The EPL tendon has a unique course — it passes through the third extensor compartment then makes a 30-degree radial turn around Lister's tubercle on the dorsal radius, functioning as a pulley. This angular course makes the EPL vulnerable to attrition rupture against the bone (Lister's tubercle) after distal radius fractures, even undisplaced ones, from disrupted local blood supply. Rupture occurs weeks to months after the fracture, distinguishing it from direct injury.
Thumb IP extension; thumb retropulsion (extension at the CMC); the only muscle that can extend the thumb from the plane of the palm
EPL attrition rupture presents as sudden loss of thumb IP extension weeks after a distal radius fracture in a patient who had otherwise recovered normally. The EIP-to-EPL transfer (at the thumb MCP level) is the standard repair — the EIP is rerouted subcutaneously from the index dorsum to the EPL stump, restoring thumb retropulsion. Primary EPL repair is rarely possible due to tendon attrition at the Lister's level.
Delayed EPL rupture at Lister's tubercle producing sudden thumb IP extension loss weeks post-injury managed with EIP tendon transfer.
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