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Flexor pollicis longus (FPL) tendon hypoplasia: A case report and literature review.

ABSTRACT: An 18-year-old female presented with long-standing inability to flex her left thumb. MRI of the left thumb revealed flexor pollicus longus (FPL) tendon hypoplasia, and subsequent ultrasound of the bilateral thumbs confirmed a left-sided hypoplastic FPL tendon. Structural integrity of the left FPL tendon was confirmed during surgical examination under anesthesia. Multiple congenital anomalies of the FPL have been described, but FPL tendon hypoplasia and its appearance on imaging are rarely reported. This case demonstrates the diagnosis of FPL tendon hypoplasia on MRI, ultrasound, and surgical examination under anesthesia; and demonstrates the importance of including this entity in the differential diagnosis for impaired thumb flexion.

SUBMITTER: Dheer S

PROVIDER: S-EPMC6402301 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Flexor pollicis longus (FPL) tendon hypoplasia: A case report and literature review.

Dheer Sachin S Oh Joon S JS Rivlin Michael M

Radiology case reports 20190305 5

An 18-year-old female presented with long-standing inability to flex her left thumb. MRI of the left thumb revealed flexor pollicus longus (FPL) tendon hypoplasia, and subsequent ultrasound of the bilateral thumbs confirmed a left-sided hypoplastic FPL tendon. Structural integrity of the left FPL tendon was confirmed during surgical examination under anesthesia. Multiple congenital anomalies of the FPL have been described, but FPL tendon hypoplasia and its appearance on imaging are rarely report ...[more]

PMID: 30886667

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Project description:Background and Objectives. The accessory head of the flexor pollicis longus muscle (AHFPL), also known as the Gantzer's muscle, was first described in 1813. The prevalence rates of an AHFPL significantly vary between studies, and no consensus has been reached on the numerous variations reported in its origin, innervation, and relationships to the Anterior Interosseous Nerve (AIN) and the Median Nerve (MN). The aim of our study was to determine the true prevalence of AHFPL and to study its associated anatomical characteristics. Methods. A search of the major electronic databases PubMed, EMBASE, Scopus, ScienceDirect, and Web of Science was performed to identify all articles reporting data on the prevalence of AHPFL in the population. No date or language restriction was set. Additionally, an extensive search of the references of all relevant articles was performed. Data on the prevalence of the AHFPL in upper limbs and its anatomical characteristics and relationships including origin, insertion, innervation, and position was extracted and pooled into a meta-analysis using MetaXL version 2.0. Results. A total of 24 cadaveric studies (n = 2,358 upper limb) were included in the meta-analysis. The pooled prevalence of an AHFPL was 44.2% (95% CI [0.347-0.540]). An AHFPL was found more commonly in men than in women (41.1% vs. 24.1%), and was slightly more prevalent on the right side than on the left side (52.8% vs. 45.2%). The most common origin of the AHFPL was from the medial epicondyle of the humerus with a pooled prevalence of 43.6% (95% CI [0.166-0.521]). In most cases, the AHFPL inserted into the flexor pollicis longus muscle (94.6%, 95% CI [0.731-1.0]) and was innervated by the AIN (97.3%, 95% CI [0.924-0.993]). Conclusion. The AHFPL should be considered as more a part of normal anatomy than an anatomical variant. The variability in its anatomical characteristics, and its potential to cause compression of the AIN and MN, must be taken into account by physicians to avoid iatrogenic injury during decompression procedures and to aid in the diagnosis and treatment of Anterior Interosseous Nerve Syndrome.

Dataset Information

Flexor pollicis longus (FPL) tendon hypoplasia: A case report and literature review.

Publications

Flexor pollicis longus (FPL) tendon hypoplasia: A case report and literature review.

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