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      Abductor pollicis longus tendon division with swan neck thumb deformity

      case-report

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          Abstract

          Swan neck thumb deformity can be caused by osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, tendon transfers and paralytic diseases. Abductor pollicis longus is one of the major stabilizing tendon of the carpometacarpal joint of thumb. To the best of our knowledge, swan neck thumb deformity owing to division of abductor pollicis longus tendon is rare. In this article, we describe a case of isolated division of abductor pollicis longus tendon presenting with swan-neck deformity of thumb and discuss the mechanism, management and outcome. The patient was treated by repair of the divided tendon using palmaris longus tendon graft. At approximately 107 weeks following treatment, the patient was having full range of thumb movement and the deformity completely disappeared. We also describe the unusual mechanism whereby an isolated division of abductor pollicis longus tendon results in swan neck thumb deformity. Level of clinical evidence IV.

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          Most cited references7

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          Disabling arthritis at the base of the thumb: treatment by resection of the trapezium and flexible (silicone) implant arthroplasty.

          Lindsay C. Swanson (1972)
          Article 0 comments Cited 13 times – based on 0 reviews     Review now
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            Deforming arthropathy of the hands in systemic lupus erythematosus.

            Renato Alarcón, Isabela Abud, J. Hernandez … (1987)
            Forty-one of 858 patients with systemic lupus erythematosus (SLE) developed clinical deformity of their hands. This deformity was clinically and radiologically different from that found in 40 patients with classical or definite rheumatoid arthritis (RA), and tended to appear early in the course of disease. Characteristics of this arthropathy included nonerosive carpal collapse; exceptional erosion of the styloid processes; Z deformity of the thumb; nonerosive ulnar deviation and subluxation of MCP joints; parametacarpophalangeal joint hook formation; scant and asymmetric joint erosions; and swan neck deformity of the fingers. Most of these changes seemed to be due to involvement of the ligaments rather than to the destructive effect of synovitis. Patients with SLE with deforming arthropathy had a higher frequency of rheumatoid factor positivity, sicca symptoms and antibodies to native DNA, whereas they had lower incidence of facial rash and photosensitivity than did those without. Other manifestations did not differ. We propose that most patients with SLE with deforming arthropathy belong to a subset of SLE rather than representing the coexistence of SLE and RA.
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              Structure and function of the abductor pollicis longus muscle.

              E Van Doorslaer (1991)
              The abductor pollicis longus muscle was examined in dissections and histologically to study the insertions around the CMC I joint. The APL consists fundamentally of a superficial and a deep division, both terminating in one or more tendons. The deep division is proximally situated, it is covered by the extensor digitorum muscle and consists of several muscle bellies; it terminates in a central tendon. The fibres are short, obliquely attached to the tendon in a pennate manner and close together. After the passage through the extensor retinaculum the tendon separates into many branches. The superficial division is more distally situated, not covered by other muscles, lying superficial to the tendon of the deep part. The fibres are long, parallel to one another and form a thin layer. The tendon passes, together with the deep division, through the same compartment of the extensor retinaculum and inserts into MC I. If the muscle contracts, then the structures around the CMC I joint will be tensed by the deep division and MC I will be affected by the superficial division. It is to be expected that in the appropriate thumb movements the superficial part will show an isotonic contraction and the deep part, an isometric action. The superficial part, with long thin fibres, presumably has the least strength while the deep part, with its larger number of fibres, is the most powerful. The functional analysis gives the impression that the deep head will mainly support the trapezium as a platform upon which MC I moves. The superficial head will be active in moving MC I.
              Article 0 comments Cited 3 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                : balaji.zacharia@gmail.com
                : drkmenon@gmail.com
                Journal
                Journal ID (nlm-ta): Strategies Trauma Limb Reconstr
                Journal ID (iso-abbrev): Strategies Trauma Limb Reconstr
                Title: Strategies in Trauma and Limb Reconstruction
                Publisher: Springer Milan (Milan )
                ISSN (Print): 1828-8936
                ISSN (Electronic): 1828-8928
                Publication date (Electronic): 24 July 2012
                Publication date PMC-release: 24 July 2012
                Publication date (Print): August 2012
                Volume: 7
                Issue: 2
                Pages: 109-112
                Affiliations
                [ ]Department of Orthopaedics, Government Medical College, Calicut, India
                [ ]Department of Orthopedics, Amala Institute of Medical Sciences, Thrissur, India
                [ ]33/6220C, Kakkathottam House, Near Government Leprosy Hospital, Chevayoor PO, Calicut, 673017 Kerala India
                Article
                Publisher ID: 141
                DOI: 10.1007/s11751-012-0141-8
                PMC ID: 3535130
                PubMed ID: 22825877
                SO-VID: 826a86d5-5075-48e1-8b31-41ee44053401
                Copyright © © The Author(s) 2012
                History
                Date received : 2 October 2011
                Date accepted : 10 July 2012
                Categories
                Subject: Case Report
                Custom metadata
                issue-copyright-statement © The Author(s) 2012

                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: abductor pollicis longus tendon,isolated division,swan neck thumb deformity
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: abductor pollicis longus tendon, isolated division, swan neck thumb deformity

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