Scientific articleThumb Interphalangeal Joint Extension By the Extensor Pollicis Brevis: Association With a Subcompartment and de Quervain's Disease
Section snippets
Cadaver group
Ninety cadaver wrists from 49 bodies were dissected. The age of the cadavers ranged from 28 to 89 years (mean age 76), and there were 38 male and 52 female specimens, and 47 right and 43 left wrists. The first dorsal compartment and the APL and the EPB tendons were dissected proximally to the level of the mid-forearm, and distally to their respective insertions. During dissection, the EPB tendon was pulled manually with a small right angle retractor to reveal maximum IP joint extension, if any,
Cadaver group
In 86 of the 90 cases, at least 2 APL tendons were seen. Four wrists had 1 APL tendon, 82 wrists had 2 APL tendons, and 4 wrists had 3 APL tendons. One EPB tendon was present in all 90 cases. In 72 cases, the EPB and APL tendons were in a single, common compartment, and a subcompartment was not found. In 18 cases, the EPB tendon was in a subcompartment within the first dorsal compartment (Table 1). In those 18 wrists that had a subcompartment for the EPB tendon, 9 showed IP joint extension with
Discussion
The first dorsal compartment of the wrist normally consists of APL and EPB tendons. The APL originates on the distal third of the radius and has multiple slips with variable insertion on the base of the thumb metacarpal and trapezium. Its primary action is thumb abduction, with some assistance to radial deviation of the wrist. The EPB originates on the dorsal surface of the radius and inserts on the base of the proximal phalanx of the thumb, and its function is generally recognized to extend
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Cited by (38)
Anatomical study of the first dorsal extensor compartment for the treatment of de Quervain's disease
2018, Annals of AnatomyCitation Excerpt :In this study, the septum or dissepiment between the APL and EPB was noted in 24 cases (60.0%), which is almost within the previously reported prevalence rate of 10.7–77.5% (Giles, 1960; Jackson et al., 1986; Loomis, 1951; Mahakkanukrauh and Mahakkanukrauh, 2000; Roy et al., 2012; Stein et al., 1951). Intracompartmental septum has been reported to be present more often in patients with de Quervain’s disease who underwent surgery than in normal cadavers, and explains the greater likelihood of failure of non-operative treatment (Alemohammad et al., 2009; Choi et al., 2011; Giles, 1960; Leslie et al., 1990; Mahakkanukrauh and Mahakkanukrauh, 2000). Some suggested that this septation is a pathological condition, and failure of treatment is related to the anatomical variations of the APL and EPB tendons, or their lying in separate compartments.
Snapping wrist due to multiple accessory tendon of first extensor compartment
2018, International Journal of Surgery Case ReportsSurgical anatomy of the first extensor compartment: A systematic review and comparison of normal cadavers vs. De Quervain syndrome patients
2017, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :We found that the most important variation is the presence of multiple compartments. Studies conducted by Mahakkanukrauh, Alemohammad, and Jackon noted a higher incidence of a subcompartment in patients with De Quervain's disease compared with normal wrists.2–4 According to these studies, a subcompartment is most often present on the dorsoulnar aspect of the first dorsal compartment, although they can also be found within the compartment floor.
Modified Extensor Pollicis Longus Rerouting Technique for Boutonniere Deformity of the Thumb in Rheumatoid Arthritis
2016, Journal of Hand SurgeryCitation Excerpt :Kulshreshtha et al13 reported a cadaver study that showed that 9 out of 44 tendons inserted into the extensor hood and, from there, continued farther to the base of the distal phalanx with the EPL. Also the EPB was able to extend the IP joint in 19 out of 90 cadaver hands and in 56 out of 143 patients who were surgically treated for de Quervain’s disease.14 According to these findings, the EPB tendon should be left in situ when IP joint extension is achieved by the EPB tendon.
Wrist and Hand Tendinopathies
2016, Hand and Upper Extremity Rehabilitation: A Practical GuideDissatisfaction after first dorsal compartment release for de Quervain tendinopathy
2016, Journal of Hand Surgery
The authors gratefully acknowledge the editorial assistance of Suzanne L. Simpson during the preparation of this manuscript.
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.