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Anatomical variations and clinical significance of first extensor compartment of the wrist: case report and review of literature

The first extensor compartment of the wrist is one of the regions of the human body with frequent variations of its contents. Only less than 20% of cases demonstrate normal anatomy. During a routine dissection of embalmed male cadaver, we found three tendons in the first extensor compartment of the left wrist. The most dorsal tendon had insertion on the base of proximal phalanx of the thumb and it was clear that was the extensor pollicis brevis (EPL) tendon. The second was abductor pollicis longus (APL) tendon. It had insertion on the base of the first metacarpal bone. The third tendon was laying palmar to the APL, it was much thinner and it had insertion on abductor pollicis brevis muscle. A muscle origin of accessory abductor pollicis longus (AAPL) was on the dorsal aspect of middle shaft of radius, just proximal to origin of the APL. Muscles of the first extensor compartment of the wrist are important for dexterity, and knowledge about their anatomical variations is important in clinical assessment and hand surgery. Numerous anatomical variations are found in the anatomy of tendons of APL and EPB. They involve multiplication of APL tendon up to 75 %, rarely EPB tendon and accessory fibrous septum. De Quervain’s disease is the most common pathology in this area, characterized with pain at radial styloid process caused by stenosing tenosynovitis of APL and EPB. Anomalies in the first extensor compartment can be a cause of failed surgery for de Quervain’s disease because of inadequate decompression. Surgeon can find APL and its accessory tendon in a single compartment which could be mistaken for APL and EPB tendons. This could lead to failure to decompress EPB tendon. The second reason could be a failure to identify accessory fibrous septum which could again be responsible for failure to decompress the EPB. Surgeon should bear in mind frequent anatomical variations while assessing diseased or traumatized hand and especially during surgery for de Quervain's disease.

extensor compartment; accessory tendon; de Qurvain's disease

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