12:45

Extensor tenolysis and intrinsic release of the hand surgical technique

Overview

Subscribe to get full access to this operation and the extensive Upper Limb & Hand Surgery Atlas.

SUBSCRIBE


Learn the Extensor tenolysis and intrinsic release of the hand surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Extensor tenolysis and intrinsic release of the hand surgical procedure.

Adhesions of the extensor tendons can occur following operations or trauma. One of the common causes of extensor tendon adhesions is a fracture fixation of the metacarpal or proximal phalanx. When this occurs in the context of a crush injury hand often there can be scarring of the intrinsic muscles of the hand. This results in a combination of extrinsic and intrinsic tightness.

To understand the pathology of this condition and to recognise it one needs to understand the anatomy of extensor tendons and instrinsic muscles. The extensor mechanism of the fingers are made up of EDC tendons, EIP and EDM which arise in the forearm. At the MCP joint level they form the extensor hood and continue into the fingers as central slip and lateral bands. The intrinsic muscles, namely the lumbricals and interossei arise in the hand and are attached to the lateral bands. Therefore if there is scarring of the long extensor tendons or the instrinsic muscles patient looses the flexion of the fingers as the lateral bands are not able to move. To differentiate the two, one uses the Bunnell’s Instrinsic tightness test. In this test the PIP joint passive movements are checked with MCP joint in flexion and hyperextension. When there is tightness of the extrinsic muscles, the PIP joint flexion is improved when the MCP joint is hyperextended and the reverse is true with intrinsic tightness. This is because with MCP joint hyperextension the long extensors are relaxed and the intrinsics are stretched.

Though both lumbricals and interossei are involved in the scarring following a crush injury, it is the lumbrical which usually causes the loss of flexion. Lumbricals originate from FDP tendons and are four in number. The radial two are supplied by median nerve and the ulnar two by ulnar nerve. Lumbricals flex the MCP joints and extend the IP joints.

The patient in the case series sustained a crush injury to is left hand in an industrial press. He had closed fractures of four metacarpals and three proximal phalanges. They were treated with open reduction and internal fixation. After six months of hand therapy the plate and screws were removed and extensor tenolysis performed. However after six months it was noted that over the middle finger he had reduced flexion and on examination intrinsic tightness test was positive. A revision tenolysis was performed along with intrinsic release.

Author: Mr Rajive Jose FRCS

Institution : The Queen Elizabeth Hospital ,Birmingham ,UK.

 

Feedback

  • Each operation and the questions associated become named course in the CPD section
  • The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
  • You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
  • The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
  • There are four possible answers of which one is correct (or on occasion more correct) than the others.
  • There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
  • The course is completed once all the lessons are read and quizzes submitted and passed.
  • On successful completion of each quiz you will receive a validated certificate in your CPD folder.
  • Your dashboard also will contain a record of the time you have spent logged onto and using the site.
  • The timer suspends after 5 minutes though if there is no activity.
  • When you restart you will resume at the same point in the module.
  • Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
    The pass mark is 75%.
  • If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
  • Once these have been read you can re-do just the questions you failed on.
  • Once you have passed the quiz you can return at a future stage & resit .
Continue to Course Content

COURSE

Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.

Our content is designed for both Surgeons in independent practice and Surgeons in training.

COURSE PROGRESS

Lessons Status
QuizzesStatus

Accreditations

Logo Logo Logo Logo

Associates & Partners

Logo Logo Logo Logo Logo