Skip to main content
SpringerLink
Log in

Bifascicular nature of the flexor digitorum profundus and flexor pollicis longus tendons: forgotten anatomical characteristics rediscovered with US imaging

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To demonstrate the bifid configuration of the flexor digitorum profundus (FDP) and flexor pollicis longus (FPL).

Methods

In the first part of this study, 20 digits from 4 cadaver hands were dissected and analyzed using anatomical and histological slices. The second part of the study was carried out over a 12-month period starting in August 2018. It was a prospective US imaging study of 300 digits from 30 healthy participants performed by two radiologists in a double-blinded manner. This study focused on two items: tendon shape and whether a central septum separated the two hemitendons. Descriptive statistics were calculated along with the inter-rater reliability.

Results

In 100% (300/300) of fingers and thumbs, the FDP and FPL tendons were made up of two parallel bundles arranged side by side, with a central vertical septum between these two hemitendons, starting at the head of the proximal phalanx (PP) and continuing distally. This central septum was always present starting at the proximal third of PP for the FDP of the index, middle, and ring fingers. The septum was more difficult to identify in the thumb and little finger. Cohen’s kappa indicated near perfect agreement when all digits were considered together (≥ 0.9), and substantial agreement for the thumb (0.71) and for the little finger (0.82).

Conclusions

With US imaging, the bifascicular nature of the FDP and FPL tendons is easy to see, as these tendons have a double-barreled configuration starting at the head of the proximal phalanx.

Key Points

•Analysis of anatomical slices of the hand tendons found a bifascicular appearance of the flexor digitorum profundus and flexor pollicis longus tendons starting at the head of the proximal phalanx.

•This distinct feature of two hemitendons arranged side by side was seen in 100% of tendons we examined with US. It is associated with a vertical central septum that causes anisotropy.

•Awareness of this “forgotten” anatomical detail has practical implications when interpreting images generated by latest-generation US systems and during surgery on hand flexor tendons.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

FDP:

Flexor digitorum profundus

FDS:

Flexor digitorum superficialis

FPL:

Flexor pollicis longus

MCP:

Metacarpophalangeal joint

PIP:

Proximal interphalangeal joint

DIP:

Distal interphalangeal joint

PP:

Proximal phalanx

MP:

Middle phalanx

DP:

Distal phalanx

References

  1. Netter FH (2019) Upper limb. In: Atlas of Human Anatomy, 7th edn. ELSEVIER, Philadelphia, p plates, pp 433–450-451

    Google Scholar 

  2. Drake RL, Vogl AW, Mitchell AWM (2020) Upper Limb. In: Gray’s anatomy for students, 4th edn. Elsevier, Philadelphia, pp 766–795

    Google Scholar 

  3. Moses KP, Banks JC, Nava PB, Petersen DK (2013) Upper limb. In: Atlas of clinical gross anatomy, 2nd edn. ELSEVIER, Philadelphia, pp 248–282

    Google Scholar 

  4. Lapegue F, Andre A, Brun C et al (2015) Traumatic flexor tendon injuries. Diagn Interv Imaging 96:1279–1292

    Article  CAS  Google Scholar 

  5. Schuenke M, Schulte E, Schumacher U (2016) Wrist and hand. In: Gilroy AM, MacPherson BR (eds) Atlas of anatomy, 3rd edn. Thieme Medical Publishers, New York, pp 338–358

    Google Scholar 

  6. Putz R, Pabst R (2006) Muscles of the upper limb. In: Sobotta J (ed) Atlas of human anatomy, head, neck, upper limb, 14th edn. Elsevier, Munich, p 209

    Google Scholar 

  7. Testut L, Latarjet A (1948) Muscles de la main. In: Traité d’Anatomie Humaine, 9th edn. G.Doin, p 1089

  8. Winslow J (1732) Les muscles qui meuvent les doigts de la main. In: Exposition anatomique de la structure du corps humain. Laurent Charles D’Houry Fils, Paris, pp 319–320

    Google Scholar 

  9. Boyer A (1797) De la myologie. In: Traité complet d’anatomie ou description de toutes les parties du corps humain. Migneret, Paris, pp 294–300

    Google Scholar 

  10. Bichat X (1812) Appareils de la locomotion des muscles et de leurs dépendances. In: Traité d’anatomie descriptive. Buisson, Paris, pp 237–240

    Google Scholar 

  11. Cruveilher J (1843) Myologie : Fléchisseurs profonds des doigts. In: Traité d’anatomie descriptive. Béchet, Paris, pp 270–273

    Google Scholar 

  12. Poirier P, Charpy A (1895) Myologie. In: Traité d’anatomie humaine. Bataille et Cie éditeurs, Paris, pp 115–117

    Google Scholar 

  13. Bourgery J-M (1831) Sujet complet de myologie. In: Traité complet de l’anatomie de l’homme comprenant la médecine opératoire. Dalauney, Paris, p Plate 123

    Google Scholar 

  14. Bommier A, McGuire D, Boyer P, Rafee A, Razali S, Oberlin C (2018) Results of heterodigital flexor digitorum profundus hemi-tendon transfer for 23 flexor tendon injuries in zones 1 or 2. J Hand Surg Eur Vol 43:487–493

  15. Elliot D, Khandwala AR, Ragoowansi R (2001) The flexor digitorum profundus “demi-tendon”--a new technique for passage of the flexor profundus tendon through the A4 pulley. J Hand Surg Br 26:422–426

    Article  CAS  Google Scholar 

  16. Durand S, Oberlin C, Macquillan A (2010) FDP to FDP hemi-tendon transfer--a new technique for delayed repair of the flexor digitorum profundus in zones I and II of the finger. J Hand Surg Eur Vol 35:677–678

    Article  CAS  Google Scholar 

  17. Leddy JP, Packer JW (1977) Avulsion of the profundus tendon insertion in athletes. J Hand Surg Am 2:66–69

    Article  CAS  Google Scholar 

  18. McCallister WV, Ambrose HC, Katolik LI, Trumble TE (2006) Comparison of pullout button versus suture anchor for zone I flexor tendon repair. J Hand Surg Am 31:246–251

    Article  Google Scholar 

  19. Murphy BA, Mass DP (2005) Zone I flexor tendon injuries. Hand Clin 21:167–171

    Article  Google Scholar 

  20. Brustein M, Pellegrini J, Choueka J, Heminger H, Mass D (2001) Bone suture anchors versus the pullout button for repair of distal profundus tendon injuries: a comparison of strength in human cadaveric hands. J Hand Surg Am 26:489–496

Download references

Acknowledgments

The authors acknowledge Joanne Archambault, Ph.D., for editorial assistance.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Service d’imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet,, Place du Dr Baylac, TSA, 40031-31059, Toulouse, France

    Franck Lapegue, Maxence Tiercelin, Florence Nougarolis, Claire Ricard, Rafy Bachour, Hubert Basselerie, Hélène Chiavassa, Marie Faruch-Bilfeld & Nicolas Sans

  2. Clinique MEDIPOLE Garonne, 45 rue de Gironis, 31100, Toulouse, France

    Franck Lapegue, Aymeric Andre & Michel Rongieres

  3. Chirurgie orthopédique et traumatologie, Institut de l’appareil locomoteur, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Dr Baylac, TSA, 40031-31059, Toulouse, France

    Mahdi Siala

  4. Laboratoire d’anatomie, Faculté de Médecine de Toulouse, 133 route de Narbonne, 31400, Toulouse, France

    Aymeric Andre & Michel Rongieres

  5. Service d’anatomopathologie, IUCT Oncopole, 1 avenue Irène Joliot-curie, 31100, Toulouse, France

    Camille Franchet & Anne Brouchet-Gomez

Authors
  1. Franck Lapegue
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maxence Tiercelin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mahdi Siala
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aymeric Andre
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michel Rongieres
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Camille Franchet
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anne Brouchet-Gomez
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Florence Nougarolis
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Claire Ricard
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Rafy Bachour
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hubert Basselerie
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hélène Chiavassa
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Marie Faruch-Bilfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Nicolas Sans
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Franck Lapegue.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Dr. Franck LAPEGUE.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dr. Ezin Jocelyn Akakpo, M.D., expert in statistics, kindly provided statistical advice for this manuscript.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Approval from the institutional animal care committee was not required (no animal subject in this study).

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• observational

• performed at one institution

Additional information

Nota bene: The references corresponding to ancient French anatomy books can be consulted on the website of the « bibliothèque nationale de France » (https://gallica.bnf.fr).

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lapegue, F., Tiercelin, M., Siala, M. et al. Bifascicular nature of the flexor digitorum profundus and flexor pollicis longus tendons: forgotten anatomical characteristics rediscovered with US imaging. Eur Radiol 30, 6653–6662 (2020). https://doi.org/10.1007/s00330-020-07048-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-020-07048-5

Keywords

Search

Navigation