The extensor digiti minimi (EDM) tendon occupies the fifth extensor compartment at the wrist, ulnar to the fourth compartment (EDC). It provides an independent extensor tendon to the little finger, usually inserting as two slips (radial and ulnar) into the little finger extensor mechanism. Its independent compartment allows independent little finger extension even when EDC activation is absent. The EDM is used as a donor for tendon transfers, particularly for EPL reconstruction.
The EDM tendon is the standard donor for extensor pollicis longus (EPL) tendon transfer after EPL rupture (a recognised complication of distal radius fracture and rheumatoid arthritis). Transfer of the EDM to the EPL distal stump restores thumb interphalangeal joint extension. The fifth extensor compartment containing the EDM is relevant in ECU and DRUJ surgery at the ulnar wrist. EDM tenosynovitis at the wrist produces fifth compartment swelling and pain, managed by corticosteroid injection.
Extensor pollicis longus rupture occurring 6-12 weeks after distal radius fracture from attrition on Lister's tubercle osteophyte produces loss of IP joint extension of the thumb; the EDM tendon harvested from the fifth compartment is rerouted through the third compartment and sutured to the EPL distal stump, restoring thumb extension.
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