Application of musculoskeletal ultrasound combined with Wide-Awake technique in extensor indicis proprius tendon transfer for repairing extensor pollicis longus tendon rupture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Xi ¹ , FAN Hua ² , SU Xixiong ² , FANG Xiang ¹ , XU Yongqing ¹ ,  HE Xiaoqing ¹

1. Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P. R. China;
2. Department of Ultrasonography, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P. R. China;

Corresponding?author：

HE Xiaoqing, Email: 6292753@qq.com

Keywords：

Musculoskeletal ultrasound; Wide-Awake technique; tendon rupture; tendon transfer; hand

DOI：

10.7507/1002-1892.202506034

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Objective To explore effectiveness of musculoskeletal ultrasound combined with Wide-Awake technique in extensor indicis proprius tendon (EIP) transfer for repairing extensor pollicis longus tendon (EPL) rupture. Methods A clinical data of 20 patients with EPL spontaneous rupture, who were admitted between January 2019 and June 2024 and met the selective criteria, was retrospectively analyzed. During EIP transfer surgery, the musculoskeletal ultrasound-guided incision marking combined with Wide-Awake technique was used in combination group (n=10) and the tourniquet-assisted surgery under brachial plexus block anesthesia in the control group. There was no significant difference in the baseline data between groups (P>0.05), including gender, age, affected side, cause and location of tendon rupture, and time from injury to hospitalization. The accuracy of preoperative musculoskeletal ultrasound in predicting the actual tendon rupture site was evaluated in the combination group. The operation time, intraoperative blood loss, visual analogue scale (VAS) scores during operation and at 6 hours after operation, total incision length, and postoperative complications were recorded. Surgical outcomes were assessed at 12 months after operation using the specific EIP-EPL evaluation method (SEEM), which included measurements of thumb elevation loss, thumb flexion loss, index finger dorsiflexion loss, and total score. Results In the combination group, the incision position marked by preoperative musculoskeletal ultrasound positioning was consistent with the actual tendon rupture position. Compared with the control group, the operation time and total incision length in the combination group were significantly shorter and the VAS score at 6 hours after operation was significantly higher (P<0.05). There was no significant difference in intraoperative blood loss or intraoperative VAS score between groups (P>0.05). All incisions in both groups healed by first intention. Two patients in the control group developed swelling and blisters in the tourniquet area, which subsided spontaneously without special treatment. All patients were followed up 12-14 months, with an average of 12.5 months. The thumb dorsiflexion function of all patients recovered to varying degrees. At last follow-up, the thumb elevation loss in combination group was significantly lower than that in control group, and the total score was significantly higher (P<0.05); there was no significant difference in thumb flexion loss or index finger dorsiflexion loss between groups (P>0.05). Conclusion Musculoskeletal ultrasound can accurately locate the site of tendon rupture, assist the Wide-Awake technique in implementing precise anesthesia, and adjust tendon tension while reducing tissue trauma, with satisfactory effectiveness.

Citation： YANG Xi, FAN Hua, SU Xixiong, FANG Xiang, XU Yongqing, HE Xiaoqing. Application of musculoskeletal ultrasound combined with Wide-Awake technique in extensor indicis proprius tendon transfer for repairing extensor pollicis longus tendon rupture. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(9): 1149-1154. doi: 10.7507/1002-1892.202506034 Copy

1.	Stirling P, Ng N, Duckworth AD, et al. Extensor indicis transfer improves function in patients after rupture of the extensor pollicis longus tendon. Hand Surg Rehabil, 2021, 40(3): 343-346.
2.	Ha C, Hong IT, Oh CH, et al. Clinical outcomes of extensor indicis proprius tendon transfer for extensor pollicis longus tendon rupture. J Hand Surg (Eur Vol), 2024, 49(10): 1243-1249.
3.	Brand PW. Biomechanics of tendon transfer. Orthop Clin North Am, 1974, 5(2): 205-230.
4.	Coulet B. Principles of tendon transfers. Hand Surg Rehabil, 2016, 35(2): 68-80.
5.	Jung SW, Kim CK, Ahn BW, et al. Standard versus over-tensioning in the transfer of extensor indicis proprius to extensor pollicis longus for chronic rupture of the thumb extensor. J Plast Reconstr Aesthet Surg, 2014, 67(7): 979-985.
6.	劉宇舟, 楊浩鈺, 魏蘇明, 等. 完全清醒技術在屈肌腱松解術中的臨床應用. 中國修復重建外科雜志, 2021, 35(5): 567-572.
7.	王長武, 朱柯楠, 梅榮飛, 等. 完全清醒無止血帶局部麻醉技術在手外科手術中的應用. 中國修復重建外科雜志, 2022, 36(12): 1566-1568.
8.	do Rosario Saraiva M, Vázquez OS, Ortiz-Huerta JH, et al. The wide-awake local anesthesia no tourniquet (WALANT) technique in thumb injuries: a systematic review. Eur J Trauma Emerg Surg, 2024, 50(6): 2833-2842.
9.	Hong J, Kang HJ, Whang JI, et al. Comparison of the wide-awake approach and conventional approach in extensor indicis proprius-to-extensor pollicis longus tendon transfer for chronic extensor pollicis longus rupture. Plast Reconstr Surg, 2020, 145(3): 723-733.
10.	邢樹國, 謝仁國, 湯錦波, 等. 完全清醒無止血帶局部止血麻醉(WALANT)在手肌腱手術中的應用. 中華手外科雜志, 2015, 31(4): 285-288.
11.	張茜. 肌骨超聲在診斷肢體肌腱和韌帶損傷中應用新進展. 影像研究與醫學應用, 2023, 7(3): 1-3.
12.	葉梅, 梁彤, 王小鳳, 等. 高頻超聲在Ⅰ區、Ⅲ區指伸肌腱斷裂與指骨近端撕脫性骨折鑒別診斷中的應用價值. 影像研究與醫學應用, 2021, 5(20): 124-126.
13.	Chew E, Lee Day A, Nazarian LN, et al. Basic musculoskeletal ultrasound. Med Clin North Am, 2025, 109(1): 137-161.
14.	Lalonde DH. “Hole-in-one” local anesthesia for wide-awake carpal tunnel surgery. Plast Reconstr Surg, 2010, 126(5): 1642-1644.
15.	張航, 劉亞平, 唐林俊, 等. Wide-awake技術在示指固有伸肌腱轉位修復拇長伸肌腱術中的應用. 實用手外科雜志, 2022, 36(2): 242-244.
16.	Lemmen MH, Schreuders TA, Stam HJ, et al. Evaluation of restoration of extensor pollicis function by transfer of the extensor indicis. J Hand Surg (Br), 1999, 24(1): 46-49.
17.	Adler RS. Musculoskeletal ultrasound: a technical and historical perspective. J Ultrason, 2023, 23(95): e172-e187.
18.	van Holsbeeck M, Soliman S, Van Kerkhove F, et al. Advanced musculoskeletal ultrasound techniques: What are the applications? AJR Am J Roentgenol, 2021, 216(2): 436-445.
19.	Fidan N, Turk AC, Yetis EUM, et al. Determination of congenital absence of palmaris longus tendon with clinical examination and ultrasonography. Surg Radiol Anat, 2021, 43(5): 741-748.
20.	Loomis KJ, Shin J, Roll SC. Current and future utility of ultrasound imaging in upper extremity musculoskeletal rehabilitation: A scoping review. J Hand Ther, 2024, 37(3): 331-347.
21.	Grandizio LC, Graham J, Klena JC. Current trends in WALANT surgery: A survey of American Society for Surgery of the Hand members. J Hand Surg Glob Online, 2020, 2(4): 186-190.
22.	Hearon BF, Isaacs-Pullins SR, Lalonde DH. Adoption of the wide-awake local anesthesia no tourniquet technique in hand surgery. JBJS Rev, 2023, 11(7). doi: 10.2106/JBJS.RVW.23.00068.
23.	Kohata K, Miyake T, Morizaki Y, et al. Treatment for complete extensor tendon rupture: A case report on extensor pollicis longus tendon transfer and tenodesis procedure to radius for a patient with rheumatoid arthritis. Mod Rheumatol Case Rep, 2024, 8(2): 237-242.
24.	Zukawa M, Osada R, Makino H, et al. Wide-awake flexor pollicis longus tendon reconstruction with evaluation of the active voluntary contraction of the ruptured muscle-tendon. Plast Reconstr Surg, 2019, 143(1): 176-180.

1. Stirling P, Ng N, Duckworth AD, et al. Extensor indicis transfer improves function in patients after rupture of the extensor pollicis longus tendon. Hand Surg Rehabil, 2021, 40(3): 343-346.
2. Ha C, Hong IT, Oh CH, et al. Clinical outcomes of extensor indicis proprius tendon transfer for extensor pollicis longus tendon rupture. J Hand Surg (Eur Vol), 2024, 49(10): 1243-1249.
3. Brand PW. Biomechanics of tendon transfer. Orthop Clin North Am, 1974, 5(2): 205-230.
4. Coulet B. Principles of tendon transfers. Hand Surg Rehabil, 2016, 35(2): 68-80.
5. Jung SW, Kim CK, Ahn BW, et al. Standard versus over-tensioning in the transfer of extensor indicis proprius to extensor pollicis longus for chronic rupture of the thumb extensor. J Plast Reconstr Aesthet Surg, 2014, 67(7): 979-985.
6. 劉宇舟, 楊浩鈺, 魏蘇明, 等. 完全清醒技術在屈肌腱松解術中的臨床應用. 中國修復重建外科雜志, 2021, 35(5): 567-572.
7. 王長武, 朱柯楠, 梅榮飛, 等. 完全清醒無止血帶局部麻醉技術在手外科手術中的應用. 中國修復重建外科雜志, 2022, 36(12): 1566-1568.
8. do Rosario Saraiva M, Vázquez OS, Ortiz-Huerta JH, et al. The wide-awake local anesthesia no tourniquet (WALANT) technique in thumb injuries: a systematic review. Eur J Trauma Emerg Surg, 2024, 50(6): 2833-2842.
9. Hong J, Kang HJ, Whang JI, et al. Comparison of the wide-awake approach and conventional approach in extensor indicis proprius-to-extensor pollicis longus tendon transfer for chronic extensor pollicis longus rupture. Plast Reconstr Surg, 2020, 145(3): 723-733.
10. 邢樹國, 謝仁國, 湯錦波, 等. 完全清醒無止血帶局部止血麻醉(WALANT)在手肌腱手術中的應用. 中華手外科雜志, 2015, 31(4): 285-288.
11. 張茜. 肌骨超聲在診斷肢體肌腱和韌帶損傷中應用新進展. 影像研究與醫學應用, 2023, 7(3): 1-3.
12. 葉梅, 梁彤, 王小鳳, 等. 高頻超聲在Ⅰ區、Ⅲ區指伸肌腱斷裂與指骨近端撕脫性骨折鑒別診斷中的應用價值. 影像研究與醫學應用, 2021, 5(20): 124-126.
13. Chew E, Lee Day A, Nazarian LN, et al. Basic musculoskeletal ultrasound. Med Clin North Am, 2025, 109(1): 137-161.
14. Lalonde DH. “Hole-in-one” local anesthesia for wide-awake carpal tunnel surgery. Plast Reconstr Surg, 2010, 126(5): 1642-1644.
15. 張航, 劉亞平, 唐林俊, 等. Wide-awake技術在示指固有伸肌腱轉位修復拇長伸肌腱術中的應用. 實用手外科雜志, 2022, 36(2): 242-244.
16. Lemmen MH, Schreuders TA, Stam HJ, et al. Evaluation of restoration of extensor pollicis function by transfer of the extensor indicis. J Hand Surg (Br), 1999, 24(1): 46-49.
17. Adler RS. Musculoskeletal ultrasound: a technical and historical perspective. J Ultrason, 2023, 23(95): e172-e187.
18. van Holsbeeck M, Soliman S, Van Kerkhove F, et al. Advanced musculoskeletal ultrasound techniques: What are the applications? AJR Am J Roentgenol, 2021, 216(2): 436-445.
19. Fidan N, Turk AC, Yetis EUM, et al. Determination of congenital absence of palmaris longus tendon with clinical examination and ultrasonography. Surg Radiol Anat, 2021, 43(5): 741-748.
20. Loomis KJ, Shin J, Roll SC. Current and future utility of ultrasound imaging in upper extremity musculoskeletal rehabilitation: A scoping review. J Hand Ther, 2024, 37(3): 331-347.
21. Grandizio LC, Graham J, Klena JC. Current trends in WALANT surgery: A survey of American Society for Surgery of the Hand members. J Hand Surg Glob Online, 2020, 2(4): 186-190.
22. Hearon BF, Isaacs-Pullins SR, Lalonde DH. Adoption of the wide-awake local anesthesia no tourniquet technique in hand surgery. JBJS Rev, 2023, 11(7). doi: 10.2106/JBJS.RVW.23.00068.
23. Kohata K, Miyake T, Morizaki Y, et al. Treatment for complete extensor tendon rupture: A case report on extensor pollicis longus tendon transfer and tenodesis procedure to radius for a patient with rheumatoid arthritis. Mod Rheumatol Case Rep, 2024, 8(2): 237-242.
24. Zukawa M, Osada R, Makino H, et al. Wide-awake flexor pollicis longus tendon reconstruction with evaluation of the active voluntary contraction of the ruptured muscle-tendon. Plast Reconstr Surg, 2019, 143(1): 176-180.

Chinese Journal of Reparative and Reconstructive Surgery

Application of musculoskeletal ultrasound combined with Wide-Awake technique in extensor indicis proprius tendon transfer for repairing extensor pollicis longus tendon rupture

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