Accessory extensor pollicis longus tendon in emergency surgery

Abstract

Background A true accessory extensor tendon of the thumb seems to be rare. We found a variation of the accessory extensor pollicis longus (EPL) tendon while performing an emergency surgical procedure. Identification of this accessory tendon during emergency surgery has not been previously reported. Case presentation: A 43-year-old man presented to our hospital after sustaining a work-related injury involving a saw. During the operation, the tendons of the EPL, accessory EPL, and extensor pollicis brevis were severed. The lacerated tendon and tendon sheath were repaired, and the wrist and thumb were positioned in extension. The patient’s postoperative activity returned to normal without the need for a second tendon release operation. Conclusions Surgeons should be aware of this anatomic anomaly of the EPL tendon. Presentation of our case increases clinicians’ chances of preoperatively detecting this anomaly, which can improve surgical outcomes.

Accessory Extensor Pollicis Longus Tendon Incidentally Discovered During Dorsal Distal Radius Plating

“…The clinical significance of this abnormality is easily overlooked considering that most variations are discovered incidentally during surgery or cadaveric and radiologic studies. 2 , 4 , 5 , 6 , 7 , 8 , 9 , 10 Few cases have presented with symptomatic EPL variations. Regardless of preoperative symptoms, knowledge of these abnormalities is imperative to avoid complications in dorsal plating of the radius.…”

An accessory extensor pollicis longus tendon: an anatomical variant

“…Anatomical variations of the EPL tendon are rare, with only a few anomalies incidentally discovered and reported in the literature 2,3 . Chiu 4 during a cadaveric dissection, discovered a supernumerary muscle during a cadaveric dissection which arose from the dorsal surface of the ulna immediately proximal to the EIP, ran between the EIP and EPL, and became tendinous within the fourth dorsal compartment before merging with the EPL tendon over the first metacarpal.…”

“…2 and 3). 2 Access to the wrist joint was obtained using the interval between accessory EPL and remaining EDC tendons, and the procedure was completed without complication. The primary EPL tendon was transposed superficial to the retinaculum on completion to prevent an attritional rupture.…”

Accessory Extensor Pollicis Longus Tendon Classification Modification

“…There have been case reports of accessory tendons to the thumb and index finger identified during cadaveric dissection and during emergency and elective surgery. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 A cadaveric study of 95 dissections reported the observed incidence of duplicate EPL tendons to be 32.6% and the observed incidence of accessory tendons to the index finger to be much rarer at 3.2%. 13 The deviation in tendon morphology of the thumb and index finger has been reported as either connections between the EIP and EPL tendons, doubling of the individual tendons, doubling of the muscle belly or abnormal origin or insertion.…”