Double Extensor Digiti Minimi Transfer for Thumb Extension : Case Report

Extensor incidis proprius (EIP) is the commonest tendon transfer to restore thumb extension after loss of Extensor pollicis longus (EPL) function. Situations exist in which, due to intraoperative observations when EIP is not available such as, fraying strands, multiple smaller strands, uncertain identification of the two tendons and absence. Another tendon transfer may be considered preferable to the standard EIP transfer method.

A 54-year-old female, right hand dominant, who was bitten by cat for 2 months ago with  thumb dropped and cannot extend her thumb. Complete examination and intraoperative finding revealed rupture of the EPL tendon. An EIP tendon transfer can’t performed owing to absence of the tendon. We reported a successful reconstruction of thumb extension using double Extensor digiti minimi (EDM).

At 6 months postoperatively, the patient was pain free and returned to her previous level of activity. She demonstrated full extension, flexion, opposition, and radial abduction. At 1 year postoperatively, the patient’s score according to the Geldmacher method was excellent results.

Reconstruction of thumb extension using double EDM may be considered the selected treatment option when EIP is not available as a donor motor with excellent outcomes. A literature review reveals that this is the first report of such a transfer in an adult with cat bite and absence of EIP with double EDM transfer.

Keywords: Thumb extension, Double extensor digiti minimi, Tendon transfer