An Intraoperative Dilemma: Absent PL with Abnormal Insertion of FCR

Author(s): Al Iqyan Juzar Fidvi, Mariya Shirpurwala

Little known variations in hand anatomy may pose an operative challenge to a hand surgeon. Palmaris longus tendon is commonly known to be absent in the forearm. Abnormality in the insertion of flexor carpi radialis (FCR) tendon is scarcely documented. We present a previously operated case of flexor pollicis tendon repair that was preoperatively planned for an ipsilateral palmaris longus (PL) tendon graft. Intraoperatively the palmaris longus tendon was absent with an abnormal attachment of the Flexor carpi radialis tendon, mimicking the palmaris longus. Pre-planned procedure to use a tendon graft was abandoned and the flexor digitorum superficialis was rerouted to the distal phalanx of the thumb. Even with the known and documented variations in hand anatomy high level of suspicion is required intraoperatively, to prevent untoward complications.

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