Hand Surgery Source

Extensor Tendon Exam

Test, Exam and Signs

The examination of the extensor tendons is essentially the same procedure as the tests done for each of the extensor tendon muscles. This section shows images for each individual extensor tendon exam and the video below shows the combined exam of all the extensor tendons at once. The extensor tendons are the connection between each extensor muscle belly and its insertion site. The tendon exam is particular useful when the examinator is looking for evidence of tendon laceration or rupture. To find additional information for each muscle tendon unit use the links below to go to the individual muscle testing and extensor tendon examination sections.

Presentation Photos and Related Diagrams
Clinical Extensor Exam and Related Diagrams
  • EPL Exam - Thumb extended off plane of table. Extensor Pollicis longus (EPL) visible under skin.
    EPL Exam - Thumb extended off plane of table. Extensor Pollicis longus (EPL) visible under skin.
  • Thumb IP Extension by thenar intrinsics not necessarily because EPL intact.
    Thumb IP Extension by thenar intrinsics not necessarily because EPL intact.
  • Extensor digitorum communis (EDC) extending MP joints against resistance
    Extensor digitorum communis (EDC) extending MP joints against resistance
  • Extensor Indicis Proprius (EIP) extending index MP while long and ring held in flexion and examiner's left hand fingers palpate the muscle belly
    Extensor Indicis Proprius (EIP) extending index MP while long and ring held in flexion and examiner's left hand fingers palpate the muscle belly
  • Extensor digiti minimi (EDM) extending little finger MP while long and ring held in flexion.
    Extensor digiti minimi (EDM) extending little finger MP while long and ring held in flexion.
  • The extensor retinaculum prevents bowstring during extension. Its vertical septa define six extensor compartments. The first contains the Abductor Longus and Extensor Pollicis Brevis; the second contains the Extensor Carpi Radialis Longus & Brevis; The third contains the Extensor Pollicis Longus; The fourth contains the Extensor Digitorum Communis & Extensor Indicis Proprius: The fifth contains the Extensor Digiti Minimi; & the sixth contains the Extensor Carpi Ulnaris.
    The extensor retinaculum prevents bowstring during extension. Its vertical septa define six extensor compartments. The first contains the Abductor Longus and Extensor Pollicis Brevis; the second contains the Extensor Carpi Radialis Longus & Brevis; The third contains the Extensor Pollicis Longus; The fourth contains the Extensor Digitorum Communis & Extensor Indicis Proprius: The fifth contains the Extensor Digiti Minimi; & the sixth contains the Extensor Carpi Ulnaris.
  • Extensor Tendon Zones of Injury. Zone I to Zone VII for the fingers, hand and wrist. Zones TI to Tv for the thumb.
    Extensor Tendon Zones of Injury. Zone I to Zone VII for the fingers, hand and wrist. Zones TI to Tv for the thumb.
Definition of Positive Result
  • In tendon exam, an abnormal result (e.g. Cut tendon) is a positive one. During a positive tendon exam, the examiner should observe a abnormal tendon function.  The tested tendon can not move the joint(s) properly and can not provide normal power against the examiner's resistance to the normal joint motion that is usually provided by the tendon.
Definition of Negative Result
  • In tendon exam, an normal result (e.g. intact tendon) is a negative one. The exam is negative for a cut or ruptured tendon. During a negative tendon exam, the examiner should observe a normal tendon function.  The tested tendon should move the joint(s) properly and provide normal power against the examiner's resistance to the normal joint motion.
Comments and Pearls
  • Grade 5 normal strength varies from individual to individual.
  • Always compare affected to unaffect extremities before concluding that the strength is normal or abnormal.
Diagnoses Associated with Tests, Exams and Signs
Video
Extensor Tendon Examination
References
  1. Hislop JH, Avers D, Brown M. Daniels and Worthingham's Muscle Testing, Techniques of Manual Examination and Performance Testing. 9th ed. St. Louis, Missouri: Elsevier Saunders, 2014, pp. 138–202.
  2. Kendall FP, McCreary EK, Provance PG. Muscles Testing and Function. 4th ed. Baltimore, MD: Williams & Wilkins, 1993, pp. 235–298.