abduction via a single tendon transfer in patients with radial nerve palsy.

Main Methods:

The extensor pollicis longus (EPL) tendon is divided at the wrist and rerouted retrogradely through the first dorsal compartment.
The EPL tendon is then repaired to a donor tendon (e.g., palmaris longus or flexor digitorum sublimis) on the radial side of the wrist.
The first dorsal compartment acts as a pulley, preventing bowstringing and maintaining tendon position.

Main Results:

The technique utilizes the first dorsal compartment as a pulley, improving the line of pull and preventing bowstringing.
Repairing the tendon proximal to the extensor retinaculum preserves donor tendon length.
This single transfer aims to restore both thumb extension and radial abduction.

Conclusions:

Rerouting the EPL tendon through the first dorsal compartment offers a biomechanically advantageous approach for radial nerve palsy.
This technique provides a single, effective solution for restoring thumb extension and radial abduction.
The method enhances functional recovery and patient outcomes following radial nerve injury.