The EPL tendon uses Lister's tubercle on the dorsal radius as a pulley, changing direction from the dorsolateral forearm to the medial dorsal thumb. This direction change at Lister's tubercle creates a zone of friction and relative avascularity making the EPL vulnerable to spontaneous rupture — particularly after distal radius fractures (occurring in 0.3-3% of cases, typically 4-8 weeks post-injury) and in rheumatoid arthritis.
Thumb IP joint extension; thumb metacarpal extension; the only extensor acting on the thumb IP joint
EPL rupture after distal radius fracture presents as sudden painless loss of thumb IP extension 4-8 weeks after the fracture (the 'drummer-boy palsy'). The reduced blood supply from haematoma and peritendinous oedema at Lister's tubercle produces ischaemic rupture. Treatment: EIP-to-EPL transfer provides reliable thumb IP extension restoration.
Ischaemic EPL tendon rupture at Lister's tubercle 4-8 weeks after distal radius fracture managed with EIP-to-EPL tendon transfer.
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