The extensor pollicis longus tendon changes direction at Lister's tubercle on the dorsal radius, turning obliquely across the wrist to reach the distal phalanx of the thumb. At the wrist level it forms the medial boundary of the anatomical snuffbox and crosses over the radial wrist extensor tendons at an angle.
The EPL wrist tendon is vulnerable to attrition rupture at Lister's tubercle and to injury in distal radius fractures. Its oblique course at the wrist makes it palpable as a taut cord on the dorsoradial wrist during active thumb IP extension. EPL tendinopathy at the wrist level presents as dorsoradial wrist pain exacerbated by resisted thumb IP extension. Transfer of the EIP to the EPL is the standard reconstruction after rupture.
Degenerative change in the EPL tendon as it crosses the wrist, producing dorsoradial wrist pain reproduced by resisted thumb IP extension, distinct from the more common Lister's tubercle rupture site.
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