Return to Work After Subcutaneous Transposition of the Extensor Indicis Proprius to Repair Inveterate Ruptures of...

Background/Objectives: An Extensor Pollicis Longus (EPL) subcutaneous rupture is a substantial complication in post-traumatic or degenerative wrist and tendinous lesions. The diagnosis is essentially dictated by a clinical evaluation; in fact, it is characterized by the inability to extend the thumb interphalangeal joint and to retropose the thumb while the hand is resting on a surface. The tendinous transposition using the Extensor Indicis Proprius (EIP) as a donor tendon is a well-known surgical technique performed to restore functional activity to the thumb, and it is preferred for the closer cerebellar network with the thumb itself. However, there is a dearth of clinical results and scientific evidence in the literature. The aim of this study is to evaluate the return-to-work eligibility after an inveterate EPL subcutaneous rupture repaired with a transposition of the EIP. Methods: Patients who reported a subcutaneous rupture of the EPL due to rheumatic diseases or who had undergone previous hand or wrist surgery were excluded; however, all patients tested positive for traumatic wrist hypertension. The surgical technique involves three small incisions to achieve tenorrhaphy of the EIP at the distal head of the EPL. Dynamic tests are carried out intraoperatively to verify the tightness and sufficient rigidity of the suture. The objective evaluation involves the range of motion, pinch strength, and power extension of the thumb and the index finger. Patient-reported outcome measures for pain and patient satisfaction include the Numeric Pain Rating Scale and the Disabilities of the Arm, Shoulder, and Hand questionnaire. Results: A total of 12 patients were eligible (7 W, 5 M, mean age 56.3 years) and were followed for at least one year. There were no surgery-related complications. After the cast was removed 3 weeks after surgery, patients could extend their thumbs, put them back, and use their index fingers. An immediate improvement in objective and subjective assessments was reported. At 10 weeks, nine patients (75%) returned to full work with no pain and without the aid of rehabilitation; two patients (17%) returned to full work with no symptoms 2 weeks later; and only one patient (8%) with a neurological disease required physical therapy, achieving pain control and restoration of full mobility approximately six months after surgery. Conclusions: This surgical technique seems to address satisfactory results in terms of skill recovery and rapid return to work. A tailored rehabilitation program should be implemented for selected patients with neurological conditions that may prolong the adaptation process of the transposed tendon, the coordination, and the independent function of the thumb and index finger.