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The Linburg Comstock anomaly: A case report
The Linburg Comstock Anomaly: A Case Report Hiroshi Takami, MD, Sadao Takahashi, MD, Masashi Ando, MD, Kawasaki, Japan
In 1979, Linburg and Comstock 1 reported anomalous tendon connections from the flexor pollicis longus to the index finger flexor digitorum profundus. We report a patient with this anomaly whose complaint was lack of independent excursion of the flexor pollicis longus.
index finger while actively flexing the thumb caused no pain. The condition in this patient was bilateral. The fight forearm was explored and an anomalous tendon slip fiom the flexor pollicis longus tendon was observed connected to the index finger flexor digitorum profundus tendon (Fig. 2). Thickened
Case Report A 23-year-old right-hand dominant police cadet Was unable to flex the distal joint of his right thumb without flexing the distal joint of the index finger when holding a gun (Fig. 1). Flexion of the distal joint of the thumb was always accompanied by simultaneous flexion of the index finger but flexion of the index finger was not accompanied by flexion of the thumb. Passively restricting flexion of the
Figure 1. The patient was unable to flex the distal joint of the thumb without flexing the distal joint of the index finger when using a gun.
Figure 2. An anomalous tendon slip (arrow) from the flexor pollicis longus tendon (arrows) was attached to the index finger flexor digitorum profundus tendon.
From the Section of Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Japan. Received for publication Aug. 24, 1994; accepted in revised form Jan. 14, 1995. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Reprint requests: Hiroshi Takami, MD, Section of Orthopaedic Surgery, Kanto Rosai Hospital, Nakahara-ku, Kawasaki, Japan.
The Journal of Hand Surgery 251
252
Takami et al. / Linburg Comstock Anomaly
tenosynovium about the tendon slip was noted and the tendon slip with its synovium was excised. A similar operation was done a week later on the left hand and similar findings were noted. One year later, the patient had independent excursion of the thumb and index finger flexor tendons in both hands.
Discussion The flexor pollicis longus in humans is usually independent of the flexor digitorum profundus. Phylogenetically, however, both tendons are derived from a common mesodermal mass. 2,3 Linburg and Comstock a observed this anomaly in 25% of cadaver limbs and described four cases of chronic tenosynovitis. Lombardi et al. 4 reported 33 patients with
restrictive thumb-index finger flexor tenosynovitis. All of the explored wrists had hypertrophic tenosynovitis between the two tendons and more than half of them had this variant.
References l. Linburg RM, Comstock BE. Anomalous tendon slips from the flexor pollicis longus to the flexor digitorum profundus. J Hand Surg 1979;4:79-83. 2. Mangini U. Flexor pollicis longus muscle. J Bone Joint Surg 1960;42A:467-70. 3. Spinner M. Kaplan's functional and surgical anatomy of the hand. Philadelphia: JB Lippincott, 1984:124-5. 4. Lombardi RM, Wood MB, Linscheid RL. Symptomatic restrictive thumb-index flexor tenosynovitis: incidence of musculotendinous anomalies and results of treatment. J Hand Surg 1988;13A:325-8.
In 1979, Linburg and Comstock 1 reported anomalous tendon connections from the flexor pollicis longus to the index finger flexor digitorum profundus. We report a patient with this anomaly whose complaint was lack of independent excursion of the flexor pollicis longus.
index finger while actively flexing the thumb caused no pain. The condition in this patient was bilateral. The fight forearm was explored and an anomalous tendon slip fiom the flexor pollicis longus tendon was observed connected to the index finger flexor digitorum profundus tendon (Fig. 2). Thickened
Case Report A 23-year-old right-hand dominant police cadet Was unable to flex the distal joint of his right thumb without flexing the distal joint of the index finger when holding a gun (Fig. 1). Flexion of the distal joint of the thumb was always accompanied by simultaneous flexion of the index finger but flexion of the index finger was not accompanied by flexion of the thumb. Passively restricting flexion of the
Figure 1. The patient was unable to flex the distal joint of the thumb without flexing the distal joint of the index finger when using a gun.
Figure 2. An anomalous tendon slip (arrow) from the flexor pollicis longus tendon (arrows) was attached to the index finger flexor digitorum profundus tendon.
From the Section of Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Japan. Received for publication Aug. 24, 1994; accepted in revised form Jan. 14, 1995. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Reprint requests: Hiroshi Takami, MD, Section of Orthopaedic Surgery, Kanto Rosai Hospital, Nakahara-ku, Kawasaki, Japan.
The Journal of Hand Surgery 251
252
Takami et al. / Linburg Comstock Anomaly
tenosynovium about the tendon slip was noted and the tendon slip with its synovium was excised. A similar operation was done a week later on the left hand and similar findings were noted. One year later, the patient had independent excursion of the thumb and index finger flexor tendons in both hands.
Discussion The flexor pollicis longus in humans is usually independent of the flexor digitorum profundus. Phylogenetically, however, both tendons are derived from a common mesodermal mass. 2,3 Linburg and Comstock a observed this anomaly in 25% of cadaver limbs and described four cases of chronic tenosynovitis. Lombardi et al. 4 reported 33 patients with
restrictive thumb-index finger flexor tenosynovitis. All of the explored wrists had hypertrophic tenosynovitis between the two tendons and more than half of them had this variant.
References l. Linburg RM, Comstock BE. Anomalous tendon slips from the flexor pollicis longus to the flexor digitorum profundus. J Hand Surg 1979;4:79-83. 2. Mangini U. Flexor pollicis longus muscle. J Bone Joint Surg 1960;42A:467-70. 3. Spinner M. Kaplan's functional and surgical anatomy of the hand. Philadelphia: JB Lippincott, 1984:124-5. 4. Lombardi RM, Wood MB, Linscheid RL. Symptomatic restrictive thumb-index flexor tenosynovitis: incidence of musculotendinous anomalies and results of treatment. J Hand Surg 1988;13A:325-8.