Rerouting Extensor Pollicis Longus Tendon Transfer

Following radial nerve palsy, loss of the extensor pollicis longus (EPL), abductor pollicis longus and extensor pollicis brevis tendons results in loss of thumb extension and radial abduction. Multiple tendon transfers are described to address the loss of thumb extension following radial palsy utilizing the palmaris longus or flexor digitorum sublimis transferred to the EPL tendon. Owing to its ulnar vector of pull, the EPL tendon is a secondary adductor of the thumb, and in order to mitigate the tendency for thumb adduction, the EPL tendon is divided at the wrist and brought subcutaneously to the radial side of the wrist for repair to the donor tendon to improve the line of pull for the donor tendon. We describe the use of a technique to reroute the EPL tendon through the first compartment in a retrograde fashion prior to repair with the donor tendon on the radial side of the wrist. The use of the first dorsal compartment provides a pulley to maintain the position of the transfer and to prevent potential bowstringing of the tendon as wrist flexion and thumb extension are attempted. because the repair is performed proximal to the extensor retinaculum, the donor tendon length is not compromised. Because the tendon is redirected through the first dorsal compartment and inserts into the distal phalanx, a single transfer attempts to restores both thumb extension and radial abduction.