Anatomical Variations Affecting the Surgery of De Quervain's Disease

Abstract

Attention has been drawn to the variations found in the anatomy of the tendons of the abductor pollicis longus and extensor pollicis brevis muscles as they lie in the first extensor compartment of the wrist. Such variations involve reduplication of the abductor pollicis longus tendon and more rarely the extensor pollicis brevis tendon. An accessory tendon may occasionally lie in a separate osseo-fibrous canal. It is not unusual to find the abductor pollicis longus and extensor pollicis brevis tendons lying in separate compartments, because an accessory fibrous septum is subdividing the first extensor compartment into two parts. Furthermore, the extensor pollicis brevis tendon may also lie in its own separate fibrous canal in the depths and the more distal part of this common compartment. Such variation could lead to two possible misinterpretations during the course of surgical decompression for de Quervain's disease and these misinterpretations could reasonably be linked with the failure rate for this particular operation. 1. The finding of the abductor pollicis longus and its accessory tendon in a single compartment (12 per cent of wrists in the series) after a limited surgical incision could be mistaken for the abductor pollicis longus and extensor pollicis brevis tendons. Such a mistake would lead to failure to decompress the extensor pollicis brevis. 2. A failure to identify the deeper-lying separate canal for the extensor pollicis brevis in the distal part of the compartment would again be responsible for failure to decompress the extensor pollicis brevis (14 per cent of wrists in this series).

Variations of the abductor pollicis longus tendon: an anatomic study

“…The comprehensive understanding of variations in tendons of the hand and the fingers is necessary for the proper diagnosis of certain neurological disorders [7]. Among all, the abductor pollicis longus (APL) muscle is one of the most known to present numerous variations.…”

“…Since there are few reports on such abnormalities in standard anatomy and surgery textbooks, the study of alterations of the APL is of much importance for any academic, surgical and clinical purpose. Variants in the number of tendons of the APL muscle may be asymptomatic and often incidental finding [7,10,19,23].…”

Sonographic Identification of the Intracompartmental Septum in de Quervain's Disease

“…The intracompartmental septum reportedly occurs in 44% to 91% of patients with de Quervain's disease [3,5,6,9,13,16,18,19] although it is seen in only 20% to 40% of cadavers [3,4,6,[8][9][10][11]13]. Two previous studies have directly compared the prevalences of an intracompartmental septum in cadavers and patients with de Quervain's disease, and both reported a higher prevalence of an intracompartmental septum in patients [6,9].…”

Bilateral Morphological Variation of Abductor Pollicis Longus and Extensor Pollicis Brevis Tendons: A Cadaveric Case Report with Clinical Perspective

“…In chimpanzee, EPB shows insertion to base of first metacarpal and dorsal surface of the base of the proximal phalanx. In gorilla, APL is attached to both radial side of shaft of first metacarpal and trapezium (10). Therefore existence of anomalies involving the APL and EPB are explained based on atavism.…”