Flexor Pollicis Longus: Difference between revisions
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In a study by Ballesteros et al.<ref>Ballesteros DR, Forero FL, Ballesteros LE. [https://journals.viamedica.pl/folia_morphologica/article/view/58316 Accessory head of the flexor pollicis longus muscle: anatomical study and clinical significance]. Folia Morphol 2019;78(2):394-400.DOI: 10.5603/FM.a2018.0091 | In a study by Ballesteros et al.<ref>Ballesteros DR, Forero FL, Ballesteros LE. [https://journals.viamedica.pl/folia_morphologica/article/view/58316 Accessory head of the flexor pollicis longus muscle: anatomical study and clinical significance]. Folia Morphol 2019;78(2):394-400.DOI: 10.5603/FM.a2018.0091 | ||
</ref> the accessory head of FPL has 47.1% originating from flexor digitorium superficialis, 29.4% from epicondyle of the [[humerus]], and 23.5% is from coronoid process of the [[Ulna]] in the forearm. Hemmady et al<ref>Hemmady MV, Subramanya AV, Mehta IM. [https://www.jpgmonline.com/article.asp?issn=0022-3859;year=1993;volume=39;issue=1;spage=14;epage=6;aulast= Occasional head of flexor pollicis longus muscle: a study of its morphology and clinical significance.] Journal of Postgraduate Medicine. 1993; 39(1):14-6</ref> reported that of the 66.6% accessory head of FPL found, 55.5% originates from the medial epicondyle of the humerus while 16.6% is from the coronoid process of the ulna | </ref> the accessory head (Gantzer's muscle)<ref>Benson D, Miao K. Anatomy, Shoulder and Upper Limb, Hand Flexor Pollicis Longus Muscle. In: Varacallo M. editor. 2020. Available from:https://www.statpearls.com/articlelibrary/viewarticle/36137/ (accessed 8 October 2020)</ref> of FPL has 47.1% originating from flexor digitorium superficialis, 29.4% from epicondyle of the [[humerus]], and 23.5% is from coronoid process of the [[Ulna]] in the forearm. Hemmady et al<ref>Hemmady MV, Subramanya AV, Mehta IM. [https://www.jpgmonline.com/article.asp?issn=0022-3859;year=1993;volume=39;issue=1;spage=14;epage=6;aulast= Occasional head of flexor pollicis longus muscle: a study of its morphology and clinical significance.] Journal of Postgraduate Medicine. 1993; 39(1):14-6</ref> reported that of the 66.6% accessory head of FPL found, 55.5% originates from the medial epicondyle of the humerus while 16.6% is from the coronoid process of the ulna | ||
=== Insertion === | === Insertion === | ||
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=== Artery === | === Artery === | ||
Blood supply to the Flexor pollicis longus is from a branch (anterior interosseous artery) of the ulnar artery. | |||
== Function == | == Function == | ||
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== Clinical relevance == | == Clinical relevance == | ||
The presence of the accessory head of FPL has several clinical implications. It can compress the median nerve and anterior interosseus nerve; the later may result in paresis or paralysis of the FDP, FPL, and pronator quadratus and the former leading to paralysis of some muscles in thenar compartment as well as sensory deficits.<ref>Caetano EB, Vieira LA, Sabongi Neto JJ, Caetano MBF, Sabongi RG. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6147764/ Anterior interosseous nerve: anatomical study and clinical implications]. Rev Bras Ortop. 2018;53(5):575-581. Doi:10.1016/j.rboe.2018.07.010</ref><ref>Caetano EB, Sabongi JJ, Vieira LÂ, Caetano MF, Moraes DV. Gantzer muscle. An anatomical study. Acta Ortopedica Brasileira. 2015;23(2):72-75. DOI: 10.1590/1413-78522015230200955.</ref>[7][10] | |||
A tendinous interconnection FPL and FDP of the second digit known as the Linburg-Comstock anomaly may lead to the inability to solely flex the distal IP of thumb and the index finger.<ref>Linburg RM, Comstock BE. Anomalous tendon slips from the flexor pollicis longus to the flexor digitorum profundus. J Hand Surg Am. 1979;4(1):79-83. Doi: 10.1016/s0363-5023(79)80110-0. </ref> | |||
== Assessment == | == Assessment == | ||
The flexor pollicis longus is tested holding stationary the proximal phalanx of the thumb is held while flexing the distal phalanx against resistance. | |||
== Treatment == | == Treatment == | ||
Revision as of 15:10, 7 October 2020
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Description[edit | edit source]
The flexor pollicis longus (FPL) is a long muscle located at the deep layer with flexor digitorum profundus and pronator quadratus in the anterior compartment of the forearm. Though it is situated at the forearm, it is classified as part of the extrinsic muscles of the hand as it's function is seen in thumb movement.
Origin[edit | edit source]
It originates from the mid half of the anterior surface of the radius and adjacent half of the interosseous membrane. FPL has also been found to take it's origin from medial epicondyle of the humerus, coronoid process of the Ulna, and from flexor digitorium superficialis.
In a study by Ballesteros et al.[1] the accessory head (Gantzer's muscle)[2] of FPL has 47.1% originating from flexor digitorium superficialis, 29.4% from epicondyle of the humerus, and 23.5% is from coronoid process of the Ulna in the forearm. Hemmady et al[3] reported that of the 66.6% accessory head of FPL found, 55.5% originates from the medial epicondyle of the humerus while 16.6% is from the coronoid process of the ulna
Insertion[edit | edit source]
The muscle forms a flattened large tendon, that courses through the carpal tunnel, crossing three joints of the hand to attach at the base of the distal phalanx.
Nerve[edit | edit source]
It is innervated by the median nerve via the anterior interosseous nerve (7th and 8th cervical nerve root).
Artery[edit | edit source]
Blood supply to the Flexor pollicis longus is from a branch (anterior interosseous artery) of the ulnar artery.
Function[edit | edit source]
- The FPL mainly flexes interphalangeal join of the distal phalanx of the thumb.
- It also serves as accessory flexors of the metacarpophalangeal of the proximal phalanx and carpometacarpal joints of the first metacarpal.
- It may also assist in wrist joint flexion.
Clinical relevance[edit | edit source]
The presence of the accessory head of FPL has several clinical implications. It can compress the median nerve and anterior interosseus nerve; the later may result in paresis or paralysis of the FDP, FPL, and pronator quadratus and the former leading to paralysis of some muscles in thenar compartment as well as sensory deficits.[4][5][7][10]
A tendinous interconnection FPL and FDP of the second digit known as the Linburg-Comstock anomaly may lead to the inability to solely flex the distal IP of thumb and the index finger.[6]
Assessment[edit | edit source]
The flexor pollicis longus is tested holding stationary the proximal phalanx of the thumb is held while flexing the distal phalanx against resistance.
Treatment[edit | edit source]
Resources[edit | edit source]
- ↑ Ballesteros DR, Forero FL, Ballesteros LE. Accessory head of the flexor pollicis longus muscle: anatomical study and clinical significance. Folia Morphol 2019;78(2):394-400.DOI: 10.5603/FM.a2018.0091
- ↑ Benson D, Miao K. Anatomy, Shoulder and Upper Limb, Hand Flexor Pollicis Longus Muscle. In: Varacallo M. editor. 2020. Available from:https://www.statpearls.com/articlelibrary/viewarticle/36137/ (accessed 8 October 2020)
- ↑ Hemmady MV, Subramanya AV, Mehta IM. Occasional head of flexor pollicis longus muscle: a study of its morphology and clinical significance. Journal of Postgraduate Medicine. 1993; 39(1):14-6
- ↑ Caetano EB, Vieira LA, Sabongi Neto JJ, Caetano MBF, Sabongi RG. Anterior interosseous nerve: anatomical study and clinical implications. Rev Bras Ortop. 2018;53(5):575-581. Doi:10.1016/j.rboe.2018.07.010
- ↑ Caetano EB, Sabongi JJ, Vieira LÂ, Caetano MF, Moraes DV. Gantzer muscle. An anatomical study. Acta Ortopedica Brasileira. 2015;23(2):72-75. DOI: 10.1590/1413-78522015230200955.
- ↑ Linburg RM, Comstock BE. Anomalous tendon slips from the flexor pollicis longus to the flexor digitorum profundus. J Hand Surg Am. 1979;4(1):79-83. Doi: 10.1016/s0363-5023(79)80110-0.
