Fast Five Quiz: Are You Prepared to Confront Holiday Decorating Injuries?

Richard H. Sinert, DO

Disclosures

December 05, 2017

As much as 80% of the extensor tendon may be lacerated without loss of function, but the chance of delayed rupture is increased when the laceration includes more than 40% of the tendon. Therefore, the dorsal hand and wrist wound must be explored well when any suspicion of tendon injury exists.

In the most straightforward case, the patient presents with one or more digits that stay more flexed than the others when the patient attempts to extend all fingers. This indicates a complete laceration of the extensor tendon on the affected digits. However, if all of the extensors in the hand are completely lacerated, then the fingers stay flexed at rest or at attempt to straighten. Also, the position of the fingers does not change regardless of the position of the wrist; this indicates loss of the normal tenodesis effect.

As with most normal structures, significant disruption should be repaired when possible. Most lacerations of the extensor system should be repaired. However, certain lesser-degree lacerations can do well without repair.

Associated fractures are common with extensor injuries in the digits. In closed injury over the dorsum of the proximal interphalangeal joint, suspect extensor tendon injury. Because of the superficial nature of the extensor tendons and the lack of significant delicate and critical adjacent structures (as opposed to the presence of the neurovascular bundle in a flexor tendon injury), these repairs can be performed immediately in the emergency department, urgent care, or office setting, given the proper lighting and instruments.

For more on the presentation of extensor tendon laceration, read here.

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