Abductor Pollicis Longus Research Articles

A case report: Surgical Release for De Quervain Syndrome after conservative treatment of distal radius fracture

Objective Describe the clinical and paraclinical characteristics of De Quervain Syndrome and the result of the surgery for De Quervain Syndrome after conservative treatment of distal radius fracture Subjects and methods A case report. Results De Quervain Syndrome is a condition that involves tendon entrapment affecting the first dorsal compartment of the wrist. It has been reported that De Quervain Syndrome can also develops after distal radius fracture. We report a case that the patient was diagnosed with De Quervain Syndrome after conservative treatment of distal radius fracture. During surgery we noticed that the patient had separated tendon sheaths for abductor pollicis longus (APL) and extensor pollicis brevis (EPB). EPB tendon sheath was released and reconstructed to prevent tendon subluxation. After 6 months, patient was feeling no pain and very satisfied. Conclusions De Quervain Syndrome development after distal radius fracture is rare. The successful surgery got the patient came back to work normally.

Rates of Early Recovery Following Thumb Carpometacarpal Arthroplasty: Comparing Ligament Reconstruction and Tendon Interposition, Abductor Pollicis Longus Suspensionplasty, and Suture Button Suspensionplasty

Abstract Background Several techniques have been previously described for the treatment of thumb carpometacarpal (CMC) arthritis, including trapeziectomy with ligament reconstruction and tendon interposition (LRTI), abductor pollicis longus suspensionplasty (APLS), or suture button suspensionplasty (SBS). It remains unclear whether a specific method produces faster recovery and more rapid return to function. The purpose of this study was to evaluate early clinical outcomes in patients undergoing thumb CMC arthroplasty stratified by method of treatment. Methods This study was conducted using a registry of patients undergoing thumb CMC arthroplasty using LRTI, APLS, or SBS. Patients were grouped by technique for comparison. Patient-reported outcomes were measured using Patient-Reported Outcome Measurement Information System (PROMIS) Upper Extremity, Pain Interference, and Pain Intensity scores and compared across cohorts using analysis of variance. Regression analysis was used to determine factors associated with early clinical outcomes. Results Note that 150 out of 201 patients met inclusion criteria for this study. Univariate regression demonstrated no difference between technique and achievement of minimal clinically important difference (MCID) by 1 year or ∆PROMIS scores at 1 and 3 months postoperatively. Stepwise multivariate regression analysis also found that technique did not contribute significantly to postoperative outcomes. Increased baseline PROMIS Upper Extremity scores were associated with lower odds of achieving MCID (odds ratio 0.80, p < 0.001). Baseline PROMIS scores were also associated with ∆PROMIS scores at 1 and 3 months postoperatively. Conclusion Patients undergoing thumb CMC arthroplasty via LRTI, APLS, or SBS can expect to experience similar improvements from baseline in the early postoperative period regardless of technique choice.

A new high-frequency ultrasound classification of De Quervain tenosynovitis

PurposeThis study aimed to introduce a new high-frequency ultrasound classification of De Quervain tenosynovitis based on a large group of patients. Detailed characteristics of classification are also reported. MethodsFrom January 2014 to February 2024, patients diagnosed with De Quervain tenosynovitis were retrospectively reviewed. High-frequency ultrasound (7−14 MHz) scanning was performed to identify the anatomy of the extensor pollicis brevis and abductor pollicis longus tendons, presence of intertendinous septa, and pathologic changes. The affected wrist was compared to the contralateral wrist. Results453 patients were included: 65 male and 388 female; mean age, 46 ± 27 years (range, 24–65 years). Symptom duration was 14 ± 27 weeks. Disease types were type 0 (n = 5), type 1 (n = 195), type 2a (n = 72), type 2b (n = 18), type 2c (n = 50), type 3 (n = 59), type 4 (n = 45), and type 5 (n = 9). Mean retinacular thickness was 2.1 ± 0.5 mm in affected wrists and 0.4 ± 0.1 mm in contralateral wrists (p < 0.01). The intercompartmental septum was significantly thicker on the affected side (1.2 ± 0.7 mm) than on the asymptomatic side (0.1 ± 0.4 mm) (p < 0.01). ConclusionsThis novel classification provides detailed ultrasonographic characteristics of De Quervain tenosynovitis, based on a large population of patients. It may help in selecting treatment and predicting outcome. However, relevance and therapeutic significance remain to be demonstrated. Level of EvidenceTherapeutic study, Level IV.

Variations of the abductor pollicis longus tendon and its insertion in the Thai population: Cadaveric study with clinical relevance

BackgroundThe abductor pollicis longus (APL) tendon exhibits significant anatomical variability, which is crucial for understanding its clinical implications in surgeries involving the thumb. While several studies have documented these variations in different populations, a systematic classification providing insights for surgical interventions targeting the thumb and its associated anatomical structures is rare. MethodsThis cadaveric study involved the dissection of 87 upper extremities from 44 embalmed cadavers (22 males, 22 females). The APL tendons were meticulously dissected, and the number of tendons slips and their insertion sites were recorded. Data were analyzed using Chi-square and Fisher's exact tests to assess differences in insertion sites between sexes and sides. ResultsThe number of APL tendon slips distal to the first extensor compartment ranged from 1 to 5, with double slips being the most common configuration. The primary insertion site was consistently the base of the first metacarpal bone, observed in all specimens. Secondary insertion sites included the abductor pollicis brevis muscle (67.82 %), trapezium (17.24 %), opponens pollicis muscle (5.75 %), and proximal phalanx (2.30 %). Statistical analysis showed no significant differences in the insertion sites between sides and sexes. A new classification system for APL tendon slips was developed, categorizing them into three main types (Type I, II, III), and two minor types (Type IV and V), based on the number and insertion sites of the tendons. Type II with double tendon slips was the most prevalent (48.28 %). Symmetrical findings were found in 21 cases (48.84 %), with subtype IIb being the most common pattern. ConclusionThis study highlights significant anatomical variations of the APL tendon in the Thai population, with important clinical implications for surgical planning and treatment of thumb-related conditions. The proposed classification system provides a structured framework for understanding these variations, aiding in the diagnosis and surgical management.

Comparing the Efficacy of Local Corticosteroid Injection and High-Intensity Laser Therapy in Patients with De Quervain Tenosynovitis

Background and Objective: De Quervain's tenosynovitis is one of the common causes of wrist pain. The present study aimed to compare the effectiveness of high-power laser therapy and local corticosteroid injection in the treatment of De Quervain's tenosynovitis. Materials and Methods: In this clinical trial, 30 patients diagnosed with De tenosynovitis were randomly assigned to two groups of 15, A and B. Group A underwent high-power laser therapy, five sessions for three consecutive weeks, and group B received corticosteroid injections of 1 ml triamcinolone and 1 ml lidocaine 2% in the wrist under ultrasound guidance. Tendon thickness, pain intensity, quality of life, and treatment satisfaction were measured and compared in both groups pre-treatment, month one, and month three post-treatment. Results: In groups A and B, respectively, the mean scores of the thickness of extensor abductor pollicis longus and abductor pollicis brevis muscles before the treatment were 7.57±0.63 and 7.25±0.58 (P=0.120). these value were calculated at 6.55±0.61 and 6.54±0.40 one month later (P=0.955). They were 5.71±0.75 and 5.99±0.45 (P=0.239) mm three months post-treatment. In addition, pain scores before the treatment were 8.60±1.18 and 8.47±1.46 (P=0.785). One month later, they were 2.73±1.66 and 4.27±1.16 (C=0.785), and three months post-treatment, they were 1.73±1.33 and 2.47±1.06 (P=0.007). There was no significant difference between the two groups in terms of quality of life and satisfaction with treatment (P&lt;0.05 for all). Conclusion: Both local corticosteroid injection and high-power laser treatment methods were safe in the treatment of De Quervain's tenosynovitis, leading to a reduction in pain and tendon thickness, as well as an increase in the patient's quality of life

Trapeziectomy and Mini TightRope Suspensionplasty for First Carpometacarpal Joint Arthritis.

First carpometacarpal (CMC) joint arthritis is a common debilitating condition affecting thumb function. Surgical management often involves trapeziectomy to alleviate pain and restore functionality. The suspensionplasty techniques maintain the trapezial height after trapeziectomy. The older techniques used the help ofligamentoplasty by takingthe flexor carpi radialis or the abductor pollicis longus. A new technique of suspensionplasty wherethe first metacarpal is suspended to the second by means of a strong suture material (fiberwire) and tied with help of a suture button (Mini TightRope; Arthrex, Naples, FL, USA). This technique is less invasive than the previous ligamentoplasties, because there is no need to harvest another nearby tendon. The addition of Mini TightRope suspensioplasty aims to stabilize the joint, potentially improving outcomes. A retrospective analysis was conducted on 20 patients undergoing trapeziectomy and Mini TightRope suspensioplasty between January 2022 and December 2023. Preoperative and postoperative assessments included pain scores, grip strength measurements, range of movement evaluations, and patient-reported outcomes using standardized questionnaires. Significant improvements were observed postoperatively in pain relief, with Visual Analog Scale scores decreasing from 7.8 preoperatively to 1.2 at six months follow-up. Grip strength increased by an average of 35%, and 85% of patients achieved near-normal range of movement. Patient-reported outcomes indicated high satisfaction rates, with enhanced ability to perform daily activities. Trapeziectomy combined with Mini TightRope suspensionplasty demonstrates favorable outcomes in managing first CMC joint arthritis. This approach effectively reduces pain, improves grip strength, and enhances functional capabilities, underscoring its role as a promising surgical option for patients seeking relief from thumb arthritis.

Double Mini TightRope Suture Suspensionplasty with FCR to APL Imbrication for Thumb Basilar Joint Arthritis: Intermediate Outcomes

Abstract Background We sought to evaluate the intermediate term outcomes of trapeziectomy with double Mini TightRope suture suspensionplasty and flexor carpi radialis to abductor pollicis longus imbrication for the treatment of basilar thumb joint arthritis. Case Description We performed a retrospective review of patients from 2012 to 2021 at a single institution within a standardized protocol. Thirty-nine patients (46 thumbs) with a mean age of 61 years and clinical follow-up of 2.8 years met our inclusion criteria. Grip strength increased from 13.8 kg preoperatively to 20.3 kg postoperatively. Appositional pinch strength increased from 3.7 to 5.7 kg, while oppositional pinch strength also increased from 2.8 to 4.4 kg. Trapezial space ratio was well maintained at 0.36 postoperatively compared with 0.46 preoperatively at a mean radiographic follow-up of 2.2 years. Literature Review and Clinical Relevance Results from our series demonstrate predictable outcomes with reduced pain levels, increased grip and pinch strengths, improved function, and preserved range of motion with few complications. Level of Evidence III therapeutic. Trial Registration Not applicable.

Accessory Abductor Pollicis Longus: An Anatomical Case Report

An accessory abductor pollicis longus (APL) tendon is present in more than 80% of people, but a separate muscle belly is present in only 20% of people. The present article documented the atypical anatomical variation of APL found during routine dissection. The muscle had three bellies and three tendons with unique bifurcation and attachments in the right upper limb of a 52-year-old male cadaver. The variation of APL is clinically important for surgeons doing flap surgeries, tendon transfer, for surgeons dealing with De Quervain’s tenosynovitis, and in any operative procedure involving the forearm and hand. Multiple APL tendons can be regarded as a functional advantage since injured tendons can be compensated by healthy ones. In addition, knowledge of the anatomy of the area is essential for treating this condition surgically by performing a tendon release after conservative treatment has failed.

Ligament Suspensionplasty With Suture Tape Augmentation​ for Basal Thumb Arthritis.

Thumb carpometacarpal arthritis is common with aging, more common in women than men, and usually occurs after age 40. If a patient fails conservative treatments such as splinting, medications, and corticosteroid injections, then surgical intervention may be appropriate. Currently, there is no consensus on the best surgical treatment. By limiting metacarpal subsidence, ligament suspensionplasty with suture tape augmentation offers great pain relief, excellent functional outcomes, and limited postoperative immobilization. With this technique, trapeziectomy is first performed. A portion of the abductor pollicis longus tendon is resected and loaded onto the SwiveLock anchor using 4-0 FiberLoop, in addition to suture tape. The prepared graft and tape construct is anchored into the lateral first metacarpal (MC) base and index metacarpal base. After surgery, patients are put in a short arm thumb spica splint, interphalangeal (IP) joints free. Active motion is initiated at the first postoperative visit, usually within 1 week. All patients who had thumb arthritis treated with carpometacarpal suspensionplasty and suture tape augmentation between 2015 and 2022 by a single hand surgeon at our institution were queried. A total of 110 patients were invited to take part in this study, and 61 patients consented and were included in this study. Mean last in-office follow up was at 7.5±4.0 months, which showed significant improvements in pinch strength (P=0.011). A survey taken at a mean 2.8±1.3 years (range: 0.5 to 5.2y) after surgery reports a postoperative DASH score of 7.3±7.7 (range: 0 to 23.3), and VAS pain score of 0.7±1.1 (range: 0 to 5).

De Quervain’s tendinitis after trapeziometacarpal arthroplasty

ObjectivesDe Quervain’s tendinitis is frequently observed after placement of a trapeziometacarpal prosthesis. The aim of this study was to investigate the relationship between De Quervain’s tendinitis, osteoarthritis of the thumb and placement of a trapeziometacarpal prosthesis. The second aim was a critical analysis of the literature in search of a cause for this postoperative event after arthroplasty or trapeziectomy. MethodsWe reviewed a series of 331 trapeziometacarpal prostheses. ResultsThere were no differences in thumb column length, gender, type of neck (straight or angled), or surgical approach between patients who developed De Quervain’s tendinitis and those who did not. However, the frequency of De Quervain’s tendinitis was much higher after arthroplasty than trapeziectomy. ConclusionsWe believe that the preoperative frequency of De Quervain’s tendinitis in trapeziometacarpal osteoarthritis is underestimated, being part of a more general pain symptomatology. More precise and specific examination is needed for a better preoperative diagnosis.Trapeziometacarpal osteoarthritis should be considered within a more global framework of peri-trapeziometacarpal pathology, including the trapeziometacarpal and triscaphoid levels, the articular ligaments and the abductor pollicis longus, extensor pollicis brevis, flexor pollicis longus, and flexor carpi radialis tendons.

Relationship to the superficial radial nerve and anatomic variations of the first extensor compartment in Thai population: a basis for successful de Quervain tenosynovitis treatment.

Knowledge of the superficial radial nerve (SRN) relationship and anatomic variations of the first extensor compartment (1st EC) will contribute to a better outcome of de Quervain tenosynovitis treatment. We dissected 87 embalmed cadaveric wrists to determine the relationship of the SRN, the 1st EC length, distance from the proximal and distal 1st EC borders to radial styloid process (RSP), abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendon slip numbers, and the presence of septum. Our results revealed SRN crossing over the 1st EC in 59.5%. The lateral branch of the superficial radial nerve to the 1st EC midline in most cases (61.9%) except for one specimen, where lateral antebrachial cutaneous nerve was the closest. Distances from proximal and distal 1st EC borders to the RSP were 19.7±4.1 mm and 7.6±1.8 mm, respectively. Extensor retinaculum (ER) width over 1st EC (1st EC length) was 14.8±3.2 mm. Complete and incomplete septa were found in 17.2%, and 42.5%, respectively. The most frequent APL tendon slip number in the compartment was two in overall 47 specimens (54.0%). Almost all compartments (85 specimens; 97.7%) contained one EPB tendon slip. We detected bilateral EPB absence in one cadaver. Moreover, we recorded a tendon slip from extensor pollicis longus traveling into 1st EC bilaterally in one cadaver and observed the EPB muscle belly extension into 1st EC in 9 wrists. Awareness of 1st EC anatomic variations would be essential for successful surgical and nonsurgical outcomes.

Anatomic location of the first dorsal extensor compartment for surgical De-Quervain's tenosynovitis release: A cadaveric study.

De-Quervain's tenosynovitis is a disorder arising from the compression and irritation of the first dorsal extensor compartment of the wrist. Patients who fail conservative treatment modalities are candidates for surgical release. However, risks with surgery include damage to the superficial radial nerve and an incomplete release due to inadequate dissection. Currently, there is a paucity of literature demonstrating the exact anatomic location of the first dorsal extensor compartment in reference to surface anatomy. Thus, this cadaveric study was performed to determine the exact location of the first extensor compartment and to devise a reliable surgical incision to prevent complications. To describe the location of the first dorsal compartment in relation to bony surface landmarks to create replicable surgical incisions. Six cadaveric forearms, including four left and two right forearm specimens were dissected. Dissections were performed by a single fellowship trained upper extremity orthopaedic surgeon. Distance of the first dorsal compartment from landmarks such as Lister's tubercle, the wrist crease, and the radial styloid were calculated. Other variables studied included the presence of the superficial radial nerve overlying the first dorsal compartment, additional compartment sub-sheaths, number of abductor pollicis longus (APL) tendon slips, and the presence of a pseudo-retinaculum. Distance from the radial most aspect of the wrist crease to the extensor retinaculum was 5.14 mm ± 0.80 mm. The distance from Lister's tubercle to the distal aspect of the extensor retinaculum was 13.37 mm ± 2.94 mm. Lister's tubercle to the start of the first dorsal compartment was 18.43 mm ± 2.01 mm. The radial styloid to the initial aspect of the extensor retinaculum measured 2.98 mm ± 0.99 mm. The retinaculum length longitudinally on average was 26.82 mm ± 3.34 mm. Four cadaveric forearms had separate extensor pollicis brevis compartments. The average number of APL tendon slips was three. A pseudo-retinaculum was present in four cadavers. Two cadavers had a superficial radial nerve that crossed over the first dorsal compartment and retinaculum proximally (7.03 mm and 13.36 mm). An incision that measures 3 mm proximal from the radial styloid, 2 cm radial from Lister's tubercle, and 5 mm proximal from the radial wrist crease will safely place surgeons at the first dorsal compartment.

De Quervain tendinitis after total trapeziometacarpal joint arthroplasty: Biomechanical evaluation of tendon excursion in the first extensor tendon compartment

De Quervain’s tenosynovitis is the most common complication after total trapeziometacarpal joint replacement. Etiology is unclear. Implantation of a ball-in-socket implant changes the biomechanics of the normal trapeziometacarpal saddle joint and increases its range of motion. The present study demonstrates that this procedure also significantly increases excursion of the abductor pollicis longus and extensor pollicis brevis tendons during thumb flexion-extension, and not during thumb abduction-adduction. Increased tendon gliding under the retinaculum of the first extensor tendon compartment could predispose to the development frictional tenosynovitis and play a role in the development of de Quervain’s syndrome after total trapeziometacarpal joint replacement. Level of evidenceNot applicable (laboratory study).

Cost-effectiveness and cost-utility of the ball-and-socket trapeziometacarpal prosthesis compared to trapeziectomy and ligament reconstruction: study protocol for a randomized controlled clinical trial

BackgroundTrapeziometacarpal (TMC) osteoarthritis (OA) is a common cause of pain and weakness during thumb pinch leading to disability. There is no consensus about the best surgical treatment in unresponsive cases. The treatment is associated with costs and the recovery may take up to 1 year after surgery depending on the procedure. No randomized controlled trials have been conducted comparing ball and socket TMC prosthesis to trapeziectomy with ligament reconstruction.MethodsA randomized, blinded, parallel-group superiority clinical trial comparing trapeziectomy with abductor pollicis longus (APL) arthroplasty and prosthetic replacement with Maïa® prosthesis. Patients, 18 years old and older, with a clinical diagnosis of unilateral or bilateral TMC OA who fulfill the trial’s eligibility criteria will be invited to participate. The diagnosis will be made by experienced hand surgeons based on symptoms, clinical history, physical examination, and complementary imaging tests.A total of 106 patients who provide informed consent will be randomly assigned to treatment with APL arthroplasty and prosthetic replacement with Maïa® prosthesis. The participants will complete different questionnaires including EuroQuol 5D-5L (EQ-5D-5L), the Quick DASH, and the Patient Rated Wrist Evaluation (PRWE) at baseline, at 6 weeks, and 3, 6, 12, 24, 36, 48, and 60 months after surgical treatment. The participants will undergo physical examination, range of motion assessment, and strength measure every appointment. The trial’s primary outcome variable is the change in the visual analog scale (VAS) from baseline to 12 months. A long-term follow-up analysis will be performed every year for 5 years to assess chronic changes and prosthesis survival rate. The costs will be calculated from the provider’s and society perspective using direct and indirect medical costs.DiscussionThis is the first randomized study that investigates the effectiveness and cost-utility of trapeziectomy and ligament reconstruction arthroplasty and Maïa prosthesis. We expect the findings from this trial to lead to new insights into the surgical approach to TMC OA.Trial registrationClinicalTrials.gov NCT04562753. Registered on June 15, 2020.

Rhizarthrosis: Resection Arthroplasty versus Resection Suspension Arthroplasty - Still the Gold Standard?

Rhizarthrosis is one of the most common arthritic changes in the hand, which has led to the development of a large number of surgical methods in recent years. In addition to the traditional resection arthroplasty with tendon suspension or interposition, if needed, thumb saddle joint prostheses are being used more and more frequently. However, these are not an option for all patients such as those with severe osteoporosis, severe nickel allergy, insufficient height of the trapezium or STT osteoarthritis. This study examined whether the traditional surgical methods continue to have their "right to exist" or whether they will be replaced by prostheses. In a retrospective study with prospective data collection, 48 hands of 45 patients diagnosed with rhizarthrosis in stages II and III according to Eaton and Littler were clinically examined 2.5 years after resection arthroplasty/resection-suspension-interposition arthroplasty using flexor carpi radialis (FCR) or abductor pollicis longus (APL) tendon strips in the years 2015-2018. The postoperative outcome was assessed using mobility, grip strength, two-point discrimination, postoperative satisfaction with regard to pain and resilience, as well as the DASH and MHQ questionnaires. There were no significant differences in surgery duration, inability to work, time to full weight-bearing, pain, satisfaction, grip strength and mobility. Regardless of the surgical method used, patients achieved an almost free range of motion in the thumb and wrist as well as age-appropriate hand strength. Pain at rest was rare; 48% were pain-free during exercise. The DASH questionnaire scored 20.2, 13.9 and 22.1 points and the MHQ scored 76.3, 79.3 and 79.4 points. Hence, the traditional surgical techniques showed good postoperative results with high patient satisfaction. "Newer procedures" such as endoprosthesis offer promising results in terms of faster regeneration times. However, this is offset by a longer surgery time and higher material costs, which means that resection arthroplasty represents a long-established procedure with a low potential for complications and a lower revision rate and should continue to be used, especially if there are relative contraindications to an endoprosthesis.

The place of B-mode ultrasonography, shear-wave elastography, and superb microvascular imaging in the diagnosis of De Quervain tenosynovitis.

Superb microvascular imaging (SMI) and Shear wave elastography (SWE) are newly developed ultrasonographic diagnostic tools used to support the diagnosis of De Quervain tenosynovitis (DQT). The aim of this study was to examine the capacity to differentiate between the wrist with DQT and the healthy wrist, as well as the potential for predicting the disease's severity using B-mode ultrasonography, SWE, and SMI. A total of 19 cases with unilateral clinical DQT were included in the prospective study. The wrists of these cases without DQT clinic constituted the control group. The SWE parameters of m/s and kPa cutoff values were ≤5.225 and ≤ 77.65, respectively, in the wrists with DQT compared to the wrists not diagnosed with DQT (p < 0.001). Regarding SMI findings no microvascularity was determined in the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendon sheaths of the wrists without DQT, and a significant increase was observed in the degree of microvascularity as the clinical severity of DQT increased. SWE results can differentiate between the presence and absence of DQT. SMI grading of the APL and EPB tendon sheaths may be helpful to the clinician in deciding the clinical severity of DQT.

Abductor pollicis longus spontaneous rupture in the context of a non-displaced distal radius fracture: A case report

Abductor pollicis longus spontaneous rupture in the context of a non-displaced distal radius fracture: A case report

Prevalence, evaluation, and clinical implications of a reticular tunnel formed by uncharacteristic distal fibers of the abductor pollicis longus

IntroductionVariations in muscles of the pollex are common, and some can elicit significant clinical implications. The abductor pollicis longus (APL) frequently exhibits non-typical morphologies; however, descriptions of uncharacteristic distal fibers from APL (APLudf) that form a reticular tunnel around the tendons of extensor carpi radialis longus (ECRL) and brevis (ECRB) are scarce in current literature. The objective of this study is to investigate the prevalence of APLudf with concurrent report of in situ and cross-sectional gross imaging. MethodsThe distal aspect of 110 APL muscles was examined for APLudf and reticular tunnel formation. Reticular tunnel length was measured over the long axis of the underlying ECRL tendon, and APLudf pennation angle was recorded. Characteristic APL and APLudf examples were photographed in situ, and one example of APLudf was cross-sectioned to show the bony attachment of the atypical fibers in relation to contiguous anatomy. A unique finding of an APLudf accessory tendon inserting onto an accessory abductor pollicis brevis muscle was removed, splayed, and photographed. ResultsAPLudf were present in 65 (59.1%) of upper limbs. The APLudf originated from a free origin over the ECRL and ECRB tendons and a fixed origin from the lateral margin of the distal radius and inserted onto the main APL tendon or an accessory tendon, creating a distinct reticular tunnel around the ECRL and ECRL with a mean length of 20.25 ± 5.55 mm (range = 11.09 mm–36.09 mm) and 12.99° ± 1.44° pennation. All APL muscles displayed one main tendon and at least one accessory tendon which originated solely from APLudf on 43 (39.1%) of the specimens. ConclusionsThe present study suggests the prevalence of APLudf is 59.1% and often occurs bilaterally. The restriction of intersecting movements within the APLudf reticular tunnel could cause ECRL and ECRB tendon inflammation (i.e., intersection syndrome), directly affect respective functions (e.g., radial extension of the wrist, abduction and extension of the thumb), and complicate surgical management in the region. This report may inform educators and healthcare providers when deliberating diagnosis, treatment, and healing of associated forearm, wrist, and pollex conditions.

Insights with consensus on Abductor Pollicis Longus from the Central Indian population at Nagpur, Maharashtra.

The anatomical snuff box is bounded laterally by the Abductor pollicis longus (APL) and the Extensor pollicis brevis (EPB) tendons. The variation in insertion of extensor tendons at the forearm and wrist is an interesting phenomenon. Therefore, a sound knowledge of such variations in extensor tendons is essential to know the consequence of tendon injury during implementation of its repair. Hence, we studied 48 formaldehyde fixed forearms of Indian-origin cadavers with age groups ranging from 33 to 67 years from the Central Indian population at Nagpur, Maharashtra, India. Variation in the insertion of APL was checked by tracing the tendon till its insertion. APL muscle was found with single tendon in 20 forearms, double in 9, triple in 8 and quadruple in 5 and five (maximum) in 6 forearms. In 93% (n=45), the APL tendon was inserted into the first metacarpal bone and in 7% (n=03), it was inserted into the trapezium bone. No variation was noted in the EPB tendon. Data shows that there are accessory slips in the APL tendon, differing from the standard description. Thus, data provides awareness of such potential variation among operating surgeons for better management of the diseased during dissection.

Tenoplasty in suspension with or without tendon interposition: A prospective randomized study in the treatment of advanced thumb carpometacarpal arthritis

IntroductionThe aim of this prospective and randomized study is to analyze and compare the outcomes of two surgical techniques for trapeziometacarpal joint osteoarthritis (Eaton-Littler grade III and IV). Materials and methods52 consecutive patients underwent surgical intervention by two different surgical techniques and checked for subjective outcomes (DASH, NPRS), objective outcomes (ROM, opposition test, grinding test, pulp pinch, hand grip) and radiographic outcomes. Surgical time was calculated. Results26 patients underwent suspension arthroplasty using abductor pollicis longus tendon interposition (Ceruso procedure) and 26 patients underwent arthroplasty using suspension tenoplasty of the flexor radialis carpi (Altissimi procedure). Both techniques were performed by a single surgeon and showed good and satisfactory results, with best outcome reported in Altissimi procedure regarding DASH and ROM (p = 0.011 and p = 0.012, respectively), with reduced surgical time (about 6 min less, p = 0.03). The proximal shift between scaphoid and the base of first metacarpal did not influence the final results of the cases treated. ConclusionThis study provides evidence that trapeziectomy in combination with both tendon suspension arthroplasty and tendon interposition are two surgical procedures useful to solve advanced basal joint arthritis. Patients who underwent suspension tenoplasty without tendon interposition seemed to be generally more satisfied with significantly better symptomatic and functional outcomes.