The first purpose of this study was to examine the reliability and reproducibility of the two methods of determining the lunate type: posteroanterior (PA) radiographic analysis (PA analysis) and capitate-triquetrum distance analysis (CTD analysis). The authors show clear anatomical photographs of this accessory muscle along with an algorithm for investigating suspected anatomical variations.īackground: Two major lunate types have been proposed on the basis of the absence (Type I) or presence (Type II) of medial facets. Because of their rarity, their diagnosis is often delayed or initially missed. However, significant functional problems have been reported in conjunction with these anatomical variations, including pain, compression neuropathy, digital triggering and stiffness. Accessory FDS muscles presenting in the palm are rare and only a few cases have been reported in the literature since they were first described in 1970 by Vichare.
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Postoperatively, the patient made a full recovery with reduced pain and significantly improved hand function.Īnomalous and accessory muscles in the palm are anatomical curiosities until they become symptomatic. The accessory muscle was excised from the FDS tendon and the accessory tendon was sutured end to side on the existing FDS tendon. A tendon ran proximally from this accessory muscle belly into the forearm. However, an accessory muscle was seen attached to the index finger FDS tendon in zone 3. At operation, the FDP tendon to the index finger and the intrinsic muscles were intact and of normal appearance. The swelling increased in size and his overall hand function decreased, so surgical exploration was planned. Hypertrophy of the index intrinsic muscles was suggested. No intrinsic muscle rupture was detected and no mass lesion was detected. Ultrasound and MRI scans were inconclusive. His grip strength was compromised and had reduced abduction of his index finger. Shortly afterwards he noticed a swelling in his right palm over the first web space which increased in size with finger flexion. The patient’s right hand was gripping the steering wheel when he was involved in a low velocity head on collision. We present the case of a 28 year old male mechanic who presented with a painful swelling over his right thenar eminence following a road traffic accident. The other clinical relevance of this is that the ring finger FDP usually supplied by the ulnar nerve was in this instance supplied by the median nerve.Īnomalous or accessory FDS muscles in the palm are rare, but when present they can be painful and interfere significantly with hand function. While most anomalous muscles are asymptomatic, ours was causing symptoms particularly due to underlying muscle spasticity. The accessory muscle was divided and improved the flexion contracture.Īnatomically distinct from the anomalous tendon slips described by Linburg and Comstock, this accessory muscle actually originated from the FPL and inserted in the ring finger. During surgical exploration and release of the muscles, an anomalous fusiform muscle was found originating from the tendon of the FPL, heading to the ring finger and flexing the distal interphalangeal joint. Of note, pre-operatively he had a very tight FPL and wrist flexors but also incidentally a severe flexion deformity of his ring little and fingers which resembled a claw hand.
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He underwent botulinum toxin injections 4 weeks previously and was undergoing tendon lengthening/release on the right side. We present an anomaly not previously described in the literature where the FDP to the ring finger was found to originate from the FPL tendon, causing tight flexion contracture of both due to underlying muscle spasticity.Īn 11-year-old boy with Leigh syndrome was under the care of our plastic surgery unit for flexion contractures of his upper limbs. Anatomical variations of the flexor pollicis longus(FPL) muscle are well described, the common two being an accessory head of FPL also known as Gantzer’s muscle described in 1813 and the anomalous tendon slips from the FPL to the flexor digitorum profundus(FDP) of the index and more rarely middle finger described by Linburg and Comstock in 1979.