Extensor Indicis Proprius to Extensor Pollicis Longus Tendon Transfer under Local Anesthesia. Surgical Technique

Abstract

Rupture of the extensor pollicis longus (EPL) tendon at the wrist has been described after fracture of the distal radius at Lister’s tubercle, in synovitis, tenosynovitis, or rheumatoid arthritis. The most common procedure for the treatment of irreparable ruptures of the extensor pollicis longus (EPL) tendon is the extensor indicis proprius (EIP) transfer. The main challenge of this technique is the correct tension setting of the transfer. The wide-awake technique allows patients to be awake during the operation and to retain full motor control of the hand. It provides the surgeon the ability to make clinical observations, adjust the tendon transfer tension according to active hand movement in order to make sure the transfer has the right tension before the skin closure. Hereby we present a technique for an EIP to EPL transfer for patients with irreparable rupture of the EPL tendon with the use of local anesthetic and tourniquet. This technique provides the surgeon the ability to assess properly the tension of the transfer by asking the patient to extend and flex his thumb during the operation.