To Describe the Various Attachments in Dorsal Digital Expansion (DDE) of Thumb: Laboratory Based Cross Sectional Observational Study
Background: Due to the thickening & inflammation of the tendons of Abductor pollicis Longus & Extensor pollicis Brevis, a movement of thumb or compression of 1st dorsal compartment of wrist causes pain & swelling. Thus, knowledge of such variations is important for surgeons while performing plastic reconstructive surgeries. The proposed study was conducted to determine contribution of tendons of Abductor Pollicis Longus and Extensor Pollicis Brevis in formation of Dorsal Digital Expansion of thumb by dissection of proposed study area.
Methods: The present study was conducted in dissection hall, both upper limbs of minimum 66 formalin preserved cadavers of Indian individual available at Department of Anatomy have been considered for study. The tendons were traced to their insertion and anatomical variations in the EPB and various attachments on Dorsal Digital Expansion of thumb on both sides recorded. All parameters were tabulated and analyzed using chi-square test.
Results: The Abductor Pollicis Longus was attached to the DDE of right thumb in 69.69 % of cases and the 1st Palmer Interosseous was attached in 51.5 % of cases. Well defined medial margin of DDE of thumb receives contribution from 96.9 % cases from oblique head of adductor pollicis, in 7.57% cases from transverse head of adductor pollicis and lateral margin of DDE of thumb receives fibres of APB in 74.23% cases.
Conclusions: In our conclusion, multiplicity of the APL and EPB, concomitant with a variant insertion pattern, attachment of various muscular tendons to DDE of thumb is the highlight of this study. Our cases show that these additional tendons may prove to be biomechanically advantageous. Moreover, these tendons may be effectively used for reconstructive surgeries.
2. Bade H, Krolak C, Koebke J. Fibrous architecture of the dorsal aponeurosis of the thumb. The Anatomical Record. 1995 Dec;243(4):524-30.
3. 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(2):153‐155. doi:10.1590/s1807-59322009000200014
4. Schafer E S, Syrrington J, Bryce T H; Quain's th Elements of Anatomy in Myology. 11 Edn; Longman's and Green and co. New York, Toronto, 1923, 142.
5. Bravo E, Barco R, Bullón A. Anatomic study of the abductor pollicis longus: a source for grafting material of the hand. Clin Orthop Relat Res. 2010;468(5):1305‐9.
6. El-Beshbishy RA, Abdel-Hamid GA. Folia Morphol (Warsz). 2013 May; 72(2):161-6.
7. Lamb DW,Hooper G and Kuczynski K, The practice of hand surgery In restoration of nd thumb. 2 Edn. Blackwell scientific publications, 1989: 376-9.
8. Nayak SR, Krishnamurthy A, Pai MM, Prabhu LV, Ramanathan LA, Ganesh Kr C, et al. Multiple variations of extensor tendons of forearm. Rom J Morphol Embryol. 2008; 49: 97–100.
9. Jackson WT, Viegas SF, Coon TM, Stimpson KD, Frogameni AD, Simpson JM (1986) Anatomical variations in the first extensor compartment of the wrist. A clinical and anatomical study. J Bone Joint Surg Am, 68: 923–6.
10. Stein AH Jr. Variations of the tendons of insertion of the abductor pollicis longus and extensor pollicis brevis.Anat Rec 1951; 110: 49–55.
11. Spinner M. Kaplan's functional and surgical anatomy of hand in thumb. 3rd Edn. J.B. Lippincott Company, 1984: 124-41.
12. Hollinshead WH; Anatomy for Surgeons.3 Edn; Vol III. Harper and Row Publishers. Philadelphia, 1982: 423-6.
Copyright (c) 2020 Saroj Lata Meena, Reena Pabri, Dhiraj Saxena
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.