Tendon surgery of the hand 9781437722307 us elsevier. The clasped thumb must be differentiated from the trigger. Abductor pollicis longus muscle an overview sciencedirect. The unusual suspects flexor pollicis longus muscle of the. Spontaneous rupture of the extensor pollicis brevis tendon. It travels through the carpal tunnel which is the point connecting the palm and forearm, and goes into the thumb. Apr 10, 2020 the 1st and 2nd metacarpals are curtained off from this space by the adductor pollicis, which arises from the shaft of the 3rd metacarpal and passes as a triangular sheet to the base of the proximal phalanx of the thumb. It lies in the same plane as the flexor digitorum profundus this muscle is unique to humans, being either rudimentary or absent in other primates. Abductor pollicis longus tendon division with swan neck. Because of its ability to pronate the forearm, the stretch position should include full forearm supination as well figure 7. Abductor pollicis longus is one of the major stabilizing tendon of the carpometacarpal joint of thumb. The prodrome of extensor pollicis longus tendonitis and. Extensor pollicis longus epl tendon rupture is a welldescribed phenomenon in patients with rheumatoid arthritis.
Repeat 10 times flexor pollicis longus repair weeks 46. Because the fpl generated greater force than all the other thumb tendons, fpl dysfunction might cause serious impairment in thumb movement especially during the pinches and grasp. Abductor pollicis longus tendon division with swan neck thumb. C the extensorpollicisbrevis tendon was repaired directly. In the clasped thumb or thumbinpalm contracture, the extensor pollicis longus, extensor pollicis brevis, and abductor pollicis longus muscle and tendon units are absent or attenuated. The composite system of extensor mechanism with extensor retinacula structures and both extrinsic and intrinsic tendon may contribute to the difficult management. The flexor pollicis longus is a flexor of the phalanges of the thumb. Its tendon runs just lateral to the extensor pollicis longus tendon to insert at the base of the first phalanx of the thumb on the dorsal aspect. Rupture of the extensor pollicis longus epl tendon. It arises from the lateral part of the dorsal surface of the body of the ulna below the insertion of the anconeus, from the interosseous membrane, and from the middle third of the dorsal surface of the body of the radius passing obliquely downward and lateralward, it ends. Nov 04, 2014 the abductor pollicis longus muscle is one of three muscles in the forearm that facilitate the movements of the thumb. Spontaneous rupture of the extensor pollicis brevis tendon in.
The standard anatomical description of the extensor pollicis brevis tendon provided in textbooks of anatomy is at odds with that of published anatomical studies. Read tendon transfers to restore opposition of the thumb by j. Because the flexor pollicis longus flexes the elbow, wrist, and thumb joints, it is stretched by extending the elbow, wrist, and thumb. This can be a result of trauma but, when spontaneous, diagnostic confusion can exist as incomplete palsy of the anterior interosseous nerve can present in a similar way. A 23% incidence of variation was observed in the apl muscle. Flexor pollicis longus, pronator quadratus, and the lateral half of the flexor digitorum profundus the medial half of the muscle is innervated by the ulnar nerve. In man and some of the apes, the thumb has the function of a contra finger.
It passes along the radial side of the tendon of the flexor pollicis longus the deeper and medial head varies in size and may be absent. Worldrenowned experts guide you through all of the newest techniques and technologies, equipping you to restore optimal function in your patients. In this study, the following prodrome of impending epl rupture was identified. Jan 26, 2015 the flexor pollicis longus muscle is located in the lower half of the arm, from the elbow down. Clinically patient had swelling and tenderness over the tendons in the first dorsal wrist compartment, besides finklesten test was. A simple clinical test of flexor pollicis longus rupture. The flexor pollicis longus muscles moves through the hand as a tendon. Abductor pollicis longus everything you need to know. Splinting and manipulation begin in infancy, and surgical correction is delayed until 3 years of age. Rupture of the extensor pollicis longus tendon youtube. Pdf abductor pollicis longus tendon interposition for. Tendon surgery of the hand ebook by jin bo tang, peter c.
The tendon of epl is located over the back of the wrist, where it bends through a tunnel, adjacent to a slight prominence of bone. This muscle is located between the two muscles which facilitate flexion of the thumb, namely the flexor pollicis brevis and the abductor pollicis. When the sheath becomes inflamed, the tendon cannot glide smoothly. Multiple tendons of abductor pollicis longus extensors of wrist extensor pollicis longus and extensor pollicis brevis. It is characterized by tendinopathy and stenosing tenosynovitis of the first extensor compartment, including the abductor pollicis longus and the extensor pollicis brevis tendons 47. Mean active interphalangeal joint flexion 44 and thumb opposition kapandji 8 10 were significantly reduced compared to the opposite side. Flexor pollicis longus washington university in st.
An accessory abductor pollicis longus aapl tendon is present in more than 80% of people and a separate muscle belly is present in 20% of people. Specifically, this muscle originates from the back surfaces of the radius and ulna and the. Jul 18, 2016 extensor pollicis longus tendinitis is characterized by pain in the back of the wrist from inflammation of a tendon sheath covering or strain of one of the tendons to the thumb, the extensor pollicis longus epl. The tendons of abductor pollicis longus apl and extensor pollicis brevis epb are located over the side of the wrist, where they pass through a tunnel. Rupture of the tendon of flexor pollicis longus is suspected when active flexion of the interphalangeal joint of the thumb is not possible. While abductor pollicis brevis and adductor pollicis, both attached to the extensor pollicis longus tendon, can extend the thumbs interphalangeal joint to the neutral position, only extensor pollicis longus can achieve full hyperextension at the interphalangeal joint.
Kettlebell exercises are more efficient for an athlete to increase his or her muscle strength. The thenar space is the space superficial to the 2nd and 3rd metacarpals and the adductor pollicis. Swan neck thumb deformity can be caused by osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, tendon transfers and paralytic. Multiple variations of the tendons of the anatomical snuffbox ncbi. Extensorpollicislongus or brevis tendon rupture after. Splinting and manipulation begin in infancy, and surgical correction is.
The extensor tendon injuries in thumb more frequently occur than flexor tendon. Apl had altogether 9 tendons and they were inserted to the lateral and anterolateral sides of the base of the first metacarpal bone and opponens pollicis two tendons each, to the abductor pollicis brevis. It is one of the five deep extensors in the forearm, along with the supinator, extensor pollicis brevis, extensor pollicis longus and extensor indicis apart from supinator, all the deep extensor muscles span from the forearm to the hand, crossing the wrist joints and thus being able to act upon them. Jul 31, 2019 the flexor pollicis longus muscles moves through the hand as a tendon.
Attachments and actions of the flexor pollicis longus. Spontaneous atraumatic extensor pollicis longus rupture in. Resist the distal phalanx from interphalangeal joint flexion of the thumb. Sep 01, 2016 extensor pollicis longus tendonitis is a condition that is classically seen in the setting of nondisplaced distal radius fractures and often progresses to tendon rupture. Includes the extensor pollicis longus by hyperextending the interphalangeal joint and allowing it to relax. Abductor pollicis longus painsignssymptomscausestreatment. Tendonitis may occur if either or both of the extensor pollicis longus and extensor pollicis brevis. After the distal necrotic tendon was trimmed, the extensorpollicislongus tendon was sutured with the transferred extensorindicisproprius tendon by using 40 nonabsorbable sutures. May 11, 2020 the flexor tendon sheaths of the remaining three fingers are separate. Clinically patient had swelling and tenderness over the tendons in the first dorsal wrist compartment, besides. A 39 year old gentleman came to our clinic with radial sided wrist pain following kettlebell exercises. The flexor pollicis longus fpl is structurally and functionally quite different from the flexor tendons of the other fingers. The tendons of the extensor pollicis brevis and abductor pollicis longus form the radial border of the anatomic snuffbox. Your fpl starts in the tip of your thumb, travels through the wrist and attaches to a muscle in your.
It passes along the radial side of the tendon of the flexor pollicis longus. Jul 24, 2019 the abductor pollicis longus muscle which along with two other muscles helps with motion of the thumb. What does the flexor pollicis longus fpl tendon do. These tendons pull the thumb up and out, as if trying to stretch out around a large object. In one study, the accessory tendon was inserted into the trapezium 41%.
Abductor pollicis longus is a muscle found in the posterior compartment of the forearm. The flexor pollicis longus is supplied by the anterior interosseous c8t1 branch of the median nerve c5t1. The abductor pollicis longus is a long, thin muscle of the forearm that allows you to give a thumbs up. The abductor pollicis longus lies immediately below the supinator and is sometimes united with it.
Multiple variations of the extensor tendons of the forearm. Repeat 10 times touch thumb tip to the tip of each finger making a circle shape and then straighten. After surgery, your forearm and hand will be in a large bandage and plaster splint. The abductor pollicis longus muscle is one of three muscles in the forearm that facilitate the movements of the thumb. To minimize swelling, you must keep your hand lifted up to your shoulder level. Although some isolated extensor pollicis longus epl ruptures are induced by radius fractures and chronic tendonitis 1,2, epb ruptures have been described only in association with softtissue injury of the thumb metacarpophalangeal mcp joint 3,4 and a sequential traumatic rupture. Please vote below and help us build the most advanced adaptive learning platform in medicine.
B methods and outcomes of zone 5 flexor tendon repairs. A second operation was performed 10 weeks after the first surgery, and intraoperative exploration revealed epl tendon entrapment. Mechanisms of epl tendon rupture in the nonrheumatoid population have also been described and include traumatic rupture, repetitive motion strain, and steroid injection into the tendon. Bakkers postop protocol important instructions following surgery. Multiple tendons of the abductor pollicis longus apl in the anatomical snuffbox of the. The others are the extensor pollicis brevis and extensor pollicis longus. However it carries the risk of injury especially in the beginners. To study the anatomy and kinematics of the thumb sagittal band sb and the influence of simulated injury on the stability of the extensor pollicis longus epl tendon. Repeat 10 times now bring your thumb up so that it is pointing towards the ceiling, hold it there for 10 seconds then relax. The flexor pollicis longus muscle is located in the lower half of the arm, from the elbow down. The radial bursa extends for the entire length of the flexor pollicis longus tendon and ends just proximal to the flexor retinaculum. The sheath secretes a fluid that lubricates the tendon. Failure of soft tissue differentiation can lead to congenital flexion deformities. Tendon transfers to restore opposition of the thumb ebook by.
Possible sites and causes of nerve compression are discussed. It usually also has a small attachment to the medial epicondyle of the humerus figure 4 note. Bilateral subluxation of the base of the thumb secondary to an unusual abductor pollicis longus insertion. The muscle system echart quick reference guide full illustrated corrugator supercilii levator labii superioris alaeque nasi nasalis levator labii superioris zigomaticus major zigomaticus minor levator anguli oris buccinator masseter, superficial portion orbicularis oris depressor labii inferioris anguli oris semispinalis capitis sternocleidomastoid longus capitis acromion. Routine dissection of ten upper limbs was performed to determine the. Pdf anatomical diversity in flexor pollicis longus muscle.
Tendon transfers to restore opposition of the thumb ebook por. Fashion a removable shortarm thumb spica splint holding the wrist in 30 degrees of extension, thumb cmc joint in full radial abduction and extension, mcp joint in neutral, and ip joint in neutral to slight hyperextension. The abductor pollicis longus muscle which along with two other muscles helps with motion of the thumb. Assisting the abductor pollicis longus in facilitating thumb movements are the extensor pollicis brevis muscle and the extensor pollicis longus muscle. Mar 05, 2016 a series of changes of primary treatment of divisions of the flexor pollicis longus tendon were carried out in the st. Palpate the flexor pollicis longus tendon as it crosses the proximal phalanx of the thumb on the palmar side. The extensor pollicis longus arises from the dorsal surface of the ulna and from the interosseous membrane, next to the origins of abductor pollicis longus and extensor pollicis brevis passing through the third tendon compartment, lying in a narrow, oblique groove on the back of the lower end of the radius, it crosses the wrist close to the dorsal midline before. It is crucial to the hand surgeon that he or she has a clear understanding of its anatomy, including its variations. It also works together with another tendon to bend the thumb over the base of the little finger. This can sometimes appear to be flexor pollicis longus function when actually it is the relaxation of the extensor pollicis longus.
The direction of resistance is towards extension of the interphalangeal. Primary repair of the flexor pollicis longus tendon plastic. Slips may connect with flexor digitorum superficialis muscle, flexor digitorum profundus muscle resulting. Anomalous abductor pollicis longus insertion in the thenar muscles. Its principal attachments are from the anterior surface of the radius to the anterior surface of the distal phalanx of the thumb. Rupture of the extensor pollicis brevis epb tendon is rare. The flexor pollicis longus is a muscle of the anterior forearm and hand. Tendon transfers to restore opposition of the thumb ebook. Perform all the latest procedures and get the best results with the new edition of operative techniques.
April 15, 2020 a tendon sheath is a membrane that wraps around a tendon, which allows the tendon to stretch and prevents it from adhering to the overlying fascia. A study of extensor pollicis longus and brevis and abductor pollicis. The ulnar and radial bursae and the synovial tendon sheaths. Gantzers muscle, an accessory head of flexor pollicis longus, was present in 45% of cadavers. Andrews unit in a total of 216 thumbs over 18 years in an attempt to reduce the rupture rate from the initial high level of 17%. Extensor pollicis longus extends the terminal phalanx of the thumb. Fashion a shortarm dorsal blocking splint with the wrist in 20 degrees of exion, the. Flexor pollicis longus tendon rupture after volar wrist plating acta. Pdf variations of the abductor pollicis longus tendon. Closed rupture of the extensor pollicis longus epl tendon was first described by duplay 1 in 1876. This oblique direction is so that it can pull the thumb up and back, as if trying to hitchhike.
The most commonly found tendon arrangement was two abductor pollicis longus apl and one extensor pollicis brevis epb. He described a 36yearold female cane maker who had fallen and injured her right hand. Posterior interosseo u s nerve c7 and c8, the contin u ation of the deep branch of the radial nerve c7, c8 arterial supply. To study the anatomy and kinematics of the thumb sagittal band sb and the influence of simulated injury on the stability of the extensor pollicis.
Extensor pollicis longus tendinitis musculoskeletal key. The flexor tendon sheaths of the remaining three fingers are separate. To the best of our knowledge, swan neck thumb deformity owing to division of abductor pollicis longus tendon is rare. Get the best results from the latest procedures with tendon surgery of the hand, the only reference that offers comprehensive coverage of this complex and challenging area. Flexor pollicis longus repair weeks 04 rehabilitation fpl repair weeks 0 to 4 rehabilitation you have injured the long tendon on the front of your ythumb flexor pollicis longus. Pollicis meaning in the cambridge english dictionary. In addition, a removable dorsal blocking splint is fashioned. It has been repaired but it will take at least 12 weeks until it is strong enough for you to return to unlimited activities. Palpate the tendon on the ulnar aspect of the anatomic snuffbox over the dorsal aspect of the hand. Swan neck thumb deformity can be caused by osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, tendon transfers and paralytic diseases. Lee tendon transfers to restore opposition of the thumb por j. Entrapment of the extensor pollicis longus tendon in a pediatric. Extensor pollicis longus tendinitis description extensor pollicis longus tendinitis is characterized by pain in the back of the wrist from inflammation of a tendon sheath covering or strain of one of the tendons to the thumb, the extensor pollicis longus epl. The deeper and medial head varies in size and may be absent.