Extensor pollicis longus. Extensor pollicis longus Specialists of the 21st century

Stenosing ligamentitis is a common disease that affects the annular muscle of the finger and sometimes affects the feet. The inflammatory process during the disease reduces mobility. In some cases, the enlarged muscle may become fused with nearby tissue.

About the disease

In common parlance, stenosing ligamentitis is called “snapping finger.” For the most part, people do not pay attention to the disease because they are unaware of the danger.

Ligamentitis affects the tendon of the hand or foot. This problem occurs not only in adults, but also in children. Inflammatory reactions occurring in the affected tendon reduce the mobility of the fingers or toes. The number of people facing this problem is growing. Of all patients with hand diseases, about 8% suffer from “snapping finger.”

Main types of disease:

Knott's disease. The most common type of problem.
De Quervain's disease. Damage to the long conduction muscle and the short extensor muscle. The disease affects one finger, most often the thumb.

Neglect of treatment leads to complete failure of the finger or toe.

Stenosing ligamentitis is divided into three stages.

Stages of development:

Stage 1. The finger begins to click, and mild pain occurs in the damaged area.
Stage 2: Thickening of the tendon leads to decreased mobility of the finger. Pressure on the damaged area causes pain. There is discomfort in the wrist joint.
Stage 3. The finger remains bent. Only surgery can correct the situation. Surgery is available for children and adults.

It is highly undesirable to start the disease. It is easy to identify a problem, even in the early stages. You should contact a specialist immediately after detecting the first symptoms.

Causes

Stenosing ligamentitis can be called polyetiological, since the disease occurs due to a host of factors. What influences the development of the disease?

Gout. Deposition of uric acid in the joint and nearby tissues is the background for inflammatory processes.
Diabetes. Leads to inflammation of connective tissues due to the deposition of pathological protein.
Rheumatoid arthritis. The disease leads to inflammation of the joints of the hand.
Stable load on fingers. Ligamentitis most often develops in people who perform repetitive work with their hands.
Heredity.
Atherosclerosis.
Incorrect structure of the annular ligament and tendons.
Injuries.
Infections.

In most cases, “snapping finger” occurs due to inflammation in the hand or foot. People who work with their hands are especially susceptible to the disease. However, the disease also occurs in children.

At risk are:

Musicians.
Welders.
Jewelers.
Masons.
Dentists.

Ligamentitis leads to thickening of the tendon. This interferes with its movement and makes the annular ligament an obstacle. The disease, which occurs in children, is in most cases congenital, and in adults it is associated with tissue inflammation.

Symptoms

Snapping finger syndrome has distinct symptoms. Diagnosing the disease is not difficult even in the early stages.

The main symptoms of Knott's disease:

Pain near the injured ligament. Appears when moving.
Swelling at the top of the joint.
Increased sensitivity.
Numbness of the finger.
Pain in the area of the wrist joint.
Problems bending your finger. Feels like an obstacle.
The finger does not straighten.
Movement of the wrist joint increases pain.
When moving, the fingers click.
Low functionality during operation.
The appearance of swelling.
Painful sensations when pressing on the arm.
Echoes of pain in the shoulder or hand.
Deterioration of joint mobility.

All stages of the disease are accompanied by swelling, which brings discomfort when pressure is applied to it. The tendons also harden. At the last stage of the disease, the phalanx thickens. A patient with the final stage of the disease cannot do without surgery.

Symptoms of De Quervain's disease:

Swelling.
Pain in affected tissues.
The work of the brush does not deteriorate.
The pain comes from the wrist.
Discomfort occurs in the shoulder area and fingertips.

This type of “snapping finger” affects people over 40 years of age. Most often, ligamentitis affects women, among them this pathology is more common.

Diagnostics

Snapping finger syndrome does not require special methods for detection. The doctor orders an x-ray and conducts an examination. An examination is necessary to rule out degenerative joint problems that have similar symptoms. This is necessary for the correct choice of treatment.

Palpation of the hand with Nott's disease helps to detect:

Thickening of the tendon located in the area of the distal fold.
Clicking.
A thickening that moves when you move your finger.

It is important to know that with prolonged absence of movement in the injured finger, all symptoms intensify.

Palpation for Querven's disease helps to detect:

Painful sensations with pressure in the area of the styloid process.
Discomfort when abducting healthy fingers. Pain in the arm from the shoulder to the hand.

Some symptoms, such as numbness in the fingers, occur in each type of disease, so a specialist must make a diagnosis. Immediately after the disease is detected, you should stop exerting yourself, and then fix the limb with the affected ligaments and joint.

Treatment

Stenosing ligamentitis can be treated using two methods. For the initial stages of the disease, a conservative method is used, and if the disease is advanced, surgical intervention is used.

Stenosing ligamentitis treated conservatively:

Electrophoresis.
Ozokerite.
Phonophoresis.
Applications.
Drugs.

The conservative method, if the disease is not advanced, gives results within a few weeks. During this time, the affected joints, ligaments and muscles of the hand are completely restored. A specialist should draw up a treatment plan. Only a doctor can prescribe medications.

It is important to know that massage is not included in the list of procedures, as it can aggravate the patient’s condition.

During treatment, the patient should avoid any stress, even the simplest. It is necessary to exclude any work, especially related to the brush. This even applies to cleaning or embroidering. The recovery time depends on compliance with this requirement.

Conservative treatment is especially effective for children. More than 70% of patients under 3 years of age make a full recovery.

Surgical intervention

If the conservative method does not provide the desired result, surgery will be required. The surgical method involves dissection of the deformed tendon or annular ligament. The intervention is safe for both adults and children.

Before surgery, during an exacerbation, the patient must follow some recommendations.

Requirements:

Avoid moving the brush. This will increase the chance of injury.
The use of drugs that reduce inflammation and pain. Medicines are prescribed by a doctor.
Tendon injections. Injections are given only by a doctor.

After the inflammatory processes have decreased and the period of exacerbation has passed, surgery is prescribed. Intervention will help avoid relapse, as well as loss of performance.

Children who underwent surgery before 2 years of age have about a 90% chance of a full recovery. Doctors perform the intervention using an open method. It avoids exacerbations and does not damage nerve cells.

Open surgery

Surgical intervention in both adults and children follows the same plan.

Operation stages:

General anesthesia.
Dissection of the ligament around the thickening.
Alignment of fingers.
Treatment of the wound.
Applying a bandage.
Tire installation.

The operation is very simple and has many advantages over other types of treatment.

Advantages:

Low probability of tissue damage.
There is no possibility of injuring blood vessels or nerves.
Decompression incision.
No damage to anatomical relationships.

The brush begins to work fully within a couple of days. Sutures are removed two weeks after surgery.

Closed operation

Surgical intervention in this way lasts only 20 minutes.

Operation plan:

Local anesthesia is used.
A small puncture is made.
The annular ligament is divided.
Fingers straighten.
A bandage is applied.

At first glance, the operation seems quick and simple. However, this method has several significant disadvantages. Therefore, especially for children, it is advisable to use the open method.

Flaws:

Possibility of flexor tendon injury.
Possibility of relapses.
Lack of visual control increases the chance of injury.
The appearance of a hematoma.

You should choose the appropriate method after consulting a doctor.

Alternative Methods

Folk remedies have a positive effect on ligaments, muscles and the wrist joint.

Treatment methods:

Warming up. Heated salt is poured into a bag and applied to the damaged area. It is advisable to repeat the procedure several times a day.
Healing mud. Healing clay is brought to the consistency of sour cream. Then 5 teaspoons of apple cider vinegar are added to the mixture. The paste must be applied to the damaged finger, wrapped and left for about 2 hours. The hand should rest at this time.
Mix six teaspoons of crushed elecampane rhizome with 1 liter of hot water and boil for 20 minutes. Boil the resulting liquid, apply to paper towels, and then apply to the damaged area.
Brew pine and coniferous branches in a ratio of 1:3. Cook for 20 minutes, then strain. Apply a rag moistened with liquid to the sore spot.
Steaming a limb. Pine oil and sea salt are added to a liter of boiling water. You should move your fingers during the steaming process.
Calendula flowers should be crushed and mixed with baby cream in a 1:1 ratio. The resulting ointment is infused for a day in the refrigerator.

Folk remedies are especially effective in the early stages of the disease. Snapping finger responds well to alternative treatments. Since folk remedies have no contraindications and are suitable even for children.

Gymnastics

Gymnastics can help relieve pain in the wrist joint, ligaments, and muscles of the hand.

Exercises:

Elbows rest on the table, palms facing up. Shaking movements are made with the brush.
Playing an imaginary flute.
Elbow on the table. Rotations are performed with a brush.
Hands at chest level, palms folded together. Alternately apply pressure with the fingers of one limb to the other.
The position is similar. The wrists are spread apart, the fingertips do not separate from each other.

Exercises are effective in the early stages of the disease.

Prevention

Detecting the snap finger is easy. Therefore, if you suspect a disease (crunching in the fingers), in adults or children, you should immediately reduce the load on the hand. Compresses and light massage will also help. You should not self-medicate; you should immediately consult a specialist.

You should not neglect folk remedies that help with tendon inflammation. It is quite possible to cure trigger finger, especially at an early age.

Nothing is more valuable to a person than health and time. That is why the main principle of the multidisciplinary Medical Center “XXI Century” is to provide a wide range of services of the highest quality at the most convenient time for the patient. We work daily from 8:00 to 22:00. Specialists from our 24-hour Coordination Center provide comprehensive advice on the provision of medical care. In addition, highly qualified doctors provide various types of services not only on an outpatient basis, but also on the premises of enterprises and directly at home. For this purpose, the XXI Century Center has more than 90 equipped vehicles. At the same time, our specialists are constantly expanding the list of medical services and using the most advanced and effective diagnostic and therapeutic methods. To achieve this, our professional staff regularly undergoes advanced training courses.

Since our center’s specialists work in various medical fields, each of our patients, by contacting us, will be able to quickly receive advice from an experienced, highly specialized specialist. After conducting a comprehensive diagnosis and establishing the correct diagnosis, the specialist will prescribe an individual treatment method for the patient. Our center employs the following specialists: therapists, surgeons, cardiologists, otolaryngologists, urologists, pediatricians, gynecologists, dentists, gerontologists and other doctors.

The main areas of work of our center:

Medicine for all age groups of patients;
surgery;
rehabilitation after illnesses, injuries and surgery;
dentistry.

We have a program to reward regular customers. Our center makes every effort to ensure that each of our clients becomes healthy and happy in the shortest possible time.

Specialists of the 21st century

Prices

Traumatology and orthopedics

Primary consultation with a traumatologist-orthopedist in an outpatient clinic	1450 rub.
Consultation with a traumatologist-orthopedist, head of department, C.M.N., primary leading specialist in an outpatient clinic	1800 rub.
Repeated consultation with a traumatologist-orthopedist at the outpatient clinic	1100 rub.
Repeated consultation with a traumatologist-orthopedist, head of the department, C.M.N., leading specialist at the outpatient clinic	1500 rub.
Dressing as part of a consultation at an outpatient clinic	530 rub.
Dressing outside of a consultation at an outpatient clinic	740 rub.
Removing stitches in an outpatient clinic	530 rub.
Reduction of a dislocated joint	2760 rub.
Closed reduction for a fracture with displacement of fragments	2760 rub.
Application of small and medium plaster splints in the outpatient clinic	1270 rub.
Application of a large plaster splint in the outpatient clinic	1730 rub.
Application of a large polymer immobilizing bandage (cellocast)	4440 rub.
Application of a medium polymer immobilizing bandage (cellocast)	3840 rub.
Application of a small polymer immobilizing bandage (cellocast)	2760 rub.
Turbocast overlay (large)	1730 rub.
Turbocast overlay (small and medium)	1270 rub.
Applying a circular plaster cast in the outpatient clinic (large)	1730 rub.
Application of a circular plaster cast in an outpatient clinic (small, medium)	1270 rub.
Joint puncture with injection of medications into the joint in an outpatient clinic (without the cost of the drug)	1660 rub.
Puncture for hemarthrosis	2000 rub.
Remodeling of the cast, shortening of the fixation bandage as part of a consultation at the outpatient clinic	940 rub.
Removal of a circular immobilizing bandage in the outpatient clinic	980 rub.
Removal of any splint in an outpatient clinic	740 rub.
Shock wave therapy in an outpatient clinic	1800 rub.
Taping for injuries and diseases of the capsular-ligamentous apparatus as part of a consultation	820 rub.
Taping for injuries and diseases of the capsular-ligamentous apparatus without consultation	1020 rub.
Osteosynthesis with plates for fractures of the bones of the hand, collarbone, foot	12000 rub.
Osteosynthesis with knitting needles for fractures of the bones of the hand and foot	3200 rub.
Surgery for Dupuytren's contracture	12000 rub.
Surgery for stenosing ligamentitis, De Quervain's disease	9750 rub.
Surgery for trigger finger	9000 rub.
Baker's cyst removal	9500 rub.
Removal of metal structures (plates) from the collarbone, ankle, forearm bones, hands and feet	12000 rub.
Removing a spoke	1500 rub.
Achilles tendon suture (within 2 weeks from the moment of injury)	12000 rub.
Achilles tendon suture late after injury (more than 2 weeks from the moment of injury)	14,000 rub.
Suture of the digital flexor tendon during PSO, including PSO on the day of injury	5600 rub.
Suture of the digital flexor tendon late after injury (more than 2 weeks)	12000 rub.
Suture of the wrist extensor tendon during PSO, including PSO on the day of injury	3200 rub.
Suture of the extensor tendon, incl. late periods after injury (1-2 weeks)	8000 rub.
Primary consultation with a doctor at home	2700 rub.
Doctor consultation at home, repeated	2100 rub.
Consultation with a leading specialist doctor/head of department/C.M.N. at home, primary	3300 rub.
Consultation with a leading specialist doctor/head of department/C.M.N. at home, repeated	2700 rub.

Why is a tendon rupture on a finger dangerous? The mobility of the hand is ensured by the coordinated work of the flexors and extensors. The first are on the palmar surface of the hand, the second are on the back of it. Fingers do not have muscles, so their movements are carried out through connective tissues. Flexors can be superficial or deep. Some of them are located on the middle phalanges, others on the nails. Tendon injuries rank first among injuries to the hands and fingers. About 30% of them are accompanied by complete or partial tendon ruptures. This is due to the special arrangement of the tissues, which makes them easy to damage.

Classification

Injuries to the ligaments of the thumb reduce the functionality of the hand by 50%, and the index and middle finger by 20%. They are most common among people who prefer amateur sports activities. Depending on the presence of skin damage, tendon ruptures are divided into open and closed. The first occurs when injured by piercing objects. The latter are diagnosed in athletes. The tendon is damaged when it is overstretched.

Tears are divided into partial and complete; the severity of the injury is assigned depending on the number of torn fibers. Total damage is more difficult to cure. A rupture of one ligament is considered isolated, while a rupture of several ligaments is considered multiple. We are talking about combined injury in the case of damage to muscle tissue, blood vessels and nerve endings.

When prescribing treatment, it is important to determine the duration of the damage. A subcutaneous rupture that occurred less than 3 days ago is considered fresh. Injuries that occurred more than 3 days ago are called stale. Those that happened 21 or more days ago are considered old.

Common Causes of Injury

Damage to the tendons and joint capsule may be traumatic or degenerative in origin. The latter type is the result of tissue thinning, the first occurs when a sudden increase in weight. Sports injury can have a mixed origin.

Provoking factors are considered:

a short break between workouts;
lack of warm-up during class;
reassessment of one's capabilities;
failure to comply with safety regulations.

Those at risk include people who are overweight and older people.

Characteristic signs

Symptoms of a torn ligament in a finger are determined by its location. Damage to tissues located on the anterior surface of the hand is accompanied by impaired flexion functions. In this case, the fingers acquire a hyperextended position. When the tendons of the back of the hand are injured, extension abilities are affected. Damage to nerve endings can lead to numbness and paresthesia. If at least one of the symptoms listed above appears, you should consult a doctor. Fresh injuries heal faster than old ones.

If a person notices that hand function is seriously impaired, he should apply a sterile bandage and a cold compress. This prevents hemorrhage and the development of swelling. The limb needs to be raised above the head, this will slow down the speed of blood flow.

In the emergency room, primary wound treatment is carried out, including applying antiseptic solutions to the skin, stopping bleeding and suturing. After this, a tetanus vaccine is given and antibacterial drugs are administered. If a rupture of the extensor tendon of the finger is detected, the patient is referred to a surgeon. Without surgery, the hand may lose its functions.

Therapeutic measures

Treatment of extensor tendon injuries can be carried out not only surgically, but also conservatively. However, this does not apply to flexor injuries. For finger injuries, long-term wearing of a cast or other fixation device is indicated.

Damage that occurs in the wrist area is treated exclusively with surgery. The ends of the torn ligament are sutured. If the damaged tissue is in the area of the distal interphalangeal joint, a splint is applied for 5–6 weeks.

A faster recovery of finger function is observed after the extensor tendon suture operation.

A fixation device after surgery is necessary to ensure the joint is in an extended position. You will have to wear it for at least 3 weeks. The splint must be placed on the finger at all times. Its early removal can contribute to the rupture of the scar that has begun to form, as a result of which the nail phalanx will again take a bent position. In such cases, re-splinting is indicated. During the treatment period, it is recommended to be under the supervision of a doctor.

In case of boutonniere-type deformation, the joint is fixed in a straight position until the damaged tissues are completely healed. A suture is necessary for contraction and complete rupture of the tendon. If there is no treatment or the splint is applied incorrectly, the finger becomes bent and freezes in this position. You must follow all the instructions of the traumatologist and wear the splint for at least 2 months. The doctor will tell you exactly when it can be removed.

Rupture of the extensor tendons at the level of the metacarpal bone, wrist joint and forearm requires surgical intervention. Spontaneous muscle contraction leads to tendon tightening and significant separation of damaged fibers.

The operation is performed under local anesthesia. First, the bleeding is stopped, after which the torn ligament is sutured to the distal phalanx. If the injury is accompanied by a fracture, the bone fragment is secured with a screw. The needle in the finger plays the role of a retainer.

The surgical intervention is performed on an outpatient basis, after its completion the patient can go home.

Recovery period

Rehabilitation for a finger flexor tendon rupture includes:

massage;
taking medications.

Rubbing accelerates the process of restoration of damaged tissues and increases their strength. The ligament needs to be worked with the fingertips, the load needs to be increased gradually. Movements are carried out along the damaged area of the tendon. Massage can be started only after the inflammation stage is completed. The procedure should not last more than 10 minutes.

Finger development is an important part of rehabilitation. It enhances blood supply and tissue nutrition. You need to squeeze your hand and hold it in this position for 10 seconds. After this, the fingers are extended as far as possible and fixed in this position for 30 seconds.

You cannot stretch the tendon sharply; you can perform the exercises as often as you like. Do not forget that classes must be regular.

In some cases, after applying a splint, anti-inflammatory drugs are prescribed. However, inhibition of the inflammatory process can interfere with normal tissue healing, which will lead to impaired hand function.

If the pain does not disappear, it is necessary to stop exercising until the condition of the ligament improves.

How long does it take for a tendon rupture to heal? For minor injuries, recovery takes no more than a month. With a complete rupture, this period can last up to six months.

longus.Origin of muscle: from the middle third of the posterior surface of the ulna.

Muscle attachment: to the base of the second phalanx. Function: unbends pain

Thy finger.

19. Extensor index finger, m. extensor indicis.The beginning of the mouse

tsy: from the distal third of the ulna. Muscle attachment: to the tendon

common extensor. Function: extends the index finger.

MUSCLES OF THE HAND

In addition to the tendons of the muscles of the forearm, passing on the dorsum and palmar

sides of the hand, the latter also has its own short muscles,

starting and ending in this section of the upper limb. Muscles

brushes are divided into three groups. Two of them are located along the radial and local

to the edges of the palm, form the eminence of the thumb (thenar) and little finger

tsa (hypothenar). The third (middle) group lies in the palmar cavity (palma

Muscles of the eminence of the thumb.

Abductor pollicis brevis muscle, m. abductor

pollicis brevis. Lies superficially in relation to the others, next to the long

the abductor pollicis muscle. Function: takes away a large pa-

2. Flexor pollicis brevis, m. flexor pollicis brevis. Le-

lives more medially than the previous one and has two heads: superficial and deep,

between which passes the tendon of the flexor pollicis longus

brushes Function: flexes the proximal phalanx of the thumb.

The muscle opposing the thumb to the hand, m. opponens

pollicis. Lies under the abductor pollicis brevis muscle. Function

tion: produces opposition of the thumb.

4. Muscle adductor pollicis, m. adductor pollicis. Le-

lives in the depths of the palm distal to the previous ones. Function: leads big

Muscles of the eminence of the little finger.

5. Palmaris brevis, m. palmaris brevis.Origin of muscle: from

ulnar edge of the palmar aponeurosis; ends in the skin on the edge of the elbow

palms. Function: stretches the palmar aponeurosis.

6. Muscle that abducts the little finger, m. abductor digiti minimi. Lies on-

superficially along the ulnar edge of the hypothenar. Function: abducts, bends and straightens

the little finger dies.

7. Short flexor of the little finger, m. flexor digiti minimi brevis. lies

along the radial edge of the previous muscle. Function: flexes the proximal

phalanx of the little finger.

Muscle opposite the little finger, m. opponens digiti minimi.

Covered by the previous two muscles. Function: pulls his little finger towards

thumb (opposites)

Muscles of the palmar cavity.

9. Vermiform muscles, mm. lumbricales, four narrow muscle

bundle located between the tendons of the deep flexor of the digitorum. Having started-

coming from the tendons of the deep flexor digitorum, they go around the heads of the metacarpals

bones on the radial side and are attached on the back of the proximal phalanges to

tendon stretch of the common extensor digitorum. Function: bend

proximal and straighten the middle and distal phalanges of the 2-5th fingers

10. Interosseous muscles, m. interossei. Occupy the spaces between five

bones, attaching to them, and are divided into three palmar and four

dorsal muscles. Function: abduction and adduction, flex the proximal

phalanx and extend the middle and distal ones like lumbrical muscles.

FASCIA AND TOPOGRAPHY OF THE UPPER LIMB

Fascia of the shoulder, fascia brachialis, surrounds the shoulder muscles. From her deep down

two fibrous ones come off intermuscular septum (septum intermusculare)

brachii mediale et laterale), which grow to the scallops of the medial and la-

lateral edges of the humerus and separate the anterior and posterior

shoulder muscle groups. The fascia of the shoulder passes into fascia of the forearm

antebrachii, which, covering all the muscles of the forearm, forms between them

fibrous septa.

In the lower third of the forearm, the fascia on the palmar and dorsal sides of the

creates a transverse thickening (ligament) – flexor and extension retinaculum

bodies, retinaculum flexorum et extensorum. The dorsal ligament through the re-

The stems fuses with the surface of the radius and ulna bones. Between these

sprouts under the ligament are six bone-fibrous canals, through which

These pass through the extensor tendons of the fingers. In the first channel (counting

from the radial edge) the tendons of m. abductor pollicis longus, etc. extensor

pollicis brevis, in the second-m. extensor carpi radialis longus and brevis; in third-

m. extensor pollicis longus; in the fourth-m. extensor digitorum and m. extensor

indici; in the fifth - m. extensor digiti minimi; in the sixth - m. extensor carpi ulnaris.

Extensor pollicis longus injury within the terminal phalanx. This injury is no different from similar injuries to the extensor muscles of the other fingers. In the presence of damage localized proximal to the main joint, there are conditions for applying a primary tendon suture, but after 3-4 weeks, a secondary tendon suture is not feasible due to shortening of the ends of the tendon.

To eliminate a defect free tendon transfer required or it is better to use tendon transposition. Transposition uses the common extensor tendon of the second finger, to which the distal end of the extensor pollicis tendon is sutured.

Extensor longus rupture occurs quite often. This damage is divided into the following types:
1. direct or indirect rupture caused by trauma;
2. spontaneous rupture:
a) occupational hazards,
b) tendon changes,
c) rupture due to damage to the limb.

Tendon rupture due to direct injury and the result of its treatment using the tendon transposition method are presented in the figure (own observation).

"Spontaneous" tendon ruptures due to occupational hazards were described at the end of the last century by military doctors (Zander). The left hand of army drummers, when holding a drumstick, was in a position of pronounced dorsiflexion; due to its unnatural position, tenosynovitis and tendon degeneration developed, which led to “spontaneous” rupture.

A 47-year-old bricklayer suffered a hand injury as a result of a falling log; there was no active extension of the thumb of the right hand (a).
Immediately after the injury, stitches are applied only to the skin. Transposition of the extensor tendon of the index finger was performed under conditions of scar tissue. The result of the intervention is shown in photo b

Wurtenau described 59 cases of rupture tendons from the drummers of the Prussian army. These typical ruptures are known in the literature as “Drummer’s palsy” (“Trommerlahmung” or “Drummer’s palsy”).

IN tendon ruptures have been described in the literature due to various diseases. Thus, ruptures due to suppuration, gout, syphilis, tuberculous tendovaginitis (10 cases of Meson), gonorrhea (Melchior), polyarthritis (Lederich, Herries) and rheumatism (Vadstein).

At post-traumatic tendon rupture From the moment of injury to tendon rupture, there is a latent period lasting from several days to several years. The rupture of the extensor pollicis longus tendon after a fracture of the radius was first noticed by Linder (1885) and Geinicke (1913). Mek Master in 1932 collected only 27 similar cases from the literature.

F. Steppelmore in 1940 he wrote a general report about 148 already known cases. In 1955, G. Strandell, including his own 14 observations, reported 60 new cases of these injuries. Thus, 208 cases of post-traumatic tendon rupture are known in the literature. This type of injury predominates in women in 67-37%. In most cases, ruptures occur when the radius is dislocated or fractured without displacement of the fragments. The incidence of rupture of the extensor pollicis longus tendon, according to different authors, varies.

Frequency of this complications after Gauck radial fracture 6:100, according to Moore 3:500, according to Steppelmore 3:1000, according to Marcus 4:2134, according to Boehler 1:500.

Extensor pollicis longus begins on the dorso-radial surface of the middle third of the ulna and on the interosseous membrane. Its tendon at the level of the wrist passes in a separate tendon sheath. This space, the third dorsal tendon sheath, is essentially a bone canal. It is deeper and narrower than the sheaths of the other extensors. The tendon runs obliquely and, crossing with the long and short extensor carpi radialis, forms the ulnar edge of the “anatomist’s snuffbox”.

Extensor tendon within the proximal phalanx of the thumb it expands and attaches to the base of the distal phalanx. The main function of the extensor pollicis longus is to extend it at the terminal, main and saddle joints. In addition, this muscle promotes the retroposition of the thumb, participates in the dorsiflexion of the hand and, together with the adductor pollicis muscle, in adducting the latter. Its most important function is to fix the saddle joint.

Due to the fact that the condition for good capture is fixation muscles of the centrally located joints, loss of function of the long extensor pollicis leads to almost complete loss of grip function with the thumb.

Overwhelming most post-traumatic ruptures, long after the moment of injury, occurs not as a result of unusual efforts, but in the process of habitual daily movements. Tendon rupture in these cases is not accompanied by pain. After rupture, the thumb droops, the distal phalanx assumes a bent position and cannot be actively straightened. Retroposition and adduction of the thumb cannot be achieved. The contours of the ulnar edge of the “anatomical snuffbox” are smoothed out.

Due to the lack stabilization of the saddle joint the grip is not strong enough, so the patient is unable to use scissors, write, or fasten buttons.

Usually gap localized at the level of the distal edge of the dorsal transverse carpal ligament. Above this level, rupture occurs rarely, in approximately 7% of cases. The distal end of the tendon is palpated above the first metacarpal bone in the form of a nodule. The proximal end of the tendon contracts and moves quite far in the central direction. The tendon sheath collapses.

In a relationship pathogenesis of long extensor tendon rupture thumb, the authors' opinions agree. The special role of the canal and the course of the tendon are emphasized. Levy and Cohen consider Lister's tubercle, which forms the radial edge of the canal, as a hypomochlion, over which the tendon lengthens and disintegrates during movement.

Significance of radius fractures for subcutaneous rupture of the extensor pollicis muscle has been studied by many authors. According to most researchers, the callus formed after a fracture of the radius narrows the tendon canal, and existing bone fragments, gradually damaging the tendon, can contribute to its rupture.

According to Rau And Weigel, in tendon rupture, the deterioration of tendon vascularization over the age of 25-30 years is crucial, since in adults there are no longitudinal intratendinous vessels, and the external vascular network can suffer from various types of injuries. Strandell believes that the occurrence of post-traumatic tendon rupture is associated with a disruption of its blood supply due to injury (hematoma, thrombosis, degenerative changes in connective tissue), and the rupture occurs at the place of least resistance, that is, within the vagina.
Complete transection of the tendon with a sharp bone fragment is suggested only in rare cases.

Treatment of post-traumatic rupture of the extensor pollicis longus tendon must always be prompt. According to their principle, operations are divided into two groups, namely: methods of direct connection of the ends of the tendon and methods of tendon transposition - connecting the distal end of the torn tendon with another extensor tendon located nearby.

Direct method tendon end connections, due to stump reduction and tendon degeneration, is now rarely used. Methods for replacing tendon defects also did not lead to satisfactory results (free tendon transfer, replacement of the defect with fascia or artificial material, etc.).

Currently it predominates tendon transposition method. This method was first used by Duplay (1876). He connected the distal end of the extensor pollicis longus to the extensor carpi radialis longus. The extensor tendons that can be used for transposition are shown in the table.

For transpositions As a rule, it is best to use a tendon whose direction of traction and amplitude of sliding do not differ from the “tendon-muscle motor” being replaced. When considering the extensor tendon from these two points of view, it turns out that the requirements are best met, firstly, by the extensor tendon of the index finger, and secondly, by the tendon of the extensor carpi radialis longus.

The first of these was first used for this purpose by Mensch (1925), and in the recent past its use was recommended by many authors (Bunnell, Pulvertaft, Christoph) and especially I. Böhler. The advantage of the extensor radialis longus is its anatomical proximity to the site of the rupture and the fact that the direction of its traction acts on the ulnar side. Given its anatomical location, this tendon is recommended for transposition by Schlatter and Fett. The disadvantage of this muscle tendon is that it has less movement than the extensor pollicis longus tendon.

Transposition of the extensor tendon of the index finger Strandell performs it as follows: the tendon of the extensor extensor propria of the index finger is intersected above the head of the second metacarpal bone through a transverse skin incision of 1 - 2 cm. The distal end of the tendon is attached to the tendon of the common extensor of the index finger so that when the finger is straightened, it provides resistance to rotation of the index finger. Within the wrist, according to the location of the tendon, a longitudinal skin incision is made, through which the cut tendon of the extensor of the index finger is removed.

Then, using new cut at the level of the middle of the first metacarpal bone, the stump of the tendon of the extensor pollicis longus is released, and then connected “end to end” with the tendon of the extensor of the index finger, carried under the skin.

Rupture of the extensor pollicis longus tendon due to a radius fracture

Case of own observation: B.I., a 28-year-old teacher, received a fracture of the radius in a typical location with slight displacement of the fragments. After reposition, four weeks of fixation, and subsequent three weeks of functional therapy following removal of the plaster cast (Fig. a), the patient felt healthy. However, in the eighth week, while cleaning the apartment, in the absence of any strong movements, the patient felt a crunch in her thumb, after which it became impossible to straighten it. A typical position of the thumb for an extensor tendon rupture is shown in Fig. b.


Extensor pollicis longus highlighted in blue
Latin name	Musculus extensor pollicis longus
Start
Attachment	distal phalanx of the first finger
Blood supply	a. interossea posterior, a. radialis
Innervation	n. radialis (C VI -C VIII)
Function	extends the thumb
Catalogs

Extensor pollicis longus(lat. Musculus extensor pollicis longus ) - muscle of the forearm of the posterior group.

It has a fusiform abdomen and a long tendon. Lies next to the short extensor pollicis muscle. It starts from the interosseous membrane of the forearm, the interosseous edge and the posterior surface of the ulna. It goes down and passes into the tendon, which is surrounded by the sheath of the tendon of the long extensor pollicis (lat. vagina tendinis musculi extensoris pollicis longi ). Then, going around the first metacarpal bone and emerging on its dorsal surface, the tendon reaches the base of the distal phalanx, to which it is attached.

Function

Extends the thumb, pulling it to the back.

Write a review of the article "Extensor pollicis longus"

Notes

Muscles of the shoulder girdle

Shoulder muscles

Front group

Back group

Forearm muscles

Front group

Back group

Lateral group

Muscles of the hand

Muscles of the eminence of the thumb

Muscles of the eminence of the little finger

Middle group muscles

Muscles of the back of the hand

- No, guessing in the bathhouse, that’s scary! - said the old girl who lived with the Melyukovs at dinner.
- From what? – asked the eldest daughter of the Melyukovs.
- Don’t go, you need courage...
“I’ll go,” said Sonya.
- Tell me, how was it with the young lady? - said the second Melyukova.
“Yes, just like that, one young lady went,” said the old girl, “she took a rooster, two utensils, and sat down properly.” She sat there, just heard, suddenly she was driving... with bells, with bells, a sleigh drove up; hears, comes. He comes in completely in human form, like an officer, he came and sat down with her at the device.
- A! Ah!...” Natasha screamed, rolling her eyes in horror.
- How can he say that?
- Yes, as a person, everything is as it should be, and he began and began to persuade, and she should have occupied him with conversation until the roosters; and she became shy; – she just became shy and covered herself with her hands. He picked it up. It's good that the girls came running...
- Well, why scare them! - said Pelageya Danilovna.
“Mother, you yourself were guessing...” said the daughter.
- How do they tell fortunes in the barn? – asked Sonya.
- Well, at least now, they’ll go to the barn and listen. What will you hear: hammering, knocking - bad, but pouring bread - this is good; and then it happens...
- Mom, tell me what happened to you in the barn?
Pelageya Danilovna smiled.
“Oh, well, I forgot…” she said. - You won’t go, will you?
- No, I'll go; Pepageya Danilovna, let me in, I’ll go,” said Sonya.
- Well, if you're not afraid.
- Luiza Ivanovna, may I? – asked Sonya.

Extensor pollicis brevis, m. extensor pollicis brevis, located in the lower part of the forearm along the lateral edge of its dorsal surface.

The muscle starts from the interosseous membrane of the forearm and the posterior surface of the body of the radius, is directed obliquely downwards and is located next to the tendon m. abductor pollicis longus.

The tendons of these two muscles are surrounded by the tendon sheath of the abductor longus and extensor pollicis brevis, vagina tendinum mm. abductoris longi et extensoris brevis pollicis. Having passed under the extensor retinaculum, the muscle is attached to the base of the dorsal surface of the proximal phalanx of the thumb.

Function: extends and slightly abducts the proximal phalanx of the first finger of the hand.

Innervation: n. radialis.

Blood supply: a. interossea posterior, a. radialis.

- m. extensor pollicis longus, has a fusiform abdomen and a long tendon. Lies next to the previous muscle...
Atlas of Human Anatomy
- m. extensor hallucis longus, lies between the two previous muscles, with the upper two-thirds of the muscle covered by them. The muscle originates from the medial surface of the middle and lower thirds of the fibula and the interosseous...
Atlas of Human Anatomy
- m. flexor pollicis longus, looks like a long unipennate flat muscle lying on the lateral edge of the forearm...
Atlas of Human Anatomy
- m. extensor hallucis brevis, lies medially from the previous muscle...
Atlas of Human Anatomy
- m. flexor poliicis brevis, lies medially from the previous muscle and also directly under the skin. It starts from the flexor retinaculum, trapezium bone, trapezoid and capitate bones and the base of the first metacarpal bone...
Atlas of Human Anatomy
Large medical dictionary
- see Symptom of the thumb...
Large medical dictionary
- see List of anat. terms...
Large medical dictionary
- see List of anat. terms...
Large medical dictionary
- see List of anat. terms...
Large medical dictionary
- see List of anat. terms...
Large medical dictionary
- see List of anat. terms...
Large medical dictionary
- see List of anat. terms...
Large medical dictionary
- see List of anat. terms...
Large medical dictionary
- see List of anat. terms...
Large medical dictionary
- involuntary flexion and adduction of the first finger with passive extension of the bent II-V fingers, as well as extension and abduction of the first finger with passive flexion of the extended II-V fingers...
Large medical dictionary

"Extensor pollicis brevis" in books

Rules of Thumb for Spiral Leaders

From the book Spiral Dynamics [Managing Values, Leadership and Change in the 21st Century] by Beck Don

Rules of Thumb for Spiral Leaders 1. If a critical mass of thinking within the circle of followers is higher in the spiral than the proposed leadership, then that leadership can only impose its control through intimidation or force. As soon as it

Thumb length

author

Thumb length The longer the thumb, the more significant success such a person can achieve (Figure 40). It is known that Napoleon had unusually large thumbs. Watch the fingers of people speaking on television. You surely