Variation of abductor pollicis longus tendons in cadavers
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20181256Keywords:
Abductor pollicis longus tendon, Slips, Metacarpal, TrapeziumAbstract
Background: First extensor compartment of the wrist comprises of abductor pollicis longus and extensor pollicis brevis. It helps in movement and stabilization of thumb. Variations in the number of tendons of APL muscle may be asymptomatic and often incidental finding. Stenosing tenosynovitis of the first dorsal compartment of the wrist or de Quervains disease is a commonly encountered debilitating condition of the wrist.
Methods: This cadaveric study was done on 40 forearms in 20 cadavers available in Department of anatomy and forensic medicine at our institute. The muscles of extensor compartments were dissected, extensor retinaculum split over first extensor compartment, tendons of APL exposed. Study period from February-2017 to February-2018.
Results: There were 6 female and 14 male cadavers. The APL muscle was found with a single tendon in 2, double in 30, triple in 8. There were variations in the insertion of the APL tendon as well. In all hands, the APL tendon had insertion into the first metacarpal bone and in 20 hands (50%), it had second insertion into the trapezium.
Conclusions: Variation of APL muscle insertion in the Indian population and two or more tendinous slips attached commonly to the first metacarpal base and the trapezium may be the cause of treatment failure in DQT and cause of Trapeziometacarpal arthritis. Further studies needs to be done for further evaluation.
References
Bahm J, Szabo Z, Foucher G. The anatomy of de Quervain's disease. A study of operative findings: Int Orthop. 1995;19(4):209–11.
Bravo E, Barco R, Bullón A. Anatomic study of the abductor pollicis longus: A source for grafting material of the hand. Clin Orthop Relat Res. 2010;468:1305-9.
Melling M, Reihsner R, Steindl M, Karimian-Teherani D, Schnallinger M, Behnam M. Biomechanical stability of abductor pollicis longus muscles with variable numbers of tendinous insertions. Anat Rec. 1998;250:475-9.
Glajchen N, Schweitzer M:MRI features in de Quervain's tenosynovitis of the wrist. Skeletal Radiol. 1996;25:63-5.
Aydinlioglu A, Tosun N, Keles P, Akpinar F, Diyarbakirli S. Variations of abductor pollicis longus and extensor pollicis brevis muscles: Surgical significance. Kaibogaku Zasshi. 1998;73:19-23.
Zingas C, Failla JM, Van Holsbeeck M. Injection accuracy and clinical relief of de Quervain's tendinitis. J Hand Surg Am. 1998;23:89-96.
Mahakkanukrauh P, Mahakkanukrauh C. Incidence of a septum in thefirst dorsal compartment and its effects on therapy of de Quervain's disease. Clin Anat. 2000;13:195-8.
Roh MS, Strauch RJ, Xu L, Rosenwasser MP, Pawluk RJ, Mow VC. Thenar insertion of abductor pollicis longus accessory tendons and thumb carpometacarpal osteoarthritis. J Hand Surg Am. 2000;25:458-63.
Schulz CU, Anetzberger H, Pfahler M, Maier M, Refior HJ. The relation between primary osteoarthritis of the trapeziometacarpal joint and supernumerary slips of the abductor pollicis longus tendon. J Hand Surg Br. 2002;27:238-41.
Bravo E, Barco R, Bullón A. Anatomic Study of the Abductor Pollicis Longus: A Source for Grafting Material of the Hand. Clin Orthop Relat Res. 2010;468(5):1305-9.
Roy AJ, Roy AN, De C, Banerji D, Das S, Chatterjee B, et al. A cadaveric study of the first dorsal compartment of the wrist and its content tendons: Anatomical variations in the Indian population. J Hand Microsurg. 2012;4:55–9.
