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Thwin SS, Fazlin Z, Than M
Correspondence: Dr San San Thwin, email@example.com
INTRODUCTION Multiple tendons of the abductor pollicis longus (APL) in the anatomical snuffbox of the wrist can lead to the development of de Quervain’s syndrome, which is caused by stenosing tenosynovitis. A cadaveric study was performed to establish the variations present in the tendons of the anatomical snuffbox in a Malaysian population, in the hope that this knowledge would aid clinical investigation and surgical treatment of de Quervain’s tenosynovitis.
METHODS Routine dissection of ten upper limbs was performed to determine the variations in the tendons of the anatomical snuffbox of the wrist.
RESULTS In all the dissected upper limbs, the APL tendon of the first extensor compartment was found to have several (3–14) tendon slips. The insertion of the APL tendon slips in all upper limbs were at the base of the first metacarpal bone, trapezium and fascia of the opponens pollicis muscle; however, in seven specimens, they were also found to be attached to the fleshy belly of the abductor pollicis brevis muscle. In two specimens, double tendons of the extensor pollicis longus located in the third extensor compartment were inserted into the capsule of the proximal interphalangeal joints before being joined to the extensor expansion. In two other specimens, the first extensor compartment had two osseofibrous tunnels divided by a septum that separated the APL tendon from the extensor pollicis brevis tendon.
CONCLUSION Multiple variations were found in the anatomical snuffbox region of the dissected upper limbs. Knowledge of these variations would be useful in interventional radiology and orthopaedic surgery.
Keywords: abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, tendon
Singapore Med J 2014; 55(1): 37-40; http://dx.doi.org/10.11622/smedj.2013216
|1. Mansur DI, Krishnamurthy A, Nayak SR, et al. Multiple tendons of abductor pollicis longus extensors. Int J Anat Var 2010; 3:25-6.|
| 2. Kulthanan T, Chareonwat B. Variations in abductor pollicis longus and extensor pollicis brevis tendons in the Quervain syndrome: a surgical and anatomical study. Scand J Plast Reconstr Surg Hand Surg 2007; 41:36-8. |
| 3. Akan M, Gideroglu K, Cakir B. Multiple tendons of the abductor pollicis longus muscle. Hand Surg 2002; 7:289-91. |
|4. Cunningham DJ, Romanes GJ. Cunningham's Manual of Practical Anatomy. 15th ed. New York: Oxford University Press, 1986.|
| 5. Nayak SR, Krishnamurthy A, Pai MM, et al. Multiple variations of the extensor tendons of the forearm. Rom J of Morpho and Embryol 2008; 49:97-100. |
| 6. Mehta V, Arora J, Suri RK, Rath G. A rare quadruplicate arrangement of abductor pollicis longus tendons: anatomical and clinical relevance. Clinics (Sao Paulo) 2009; 64:153-5. |
|7. Kocabiyik N, Tatar I, Yalcin B, Yazar F, Ozan H. Tendon variations of extensor digitorum and abductor pollicis longus muscles. Int J Anat Var 2009; 2:54-6.|
|8. Cihák R. Connections of the abductor pollicis longus and brevis in the ontogenesis of the human hand. Folia Morphol (Praha) 1972; 20:102-5.|
| 9. Nishijo K, Kotani H, Miki T, Senzoku F, Ueo T. Unusual course of the extensor pollicis longus tendon associated with tenosynovitis, presenting as de Quervain Disease--a case report. Acta Orthop Scand 2000; 71: 426-28. |
| 10. Trevor D. Rupture of the extensor pollicis longus tendon after Colles fracture. J Bone Joint Surg Br 1950; 32-B:370-5. |
| 11. Magnussen PA, Harvey FJ, Tonkin MA. Extensor indicis proprius transfer for rupture of the extensor pollicis longus tendon. J Bone Joint Surg Br 1990; 72:881-3. |
| 12. Nayak SR, Hussein M, Krishnamurthy A, et al. Variation and clinical significance of extensor pollicis brevis: a study in South Indian cadavers. Chang Gung Med J 2009; 32:600-4. |
| 13. Witt J, Pess G, Gelberman RH. Treatment of de Quervain tenosynovitis: a prospective study of the results of injection of steroids and immobilization in a splint. J Bone Joint Surg Am 1991; 73:219-22. |