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A Technique for Accurately Identifying and Harvesting the Extensor Indicis Proprius for Tendon Transfer
Rouzbeh K Kordestani1, Natalie Rodriquez1, Sunil M Thirkannad1
1Kleinert Kutz Hand Care Center and University of Louisville, Louisville, KY, USA.
The Journal of Hand Surgery Asian-Pacific Volume
|February 26, 2026
Summary
The extensor indicis proprius (EIP) tendon, often used in transfers, showed a higher than expected insertion variation in our study. We identified radial insertion in 5% of cases, suggesting careful identification is crucial for successful tendon transfers.
Area of Science:
- Orthopedic surgery
- Anatomy
- Hand surgery
Background:
- The extensor indicis proprius (EIP) is a common donor tendon for surgical transfers.
- Typical EIP insertion is on the ulnar aspect of the index finger's extensor hood.
- Anatomical variations in EIP insertion exist, though infrequently reported.
Purpose of the Study:
- To report a higher incidence of extensor indicis proprius (EIP) tendon radial insertion.
- To highlight the importance of accurate tendon identification in EIP transfers.
- To provide technical guidance for avoiding inadvertent harvesting of incorrect tendons.
Main Methods:
- Retrospective review of 60 extensor indicis proprius (EIP) tendon transfers over 18 years.
- Intraoperative observation of EIP insertion anatomy.
- Identification of extensor digitorum communis (EDC) via juncturae tendinae.
Main Results:
- The extensor indicis proprius (EIP) tendon was found to insert on the radial aspect of the extensor hood in 5% (3 out of 60) of patients.
- This observed incidence (5%) is higher than previously reported anatomical variations (1%-1.5%).
- The extensor digitorum communis (EDC) was confirmed using juncturae tendinae.
Conclusions:
- The incidence of extensor indicis proprius (EIP) tendon radial insertion may be higher than previously documented.
- Accurate preoperative and intraoperative identification of the correct tendon is critical for successful tendon transfers.
- Reviewing anatomical variations and employing specific surgical techniques can prevent errors in tendon harvesting.
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