The distal part of right forearm and hand showing six abductor pollicis longus tendons 16. Sonography of a rupture of the tendon of the extensor pollicis longus muscle. Its tendon is present in the first extensor compartment of the wrist. Extensor pollicis longus epl is the most commonly injured extensor tendon in the hand. 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. Extensor pollicis longus epl is a muscle of the deep compartment in the posterior compartment of the forearm. We report the case of a delayed flexor pollicis longus tendon rupture post distal radius fracture and its reconstruction using the demi tendon technique.
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%. We present a 24yearold male who sustained an open musculotendinous avulsion of the flexor pollicis longus tendon. However, plate prominence on followup radiographs is common. The surface anatomy of the fpl tendon at the thumb, the flexor retinaculum of the wrist, and the flexor carpi radialis fcr tendon just proximal to the flexor retinaculum fr are marked.
The unusual suspects flexor pollicis longus muscle of the. 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. It travels through the carpal tunnel which is the point connecting the palm and forearm, and goes into the thumb. Nov 04, 2014 the abductor pollicis longus muscle is one of three muscles in the forearm that facilitate the movements of the thumb. The tendons of the extensor pollicis brevis and abductor pollicis longus form the radial border of the anatomic snuffbox. Tips and tricks for getting more out of your delayed. Gliding resistance of the extensor pollicis brevis tendon. 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. Extensor pollicis longus extends the terminal phalanx of the thumb. 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. Longitudinal split tear of the extensor pollicis brevis. If an individual injures the abductor pollicis longus muscle and has pain and difficulty moving or using the thumb then the following treatment options and exercises may do a world of good in treating the condition and providing pain relief.
The present case reports about a variation in the origin of abductor pollicis longus apl. The clinical diagnosis was rupture of the left extensor pollicis longus tendon. Jul 24, 2019 if an individual injures the abductor pollicis longus muscle and has pain and difficulty moving or using the thumb then the following treatment options and exercises may do a world of good in treating the condition and providing pain relief. Two major tendons the extensor pollicis brevis and abductor pollicis longus tendons connect the thumb to the forearm, passing through. Sonography of a rupture of the tendon of the extensor pollicis. Abductor pollicis longus everything you need to know.
Extensor indicis to extensor pollicis longus transfer rehabilitation ei to epl weeks 04 rehabilitation you have ruptured the long extensor tendon to your thumb extensor pollicis longus. Several techniques have been described to enhance stability of the cmc 1. Flexor pollicis longus tendon rupture after volar wrist plating acta. The flexor pollicis longus muscle may be palpated on the posterior surface of the thumb. Extensor pollicis longus tendinitis musculoskeletal key. Rupture of the extensor pollicis longus epl tendon has been. Tendon graft and pulley reconstruction extensor pollicis. The structure indicated is the extensor pollicis longus muscle of the posterior forearm the extensor pollicis longus muscle is one of the muscles located in the deep layer of muscles in the posterior compartment of the forearm. The two tendons concerned are those of the extensor pollicis brevis and. Oct 26, 2015 we present a 24yearold male who sustained an open musculotendinous avulsion of the flexor pollicis longus tendon. You have had an operation to move one of the extensor tendons from your index finger to the remains of the thumb tendon. It is much larger than the extensor pollicis brevis, the origin of which it partly covers and acts to stretch the thumb together with this muscle.
The extensor pollicis longus was released from its 3rd compartment and transposed radialward. We report 2 cases of radialsided wrist pain caused by split tear of the extensor pollicis brevis tendon at the level of the carpus. A 30yearold righthanded man with no notable medical history presented with a 15month history of left radialsided wrist pain. The abductor pollicis longus apl is one of a deep extensor of the forearm and is responsible for facilitating movement and stabilisation of the thumb. The flexor pollicis longus fpl is structurally and functionally quite different from the flexor tendons of the other fingers. Extensor pollicis longus muscular, musculoskeletal. This technique has been well described in relation to delayed closed flexor digitorum profundus injuries as a method to facilitate primary repair. This page includes the following topics and synonyms. Extensor indicis proprius transfer for rupture of the extensor pollicis. Tips and tricks for getting more out of your delayed primary repair of ruptured flexor pollicis longus tendon charles yuen yung loh, alethea tan, makarand tare st andrews centre for plastic and reconstructive surgery, broomfield hospital, chelmsford cm1 7et, uk. Fibers of the flexor pollicis longus end in a flattened tendon that pass through the carpal channel and reach the thumb. Primary repair of the flexor pollicis longus tendon plastic. After surgery, your forearm and hand will be in a large bandage and plaster splint.
In fact, strictly speaking, this is not a tendonitis, as tendons are not inflamed, but the tunnel through which they pass becomes thickened and painful. The palmaris longus muscle itself is a weak flexor, and provides no substantial flexing force that would inhibit movement in the wrist if its tendon were cut and moved elsewhere. 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 is one of three muscles in the forearm that facilitate the movements of the thumb. It passes along the radial side of the tendon of the flexor pollicis longus.
Injuries to wrist are common especially with the beginners due to direct impact over the wrist or due to offcenter handling. Palpate the tendon on the ulnar aspect of the anatomic snuffbox over the dorsal aspect of the hand. The purpose of this study was to measure the gliding resistance of the extensor pollicis brevis and abductor pollicis longus tendons within the first dorsal compartment in a human cadaver model. 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. Instabilities of the thumb carpometacarpal cmc joint, caused by idiopathic ligamentous hyperlaxity, trauma or other conditions may lead to pain, functional impairment and eventually osteoarthritis. Subsequently, decompression of left epl and reconstruction of right epl with palmaris longus tendon graft was undertaken. Sep 19, 2016 closed rupture of the extensor pollicis longus epl tendon was first described by duplay 1 in 1876. Anatomy of the flexor pollicis longus muscle everything you.
This muscle is located between the two muscles which facilitate flexion of the thumb, namely the flexor pollicis brevis and the abductor pollicis. Flexor pollicis longus fpl tendoscopy of the left hand. The tendons most commonly replaced or supplemented by the palmaris longus tendon when ruptured are the long flexors of the fingers and the flexor pollicis longus tendon. The flexor pollicis longus muscle forms a part of the lower half of the arm which means it is located from the elbow moving downwards. Abductor pollicis longus muscle an overview sciencedirect. Present series of cases in view of the apparent rarity of spontaneous rupture of the extensor pollicis longus, its occurrence in a series of cases of rheumatoid arthritis seems worth reporting. Extensor pollicis longus radiology reference article. Injury to and rupture of the flexor pollicis longus fpl tendon are known complications after volar locking plate fixation for distal radial fractures. 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. Posterior surface of middle of ulna and interosseous membrane insertion.
Includes the extensor pollicis longus by hyperextending the interphalangeal joint and allowing it to relax. There is a debate in the literature about the number of distinct pulleys found at the thumb 17, 2427. The extensor pollicis longus tendon is at risk of rupture during healing 4 10 weeks of a distal radius fracture. Two patients presented with radialsided wrist pain and longitudinal split tears of the extensor pollicis brevis tendon. Origin, insertion, functions, and exercises for the flexor pollicis longus muscle. 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. Mean active interphalangeal joint flexion 44 and thumb opposition kapandji 8 10 were significantly reduced compared to the opposite side. Proximal tenotomy performed allowing endtoend tendon transfer with thumb in maximal abduction and extension, under maximal tension, of both distal and proximal stumps with pulvertaft weave with 40 prolene, assessing tension under passive tenodesis. Routine dissection of ten upper limbs was performed to determine the. Extensor indicis to extensor pollicis sussex hand surgery. Small cysts may be present at the pulley boundaries due to fluid trapping. Case reports in orthopedics hindawi publishing corporation.
Splinting and manipulation begin in infancy, and surgical correction is. In human anatomy, the extensor pollicis longus muscle epl is a skeletal muscle located dorsally on the forearm. Spontaneous atraumatic extensor pollicis longus rupture in. Extensor pollicis longus epl tendon rupture is a welldescribed phenomenon in patients with rheumatoid arthritis. 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. Jan 23, 2015 the extensor pollicis longus muscle begins at the ulna and the interosseous membrane, a tough fibrous tissue that connects the ulna and the radius in the lower arm. The first compartment consists of the abductor pollicis longus and extensor pollicis brevis tendons. The extensor pollicis longus tendon forms the lateral border of the anatomic snuffbox, the. Failure of soft tissue differentiation can lead to congenital flexion deformities. Figure 1 from flexor pollicis longus reconstruction using. The prodrome of extensor pollicis longus tendonitis and.
It passes through the 3 rd extensor compartment of the wrist, then continues laterally towards the thumb around listers tubercle. 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. The function of this muscle is to facilitate thumb flexion. The deeper and medial head varies in size and may be absent. May 18, 2018 adequate covering of the volar plate by the pronator quadratus muscle may help in decreasing the incidence of flexor pollicis longus tendon rupture. Plate protrusion is a risk factor for flexor pollicis longus fpl rupture following volar locking plate vlp surgery. The abductor pollicis longus is a muscle that moves the thumb in multiple directions. Nineteen of 37 abductor pollicis longus tendon sheaths were fluid. Any opinions in the examples do not represent the opinion of the cambridge dictionary editors or of cambridge university press or its licensors. Total time should be 8 10 minutes with a break or two. Because of its ability to pronate the forearm, the stretch position should include full forearm supination as well figure 7. The effect of plate design on the flexor pollicis longus.
On physical examination, the left extensor pollicis longus tendon was not palpable, and no tendon motion was noted with wrist tenodesis. We present a case of a patient with spontaneous rupture of right extensor pollicis longus epl tendon, who had also developed left wrist pain and weakness in his left epl that mri studies confirmed to be caused by tendinosis. Restoration of thumb flexion at the interphalangeal joint. Recent investigations have demonstrated that plate positioning contributes to the risk of tendon rupture. The functional result at 10 months following surgery was excellent. Differential sonographic features of the extensor pollicis longus. Abductor pollicis injuries usually involve the longus tendon, which is located right next to the extensor pollicis. Aug 27, 2017 origin, insertion, functions, and exercises for the flexor pollicis longus muscle. Which superficial flexor muscle of the forearm is the most lateral. For tendon transfer, the extensor indicis proprius eip is typically used 5 as it has a similar amplitude and direction of pull to the epl, and provides a predictable outcome. Pollicis meaning in the cambridge english dictionary. In this study, the following prodrome of impending epl rupture was identified. 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. Following repair of this tendon, whilst early active motion within a volar orthosis is simple and inexpensive, it is not known whether it is more effective at regaining thumb motion than immobilisation. Enthesopathy of the abductor pollicis longus tendon was identified in seven dogs. Can show varying degrees of flexor pollicis longus tendinosis local swelling of the flexor tendons distal to the pulley with a distinct nodule, a1 pulley thickening, and tenosynovitis. The second comprises the extensor carpi radialis longus and. Tendon graft and pulley reconstruction extensor pollicis longus epl for prehension. Multiple tendons of the abductor pollicis longus apl in the anatomical snuffbox of the. Early diagnosis in the second patient led to successful treatment with immobilization alone. Extensor pollicis tendonitis syndrome the extensor pollicis longus muscle has its origin on the lateral part of the middle third of the ulnar shaft on the dorsal border below the abductor pollicis longus muscle.
Multiple variations of the tendons of the anatomical snuffbox ncbi. This can sometimes appear to be flexor pollicis longus function when actually it is the relaxation of the extensor pollicis longus. Extensorpollicislongus or brevis tendon rupture after. Eavdi 12th annual conference ss 2 oral presentations x. Friction the tendon at a 90degree angle to the fibers for 45 minutes, take a break and then do it again. Abductor pollicis longus is supplied by the posterior interosseous artery. We hypothesize that these conditions might produce high gliding resistance, which could then induce micro.
The flexor pollicis longus inserts at the base of the distal phalanx of the thumb. Want a crash course in the origin, insertion, and innervation. Abductor pollicis longus is known for its variations in the form of multiple tendons at its insertion. Mayrhofer department of diagnostic procedures, radiology clinic, university of veterinary medicine, vienna. These examples are from the cambridge english corpus and from sources on the web. Loss of active flexion of the interphalangeal ip joint of the thumb if there is a transection of the flexor pollicis longus fpl tendon at the tendon channel of the thumb or thenar and direct suture is not possible but the tendon channel is intact, as alternative procedure to a free tendon graft if the transection is proximal to. Upon exploration, the distal end of the extensor pollicis longus tendon and the proximal stump of the extensor pollicis brevis tendon were identified red arrows. Eavdi 12th annual conference ss 2 oral presentations xray orthop. This muscle is believed to be unique and present only in humans. The flexor pollicis longus muscle has its origin in the middle 24 of the anterior surface of the radius and the adjacent interosseous membrane. 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. The sheath secretes a fluid that lubricates the tendon.
Severe disabling tendinopathy caused by anastrazole h. Mannerfelt syndrome refers to rupture of the flexor pollicis longus tendon from attrition caused by a bony spur in the carpal tunnel. The number of pulleys of the thumb varies from three to four 2427. Case report prophylactic decompression of extensor. Mean active interphalangeal joint flexion 44 and thumb opposition kapandji 810 were significantly reduced compared to the opposite side. Jul 31, 2019 the flexor pollicis longus muscles moves through the hand as a tendon. Because the flexor pollicis longus flexes the elbow, wrist, and thumb joints, it is stretched by extending the elbow, wrist, and thumb. The abductor pollicis longus apl is an important muscle. Anatomical variations of the extensor pollicis brevis. Bakkers postop protocol important instructions following surgery. He described a 36yearold female cane maker who had fallen and injured her right hand. Surgical debridement and repair was performed on the first patient with good results.
He was treated with primary tendon transfer using the flexor digitorum superficialis of ring finger, in flexor zone 3. Authors tested the looping of a slip from the abductor pollicis longus apl tendon around the first intermetacarpal ligament. Severe disabling tendinopathy caused by anastrazole. Conservative approach is the first line of treatment for abductor pollicis longus pain.
The abductor pollicis longus muscle is innervated by the posterior interosseous nerve, which is a continuation of the deep branch of the radial nerve after it passes through the supinator muscle. Revisiting spontaneous rupture of the extensor pollicis longus tendon. In addition, a removable dorsal blocking splint is fashioned. Its tendon appears at its distal extreme, just proximal of the distal head of the. The others are the extensor pollicis brevis and extensor pollicis longus. Anatomical variations of the extensor pollicis brevis tendon and abductor pollicis longus tendon relation to tenosynovectomy article in okajimas folia anatomica japonica 821. Abductor pollicis longus painsignssymptomscausestreatment. The three wrist flexors, from medial to lateral, are the flexor carpi ulnaris, palmaris longus. Anatomical variations of the extensor pollicis brevis tendon. The muscle belly consists fundamentally of three parts which results into two divisions of tendons.
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. Photograph of the radial side of the right wrist showing swelling of the tendon of the abductor pollicis longus. Rupture of the extensor pollicis longus epl tendon. Acute management and secondary reconstruction kevin r. Wrist european society of musculoskeletal radiology. Fashion a shortarm dorsal blocking splint with the wrist in 20 degrees of exion, the.
Tendon rupture associated with excessive smartphone gaming. Volar locking plates not touching the flexor pollicis. Abductor pollicis longus hemitendon looping around the first. Prophylactic decompression of extensor pollicis longus to. The aim of this study was to evaluate postoperative outcomes after cmc 1 joint stabilization using a softtissue. We studied six current designs of widely used plates in. Outcomes after thumb carpometacarpal joint stabilization. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Carson robertson flexor pollicis longus trigger point. This oblique direction is so that it can pull the thumb up and back, as if trying to hitchhike. Posthumus, severe disabling tendinopathy caused by anastrazole, rheumatology, volume 46, issue 10, october 2007. We hypothesised that a vlp that does not touch the fpl tendon can appear as a plate prominence projected over the volar ridge on lateral radiographs. The proximal stump of the extensor pollicis longus tendon was unavailable because it had retracted into the patients forearm.
The benefits of early active motion on thumb range of. Mar 05, 2016 a series of changes of primary treatment of divisions of the flexor pollicis longus tendon were carried out in the st. Stenosing synovitis of the extensor pollicis longus tendon. In this image, you will find extensor digitorum, supinator, extensor carpi radialis longus, abductor pollicis longus, extensor pollicis brevis, cut tendons of extensor digitorum, extensor indicis, extensor pollicis longus, extensor carpi radialis brevis, extensor carpi ulnaris, extensor digiti minimi, anconeus in elbow and forearm muscle and tendon anatomy in detail.