Variations of the Extensor Pollicis Brevis Tendon and its Insertion: A Study of 44 Cadaveric Hands

Kulshreshtha, R; Patel, S.; Arya, Anand; Hall, Susan; Compson, J. P.

doi:10.1016/j.jhse.2007.04.013

Cited by 32 publications

(29 citation statements)

References 9 publications

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“…Many anatomical variations of the first dorsal compartment of the wrist and the tendons of the EPB and the APL have been reported. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Reports have documented higher incidences of multiple APL tendons and an EPB subcompartment in patients with de Quervain's disease than in the general population, 1,2,[5][6][7]9,10,14 and the possible impact on the etiology and treatment of the disease has been discussed. 1,2,14 It has previously been noted 15 that the EPB is absent in 5% to 7% of individuals, which is consistent with the incidence of 6% of the wrists having no EPB in the de Quervain's group in this study.…”

Section: Discussionmentioning

confidence: 99%

“…The APL is classically considered to be a thumb abductor and the EPB to be a metacarpophalangeal joint extensor, although their action may vary because there are many anatomical variations in this region. [1][2][3][4][5][6][7][8][9][10][11] The APL has more than 1 tendon slip in most cases, [1][2][3]6,7,9 and the EPB may be found in a separate subcompartment within the first dorsal compartment. 1,2,4 -7,9,10,12,13 The ability of the EPB to extend the thumb interphalangeal (IP) joint has been noted.…”

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confidence: 99%

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Thumb Interphalangeal Joint Extension By the Extensor Pollicis Brevis: Association With a Subcompartment and de Quervain's Disease

Alemohammad

Yazaki

Morris

et al. 2009

The Journal of Hand Surgery

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Thumb Interphalangeal Joint Extension By the Extensor Pollicis Brevis: Association With a Subcompartment and de Quervain's Disease

Alemohammad

Yazaki

Morris

et al. 2009

The Journal of Hand Surgery

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“…The EPB could be missing in 7.6% (Shigematsu et al, ), in 2.1% (Abdel‐Hamid et al, ), in 0% (Nayak et al, ; Kulshreshtha et al, ), in 2% (Jackson et al, ; Joshi and Joshi, ), in 3.75% (Brunelli and Brunelli, ), in 6.2% (Dawson and Barton, ), and in 5.5% (Wood, 1867, 1868). The average absence frequency is 2.7%.…”

Section: Resultsmentioning

confidence: 99%

The Relationship Between Digit Independence and Digital Sesamoids in Humans and a Proposal of a New Digital Sesamoid Evolutionary Hypothesis

Yammine

2018

The Anatomical Record

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Digital sesamoids are found in the metapodial-phalangeal joints of most mammals and quadrupedal tetrapods, yet their functional significance is still unclear. During primate evolution, a slight decline in their frequency has been associated with brachiation in gibbons, followed by a quasi-complete absence in orangutans then a slight resurgence occurred in gorillas and chimpanzees. Simultaneously, forearm muscles showed a progressive division in hominoid evolution towards a more "individualistic" musculature yielding more mobility and independence to some fingers. In humans, sesamoids are consistently observed in thumbs and big toes and frequently in other hypermobile digits such as the index and little fingers. Using a simple mathematical equation, this paper attempted to quantify a presumed association between hypermobile fingers and sesamoid frequency and distribution in humans. To this, an anatomic definition of digital independence has been formulated which includes three variables; (1) number and (2) frequency of independent flexor/extensor forearm muscles destined to a single finger, (3) and number of free/absent webspace. Results of previous meta-analyses and means of big sample studies were used to evaluate the frequency of such muscles. The expected values obtained via this model were found to be very close to the observed (published) values of the ossified sesamoids in human hands, and that in terms of frequency and distribution. The findings in humans showed a quasi-linear association between the degree of mobility and sesamoid frequency. The more the number of independent muscles destined to a finger, the more its metacarpo-phalangeal joint is likely to bear sesamoids. Based on our results and on a new analysis of primates' forearm/hand muscles and sesamoid evolution, a new hypothesis is proposed to answer two questions; the evolution of digital sesamoid frequency in primates and its sesamoid distribution in human digits. It claims that the number/frequency of independent forearm/hand muscles, and particularly the independent extensors, is likely to be a major factor in sesamoid reversion in hominoids. The argument is based on the link between the metatarsal break induced by the digitigrade locomotion observed in quadrupedal mammals and tetrapods and the amount of extra-extension of the metacarpo-phalangeal joints conferred by the individualization of some forearm extensors. The same rationale yielded similar conclusions when applied to both the hand and foot. The manipulative function of the hand and the plantigrade locomotion of the foot required such extra-extension in specific digits and consequently, a higher frequency of digital sesamoids was associated with these two different functions. The new evolutionary analysis suggests evolutionary pathways for both, the sesamoids of the hands and feet, and speculates that muscle individualization would have induced a very slow re-acquisition of digital sesamoids when compared to their rapid decline after brachiation. It is the first hypothesis offering ...

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“…26--28 The absence of the EPB altogether was seen in up to 20% of cadavers. 12,26--28 Ninety-three percent of hands had only one slip of EPB tendon, 3 and asymmetry of EPB insertion patterns was seen in half of the specimens, which Kulshreshtha et al 26 noted as well. As the data from these cadaver studies have shown, the variation in the EPB tendon anatomy is quite diverse.…”

Section: Extensor Pollicis Brevismentioning

confidence: 96%

“…Recently, Kulshreshtha et al 26 noted considerable differences in the EPB insertion patterns among cadaver studies. In these studies, the EPB inserting onto the first phalanx was seen from 0--25% of specimens, to both phalanges in up to 27%, and to only the distal phalanx up to about 6.8--8%.…”

Section: Extensor Pollicis Brevismentioning

confidence: 99%

Extensors of the hand

Chen

Gonzalez

Mohan

2013

Current Orthopaedic Practice

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The complex yet delicate anatomy of the hand allows for the array of functions it can accomplish. The coupled forces of flexion and extension with respect to each joint keep the digits in balance. To comprehend the sophisticated functions of the extensor tendons, one must have a clear appreciation for both the myriad of anatomical variations described in the literature and the dynamic forces occurring within this physical system. With an awareness of the possible aberrations and an understanding of these principles, the surgeon can make better preoperative and intraoperative decisions when dealing with a diseased or traumatized hand. To this extent, anatomical and functional variations documented in the literature are described here to better appreciate the extensor system of the hand with surgical applications in mind.

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Variations of the Extensor Pollicis Brevis Tendon and its Insertion: A Study of 44 Cadaveric Hands

Cited by 32 publications

References 9 publications

Thumb Interphalangeal Joint Extension By the Extensor Pollicis Brevis: Association With a Subcompartment and de Quervain's Disease

Thumb Interphalangeal Joint Extension By the Extensor Pollicis Brevis: Association With a Subcompartment and de Quervain's Disease

The Relationship Between Digit Independence and Digital Sesamoids in Humans and a Proposal of a New Digital Sesamoid Evolutionary Hypothesis

Extensors of the hand

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