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Dorsum of thumb proximal phalanx base
13%
110/860
Dorsum of thumb distal phalanx base
16%
141/860
Radial aspect of 1st metacarpal base
15%
127/860
Base of 2nd metcarpal
52%
449/860
Extensor hood at 2nd metacarpophalangeal joint
2%
21/860
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The extensor carpi radialis longus (ECRL) attaches at the base of the 2nd metacarpal and is effectively decompressed by the release of the 2nd extensor compartment in cases of intersection syndrome. Intersection syndrome is a condition that causes increased friction between the 1st and 2nd dorsal compartments, leading to an inflammatory response. Repetitive wrist extension tends to worsen symptoms as this causes increased irritation where the 1st compartment tendons (abductor pollicus longus, extensor pollicus brevis) cross under the tendons of the 2nd dorsal compartment (extensor carpi radialis longus/brevis). Patients complain of pain 5-6 cm proximal to the wrist joint and sometimes note crepitus with resisted wrist and thumb extension in this region. Nonoperative modalities including splinting, therapy, and injections are often enough to improve symptoms, but occasionally surgical release of the 2nd dorsal compartment is required and should be performed 5-6 cm proximal to the wrist. Adams et al. published a JAAOS review article discussing tendinopathies of the hand and wrist. They note that many of these can be managed nonoperatively with splinting, injections, and therapy but may ultimately require surgical release if patients fail conservative management. Common tendinopathies include trigger finger, dorsal compartment tenosynovitis, and FCR tendonitis. Patrick et al. also reviewed hand and wrist tendinopathies, particularly in athletes. They discuss diagnosis and nonoperative/operative management strategies for these conditions. Further, they discussed return-to-play recommendations for these conditions for athletes. Incorrect Answers: Answer 1: This describes the insertion of the extensor pollicus brevis (EPB), found in the 1st dorsal extensor compartment. Answer 2: This describes the insertion of the extensor pollicus longus (EPL), found in the 3rd dorsal extensor compartment. Answer 3: This describes the insertion of the abductor pollicus longus (APL), found in the 1st dorsal extensor compartment. Answer 5: This describes the insertion of the extensor indicis proprius (EIP), found in the 4th dorsal extensor compartment.
3.6
(7)
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