|
Year |
2002 |
|---|---|
|
Question Number |
43. |
|
Category |
Hand |
Question
A 35 y/o man sustains a minimally displaced fracture of the distal radius that is treated in a long arm cast. Eight weeks after injury, he is unable to extend the IP joint of his thumb. Treatment should now consist of
1. decompression of the radial nerve in the forearm.
2. decompression of the radial nerve in the spiral groove.
3. tenolysis of the flexor pollicis longus tendon.
4. A1 pulley release in the thumb.
5. extensor indicis propius to extensor pollicis longus tendon transfer.
Figures
Answer (click for answer)
Preferred answer: 5
Discussion: Dr Culp loves this question!! He will always mention it in his tendon transfer talk and he gets angry when you get this question wrong!! The EPL is the main extensor of the IP joint of the thumb and an important extensor of the MCP joint of the thumb. Rupture of the tendon results in the inability to elevate the thumb in the plane of the palm.
The wording of the question should lead you to the answer. First clue: distal radius fracture, Second clue: cannot extend IP joint of thumb. Dr. Culp discussed the association of distal radius fractures and EPL rupture. Answers #3 and #4 are wrong. Each answer refers to a problem with flexion and the question does not mention anything about flexion. Also #4 is the treatment for a trigger thumb. A radial nerve palsy would result in more that just a loss of thumb extension. Therefore #5 addresses the fact that the tendon is ruptured and needs repair.
Reference: Magnussen PA, Harvey FJ, Tonkin MA: Extensor indicis proprius transfer for rupture of the extensor pollicus longus tendon. J Bone Joint Surg Br 1990;72:881-883.