Accessory Tendons and Anatomical Variations of the Dorsal Compartments of the Wrist: A Descriptive Cadaveric Study

Main Article Content

Eren Öğüt
Cagatay Barut


Objective: Detailed anatomical knowledge of the accessory tendons of the dorsal compartments of the wrist is crucial for understanding the effects of tendon injury due to external trauma or rupture. This study was performed to investigate the variations of the extensor compartments of the wrist and a relation between the thickness of extensor digiti minimi (EDM) and abductor pollicis longus (APL) tendons and accessory extensor digiti quinti proprius (EDQP) slip to the little finger.

Methods: Fourteen fixed wrists of adult cadavers were dissected. The tendon variations in the extensor compartments of the wrist and their abnormal insertion sites were recorded, and the number, length, width, and type of accessory tendons were also recorded.

Results: A double tendon of the extensor digiti minimi was detected in one female cadaver out of the 14 fixed cadavers. Ulnar and radial tendons of the EDM were detected in the right wrist of one female cadaver. The radial tendon was accepted as an accessory EDQP but did not join the extensor digitorum (ED), and the ulnar tendon was normal. Four out of fourteen wrists (28.5%) had APL tendon variations. The lateral was accepted as the main APL and the medial as the accessory tendon. A thin accessory tendon was detected from the extensor carpi ulnaris (ECU) at the ulnar styloid process.

Conclusion: Tendon variations of the dorsal compartments of the wrist and the relationship between the ED slip and accessory tendons should be considered when planning surgical treatment. The presence of accessory tendons might assist in finding alternative tendon sources for tendon grafts.

Article Details

Original Research
Author Biography

Cagatay Barut, Bahçeşehir Univesity

Department of Anatomy


Casal D, Pais D, Bilhim T, Ribeiro V, Cunha S, Damásio C, et al. A Rare Variation of the Extensor Indicis Proprius Tendon With Important Clinical Implications. Journal of Morphological Sciences. 2011;28.
2. Sookur PA, Naraghi AM, Bleakney RR, Jalan R, Chan O, White LM. Accessory Muscles: Anatomy, Symptoms, and Radiologic Evaluation. RadioGraphics. 2008;28(2):481-99.
3. Murakami Y, Todani K. The extensor indicis brevis muscle with an unusual ganglion. Clin Orthop Relat Res. 1982(162):207-9.
4. Hoch J, Fritsch H, Lewejohann S. [Congenital or acquired disposition of the separate compartment of the extensor pollicis brevis tendon associated with stenosing tendovaginitis (de Quervain's disease)? Macroanatomical and fetal-plastinationhistological studies of the first compartment of the wrist]. Ann Anat. 2004;186(4):305-10.
5. Lee ZH, Stranix JT, Anzai L, Sharma S. Surgical anatomy of the first extensor compartment: A systematic review and comparison of normal cadavers vs. De Quervain syndrome patients. J Plast Reconstr Aesthet Surg. 2017;70(1):127-31.
6. Stranding S, H. G. Gray's anatomy. Forty-fİrst ed. Standring S, editor. New York: Elsevier; 2016.
7. Plotkin B, Sampath SC, Sampath SC, Motamedi K. MR Imaging and US of the Wrist Tendons. RadioGraphics. 2016;36(6):1688-700.
8. Teh J, Whiteley G. MRI of soft tissue masses of the hand and wrist. The British Journal of Radiology. 2007;80(949):47-63.
9. Ouellette H, Thomas BJ, Torriani M. Using dynamic sonography to diagnose extensor digitorum brevis manus. AJR Am J Roentgenol. 2003;181(5):1224-6.
10. Ross JA, Troy CA. The clinical significance of the extensor digitorum brevis manus. J Bone Joint Surg Br. 1969;51(3):473-8.
11. Barut C, Ertilav H. Guidelines for standard photography in gross and clinical anatomy. Anat Sci Educ. 2011;4(6):348-56.
12. Reef TC, Brestin SG. The extensor digitorum brevis manus and its clinical significance. J Bone Joint Surg Am. 1975;57(5):704-6.
13. Xu H, Wu JX, Wang Q, Gao ZY. Anatomical variations in the first extensor compartment: a cadaver study. ANZ J Surg. 2018;88(9):913-6.
14. Rousset P, Vuillemin-Bodaghi V, Laredo J-D, Parlier-Cuau C. Anatomic Variations in the First Extensor Compartment of the Wrist: Accuracy of US. Radiology. 2010;257(2):427-33.
15. Abdel-Hamid G, El-Beshbishy R, Abdel Aal I. Anatomical variations of the hand extensors. Folia morphologica. 2013;72:249-57.
16. Suwannakhan A, Tawonsawatruk T, Meemon K. Extensor tendons and variations of the medial four digits of hand: a cadaveric study. Surgical and Radiologic Anatomy. 2016;38(9):1083-93.
17. Li J, Mao QH.Accessory slips of the extensor digiti minimi. Rom J Morphol Embryol.2014;55(2):487-9.
18. Dass P, Prabhu LV, Pai MM, Nayak V, Kumar G, Janardhanan JP. A comprehensive study of the extensor tendons to the medial four digits of the hand. Chang Gung Med J. 2011;34(6):612-9.
19. el-Badawi MG, Butt MM, al-Zuhair AG, Fadel RA. Extensor tendons of the fingers: arrangement and variations--II. Clin Anat. 1995;8(6):391-8.
20. Godwin Y, Ellis H. Distribution of the extensor tendons on the dorsum of the hand. Clinical Anatomy. 1992;5(5):394-403.
21. Hirai Y, Yoshida K, Yamanaka K, Inoue A, Yamaki K, Yoshizuka M. An anatomic study of the extensor tendons of the human hand. J Hand Surg Am. 2001;26(6):1009-15.
22. von Schroeder HP, Botte MJ. Anatomy of the extensor tendons of the fingers: Variations and multiplicity. The Journal of Hand Surgery. 1995;20(1):27-34.
23. Peker T ea. Duplication of extensor carpi ulnaris muscle and insertion abnormality of extensor digiti minimi. Journal of Morphology. 1998;6(2):50-2.
24. Nakashima T. An accessory extensor digiti minimi arising from extensor carpi ulnaris. J Anat. 1993;182 (1):109-12.
25. Mestdagh H, Bailleul JP, Vilette B, Bocquet F, Depreux R. Organization of the extensor complex of the digits. Anatomia Clinica. 1985;7(1):49-53.
26. Pinar Y. Accessory tendon slip arising from the extensor carpi ulnaris and its importance for wrist pain. Acta Orthopaedica et Traumatologica Turcica. 2012;46(2):132-5.
27. Kaplan EB, M. S. Kaplan’s functional and surgical anatomy of the hand 1984. 3rd edition ed. New York: Lippincott Williams & Wilkins; 1984.
28. Barfred T, Adamsen S. Duplication of the extensor carpi ulnaris tendon. J Hand Surg Am. 1986;11(3):423-5.
29. Cigali BS, Kutoglu T, Cikmaz S. Musculus Extensor Digiti Medii Proprius and Musculus Extensor Digitorum Brevis Manus - A Case Report of a Rare Variation. Anatomia, Histologia, Embryologia: Journal of Veterinary Medicine Series C. 2002;31(2):126-7.
30. Zilber S, Oberlin C. Anatomical variations of the extensor tendons to the fingers over the dorsum of the hand: a study of 50 hands and a review of the literature. Plast Reconstr Surg. 2004;113(1):214-21.
31. Kayalar M, Bal E, Toros T, Süğün T, Keleşoğlu B, Kaplan I. [The results of treatment for isolated zone 3 extensor tendon injuries]. Acta Orthop Traumatol Turc. 2009;43(4):309-16.