An accessory extensor tendon of the thumb as a cause of dorsal wrist pain

Accessory Extensor Pollicis Longus Tendon Classification Modification

Supernumerary extensor pollicis longus (EPL) and extensor indicis proprius tendons are infrequently reported. There are few case reports on more than one accessory tendon in one individual. As a result, they are not represented in previously described classifications for variations in extensors to the thumb. Elective surgery was performed on a 57-year-old right-handed female. Within the fourth compartment, two anomalous accessory tendons were present. These tendons were identified as an accessory EPL tendon and an accessory extensor indicis proprius tendon. The normal EPL tendon occupied the third compartment ulnar to Lister's tubercle, as usual. The previous classification system for anomalous EPL tendons is useful in the organization and description of thumb extensor tendon variations. However, it is not a complete representation of the anomalies identified, including the one in this report. We have proposed an additional category for this classification system to better encompass the variation in anomalous tendon anatomy.

Accessory extensor pollicis longus from the extensor digitorum: a rare case report and review of the literature

PURPOSE

Variations of the extensor pollicis longus are rare. When present, these include a separate extensor pollicis longus muscle, tendon or an intertendinous connection with nearby tendons within the deep extensor compartment of the forearm. Here, we report an extremely rare variation of an accessory extensor pollicis longus originating from the extensor digitorum.

METHODS

An unusual muscle was found during the routine dissection forearm of a 71 year-old at death male cadaver.

RESULTS

This variant muscle originated from part of the extensor digitorum muscle belly that supplies the index finger. It became tendinous and entered the third extensor compartment of the wrist before joining the ulnar side of the extensor pollicis longus tendon. Traction on the muscle belly resulted in simultaneous extension of both the thumb and the index finger.

CONCLUSION

This study documents an extremely rare extensor tendon to the thumb originating from the extensor digitorum, with a unique attachment to the normal extensor pollicis tendon. There have been minimal accounts of this variation, and the present report adds to the limited literature. Furthermore, the report suggests a new subtype, 1f, be included in the existing classification system. Surgeons should be aware of this rare variant for proper evaluation, diagnosis and surgical treatment. Further anatomical studies are needed to study the prevalence of this variant.

Supernumerary extensor pollicis longus tendon masking an extensor pollicis longus rupture following non-surgical treatment of a distal radius fracture

Extensor pollicis longus tendon pathology is a recognised complication following non-surgical treatment of non-displaced distal radius fractures. Tendon entrapment typically presents with pain, but preservation of thumb retropulsion during complete rupture results in loss of active thumb retropulsion and tenodesis effect. We present the case of a 52-year-old woman who developed extensor pollicis longus tendon entrapment with full active thumb extension following a non-displaced distal radius fracture. During her elective third dorsal compartment release, the extensor pollicis longus tendon was found to be completely ruptured and a rare supernumerary extensor pollicis longus tendon was found emerging from the fourth dorsal compartment. Gentle traction of this tendon resulted in thumb interphalangeal joint extension and simultaneous index finger metacarpophalangeal joint extension. An extensor indicis proprius to extensor pollicis longus tendon transfer was performed. At her final 6-month follow-up, she had painless full active thumb motion comparable to her contralateral side.

Accessory extensor pollicis longus tendon in emergency surgery

Background

A true accessory extensor tendon of the thumb seems to be rare. We found a variation of the accessory extensor pollicis longus (EPL) tendon while performing an emergency surgical procedure. Identification of this accessory tendon during emergency surgery has not been previously reported.

Case presentation: A 43-year-old man presented to our hospital after sustaining a work-related injury involving a saw. During the operation, the tendons of the EPL, accessory EPL, and extensor pollicis brevis were severed. The lacerated tendon and tendon sheath were repaired, and the wrist and thumb were positioned in extension. The patient’s postoperative activity returned to normal without the need for a second tendon release operation.

Conclusions

Surgeons should be aware of this anatomic anomaly of the EPL tendon. Presentation of our case increases clinicians’ chances of preoperatively detecting this anomaly, which can improve surgical outcomes.

Accessory extensor pollicis longus: A rare tendon anomaly

This report provides a complete review of a rare anatomical variation, the accessory extensor pollicis longus (EPL) tendon and its clinical significance. We will describe a case of an asymptomatic accessory EPL that was found incidentally during surgery with a tendon located in the fourth extensor compartment. Pulling on it induced extension of the thumb interphalangeal joint. Very few cases of accessory EPL have been previously reported with various muscle origins and tendon insertions. In the literature, three symptomatic cases of accessory EPL were reported with a tendon running in a compartment other than the fourth. Although this variation is asymptomatic in most cases, knowledge of its existence might be useful in routine procedures to avoid inadvertent tendon damage, or during tendon repair.

Transfer of either index finger extensor tendon to the extensor pollicis longus tendon

BACKGROUND

Extensor pollicis longus (EPL) tendon ruptures have been treated succesfully with the transfer of the extensor indicis proprius (EIP) tendon. Situations exist in which, due to intraoperative observations, another tendon transfer may be considered preferable to the standard EIP transfer method.

OBJECTIVES

To determine whether transfer of the extensor digitorum communis II (EDC II) tendon from the index finger to the EPL tendon, leaving the EIP tendon to the index finger intact, would serve as an equally efficient transfer and not adversely affect the function of the hand.

METHODS

Two patients who had the EDC II tendon transferred to the ruptured EPL tendon, and two patients who had the EIP tendon transferred, were retrospectively reviewed. In each transfer type, one patient had suffered an EPL tendon rupture after a Colles' fracture, and the other had rheumatoid arthritis. The rupture occurred on the non-dominant side in one patient in each transfer type. Each patient was examined and subjected to range of motion and power testing at least one year following surgery.

RESULTS

All four patients showed a minimal extension lag with the lift off test, but there was no noticeable difference in range of motion, pinch grip and hand grip strength between the transfer types. Both EDC II transfer patients demonstrated an 8° to 15° loss of thumb interphalangeal joint flexion compared with the unoperated side; EIP transfer patients demonstrated less than a 5° loss. Three patients demonstrated a minor extension lag in the index finger and middle finger. Extension power of the thumb and index finger in all patients varied with wrist flexion and extension and ranged from 50% to 150% of the unoperated side.

CONCLUSIONS

These case reports suggest that either index finger tendon may be successfully transferred in EPL tendon ruptures.

A classification system for anomalies of the extensor pollicis longus

INTRODUCTION

Variations of the long extensor tendon to the thumb are very rare.

MATERIALS AND METHODS

We present three cases in which there was a supernumerary long extensor tendon to the thumb. In all three cases, the supernumerary tendon emerged from the fourth dorsal compartment and had a parallel course to the extensor pollicis longus.

RESULTS

Details of the anomalies are described along with a meta-analysis of relevant literature. A classification system of these anomalies is also proposed.

Double extensor pollicis longus tendon in independent extensor compartments: a case report of an anatomical variation requiring alteration of surgical strategy

The authors report the case of an anatomical variation with a double extensor pollicis longus tendon found during a dorsal approach to the wrist for rheumatoid arthritis. The accessory tendon was located in an additional separate wrist dorsal compartment, which is an extremely rare arrangement.

Sports-Related Injuries of the Wrist: An Approach to MRI Interpretation

Sports-related injuries to the wrist range from minor sprains to severe soft tissue disruption that can pose a risk to the normal function of the upper extremity. It is important to identify the specific nature of such injuries so as to establish an accurate diagnosis and deliver appropriate treatment. MRI of the wrist has greatly benefited from the use of dedicated surface coils, which allow fine depiction of soft tissue and cartilaginous structures. A review of the normal anatomy, MR interpretation pitfalls, and most common abnormalities of the tendons, ligaments, triangular fibrocartilage complex, and nerves of the wrist are presented.

MR imaging of tendon lesions of the hand and wrist

MR imaging of the hand and wrist tendons has greatly benefited from the use of dedicated surface coils, which allow fine depiction of the intricate anatomy of these structures, owing to high spatial resolution images as well as superb soft tissue contrast. MR imaging of the wrist and hand is obtained in the axial, sagittal, and coronal planes. The axial and sagittal planes provide most of the information necessary, however, to assess the tendons at the wrist and hand. The axial images are optimal for evaluating tendon morphology, longitudinal splits, tendon sheath fluid, and adjacent soft tissues such as overlying retinacula. The sagittal images are most useful for depicting abnormalities of the finger flexor and extensor tendons.

Estudo anatômico das inserções distais do tendão extensor longo do polegar

Registramos pelo presente estudo que o músculo (ELP) e seu tendão apresentaram poucas variações anatômicas. Não registramos a presença de tendões acessórios e nem a ausência desse músculo ou de seu tendão. Verificamos em todas as preparações a passagem do tendão pelo terceiro compartimento osteofibroso, cruzando sobre os extensor radial curto (ERCC) e longo (ERLC) do carpo e dirigindo-se ao polegar. A alteração no trajeto tendinoso, desviando-se no sentido radial foi verificada em uma das preparações (1,6%). A duplicação parcial do tendão proximal a articulação metacarpofalângica (AMFP) foi verificada em 3 observações (4,8%), sendo 1 bilateral, e distal à articulação em 5 (8,3%), 2 bilateralmente. A inserção óssea na base da falange distal (BFD) foi encontrada em todas as observações. Durante sua passagem pela articulação metacarpofalângica, registramos sua inserção na cápsula articular em 14 observações (23,3%), porém não registramos a inserção óssea nesse local. O padrão mais comum em relação ao músculo ELP foi a presença constante de 1 tendão, passando pelo terceiro compartimento osteofibroso dorsal do punho com inserção óssea na base da falange distal do polegar.

Supernumerary extensor pollicis longus tendon: a case report

We report a rare case in which the extensor pollicis longus (EPL) tendon was separated into 2 slips at the site of origin, ran an abnormal course across the wrist, and combined in the vicinity of the metacarpophalangeal (MCP) joint; the tendon on the radial side passed through another tendon sheath between the first and second compartments and the tendon on the ulnar side passed over the extensor retinaculum.