Lister tubercle (dorsal radial tubercle) is a bony prominence on the dorsal surface of the distal radius, near the midline, at approximately the level of the wrist joint. It separates the second extensor compartment (ECRL and ECRB) on its radial side from the third compartment (EPL) on its ulnar side. The extensor pollicis longus tendon uses this tubercle as a pulley, changing direction around it to reach the thumb. It is easily palpated on the dorsal wrist and serves as the central landmark for dorsal wrist approaches.
| Articulations | |
|---|---|
| Landmarks |
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| Ossification | Part of the distal radial epiphysis, which appears at about 1 year and fuses with the shaft at about 17-19 years. |
Lister tubercle is a critical landmark in wrist surgery and interventional procedures. The radiocarpal joint injection and the 3-4 arthroscopy portal are placed just distal and ulnar to the tubercle, between the EPL and extensor digitorum tendons. EPL tendon rupture, occurring weeks after distal radius fracture, is caused by ischaemia and attrition of the tendon in its groove around the tubercle; it also occurs with rheumatoid tenosynovitis. It is usually treated by transferring the extensor indicis tendon. SLAC wrist reconstruction and wrist fusion approaches also use this tubercle as a starting point.
Turn the hand palm down and run a fingertip along the back of the distal radius in line with the gap between the index and middle fingers. About 1 cm above the wrist joint you will feel a small bony ridge; this is Lister tubercle. The extensor pollicis longus tendon hooks around its ulnar side, which you can feel by extending the thumb.
Delayed rupture of the extensor pollicis longus tendon in its groove around Lister tubercle, occurring 4-12 weeks after distal radius fracture from attrition on fracture callus or ischaemia from haematoma, produces sudden loss of thumb IP extension requiring immediate EI to EPL tendon transfer.
Inflammatory tenosynovitis of the EPL tendon in the third extensor compartment around Lister tubercle produces dorsal radial wrist pain and crepitus with thumb extension, managed with splinting, injection, and tenosynovectomy for refractory cases.
