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Munn A, Gillis J. Accessory Extensor Pollicis Longus Tendon Classification Modification. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:114-116. [PMID: 38313616 PMCID: PMC10837284 DOI: 10.1016/j.jhsg.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 02/06/2024] Open
Abstract
Supernumerary extensor pollicis longus (EPL) and extensor indicis proprius tendons are infrequently reported. There are few case reports on more than one accessory tendon in one individual. As a result, they are not represented in previously described classifications for variations in extensors to the thumb. Elective surgery was performed on a 57-year-old right-handed female. Within the fourth compartment, two anomalous accessory tendons were present. These tendons were identified as an accessory EPL tendon and an accessory extensor indicis proprius tendon. The normal EPL tendon occupied the third compartment ulnar to Lister's tubercle, as usual. The previous classification system for anomalous EPL tendons is useful in the organization and description of thumb extensor tendon variations. However, it is not a complete representation of the anomalies identified, including the one in this report. We have proposed an additional category for this classification system to better encompass the variation in anomalous tendon anatomy.
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Affiliation(s)
- Alexandra Munn
- Division of Orthopedic Surgery, St. John's, Newfoundland, Canada
| | - Joshua Gillis
- Division of Orthopedic Surgery, St. John's, Newfoundland, Canada
- Division of Plastic and Reconstructive Surgery, St. John's, Newfoundland, Canada
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Taradolpisut N, Suwannakhan A, Berkban T, Chaiyamoon A, Yurasakpong L, Iwanaga J, Tubbs RS, Kruepunga N, Georgiev GP, Samrid R. Accessory extensor pollicis longus from the extensor digitorum: a rare case report and review of the literature. Surg Radiol Anat 2023:10.1007/s00276-023-03155-2. [PMID: 37106240 DOI: 10.1007/s00276-023-03155-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/21/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE Variations of the extensor pollicis longus are rare. When present, these include a separate extensor pollicis longus muscle, tendon or an intertendinous connection with nearby tendons within the deep extensor compartment of the forearm. Here, we report an extremely rare variation of an accessory extensor pollicis longus originating from the extensor digitorum. METHODS An unusual muscle was found during the routine dissection forearm of a 71 year-old at death male cadaver. RESULTS This variant muscle originated from part of the extensor digitorum muscle belly that supplies the index finger. It became tendinous and entered the third extensor compartment of the wrist before joining the ulnar side of the extensor pollicis longus tendon. Traction on the muscle belly resulted in simultaneous extension of both the thumb and the index finger. CONCLUSION This study documents an extremely rare extensor tendon to the thumb originating from the extensor digitorum, with a unique attachment to the normal extensor pollicis tendon. There have been minimal accounts of this variation, and the present report adds to the limited literature. Furthermore, the report suggests a new subtype, 1f, be included in the existing classification system. Surgeons should be aware of this rare variant for proper evaluation, diagnosis and surgical treatment. Further anatomical studies are needed to study the prevalence of this variant.
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Affiliation(s)
- Napawan Taradolpisut
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand
- In Silico and Clinical Anatomy Research Group (iSCAN), Bangkok, Thailand
| | - Athikhun Suwannakhan
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand
- In Silico and Clinical Anatomy Research Group (iSCAN), Bangkok, Thailand
| | - Thewarid Berkban
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Nai-Muang, Muang District, Khon Kaen, 40002, Thailand
| | - Arada Chaiyamoon
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Nai-Muang, Muang District, Khon Kaen, 40002, Thailand
| | - Laphatrada Yurasakpong
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
- Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA
- University of Queensland, Brisbane, Australia
| | - Nutmethee Kruepunga
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand
- In Silico and Clinical Anatomy Research Group (iSCAN), Bangkok, Thailand
| | - Georgi P Georgiev
- Department of Orthopedics and Traumatology, University Hospital Queen Giovanna-ISUL, Medical University of Sofia, Sofia, Bulgaria
| | - Rarinthorn Samrid
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Nai-Muang, Muang District, Khon Kaen, 40002, Thailand.
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Tordjman D, Pierrart J, Bellity J, Delgrande D, Masmejean E. Accessory extensor pollicis longus: A rare tendon anomaly. HAND SURGERY & REHABILITATION 2017; 37:60-63. [PMID: 29248395 DOI: 10.1016/j.hansur.2017.10.234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 10/29/2017] [Indexed: 10/18/2022]
Abstract
This report provides a complete review of a rare anatomical variation, the accessory extensor pollicis longus (EPL) tendon and its clinical significance. We will describe a case of an asymptomatic accessory EPL that was found incidentally during surgery with a tendon located in the fourth extensor compartment. Pulling on it induced extension of the thumb interphalangeal joint. Very few cases of accessory EPL have been previously reported with various muscle origins and tendon insertions. In the literature, three symptomatic cases of accessory EPL were reported with a tendon running in a compartment other than the fourth. Although this variation is asymptomatic in most cases, knowledge of its existence might be useful in routine procedures to avoid inadvertent tendon damage, or during tendon repair.
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Affiliation(s)
- D Tordjman
- Division of hand surgery, department of orthopedic surgery, Tel-Aviv-Sourasky medical center, Weizmann St 6, Tel Aviv, Israel.
| | - J Pierrart
- Department of hand, upper limb and peripheral nerve surgery, Georges-Pompidou European Hospital (HEGP), AP-HP, 20, rue Leblanc, 75908 Paris cedex 15, France; Paris-Descartes University, Sorbonne-Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - J Bellity
- Department of hand, upper limb and peripheral nerve surgery, Georges-Pompidou European Hospital (HEGP), AP-HP, 20, rue Leblanc, 75908 Paris cedex 15, France; Paris-Descartes University, Sorbonne-Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - D Delgrande
- Department of hand, upper limb and peripheral nerve surgery, Georges-Pompidou European Hospital (HEGP), AP-HP, 20, rue Leblanc, 75908 Paris cedex 15, France; Paris-Descartes University, Sorbonne-Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - E Masmejean
- Department of hand, upper limb and peripheral nerve surgery, Georges-Pompidou European Hospital (HEGP), AP-HP, 20, rue Leblanc, 75908 Paris cedex 15, France; Paris-Descartes University, Sorbonne-Paris-Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
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