The EPL tendon runs in the third dorsal compartment and takes a sharp turn around Lister tubercle on the dorsal distal radius, crossing over the radial wrist extensors and the anatomical snuffbox to insert on the thumb distal phalanx. This change of direction creates friction against the tubercle and leaves a poorly vascularised segment of tendon, making it susceptible to attrition rupture after distal radius fractures, including undisplaced ones, typically several weeks after injury. EPL rupture produces drooping of the thumb tip without pain.
| Muscle | |
|---|---|
| Attachment | Passes around Lister tubercle at the dorsal distal radius, crosses the anatomical snuffbox to insert on the thumb distal phalanx |
Thumb IP joint extension; retropulsion of the thumb; forms the dorsal border of the anatomical snuffbox
EPL rupture after distal radius fracture is detected by loss of thumb retropulsion: the patient cannot lift the thumb off a table with the palm flat. It is managed with extensor indicis proprius transfer rather than primary repair, as the tendon ends are typically too frayed for direct repair, and the transfer reliably restores thumb IP extension. EPL tenosynovitis at Lister tubercle, from inflammatory arthritis or repetitive use, produces dorsal wrist pain and crepitus with thumb extension and can precede rupture.
Tendon disruption at Lister tubercle after distal radius fracture producing sudden painless thumb droop, managed with EIP tendon transfer.
Inflammation of the EPL in its third compartment groove at Lister tubercle producing dorsal wrist pain and crepitus with thumb extension, managed with rest, splinting, injection or release.
This website uses cookies to enhance your experience. Some are essential for site functionality, while others help us analyze and improve your usage experience. Please review your options and make your choice.
If you are under 16 years old, please ensure that you have received consent from your parent or guardian for any non-essential cookies.
Your privacy is important to us. You can adjust your cookie settings at any time. For more information about how we use data, please read our privacy policy. You may change your preferences at any time by clicking on the settings button below.
Note that if you choose to disable some types of cookies, it may impact your experience of the site and the services we are able to offer.
Some required resources have been blocked, which can affect third-party services and may cause the site to not function properly.
This website uses cookies to enhance your browsing experience and ensure the site functions properly. By continuing to use this site, you acknowledge and accept our use of cookies.
