The APL tendon passes through the first extensor compartment with the EPB, inserting on the first metacarpal base. It may split into multiple slips (two or more slips present in up to 87 percent of specimens), with the additional slips inserting on the trapezium or thenar musculature. Multiple APL slips may fill the first compartment and contribute to de Quervain tenosynovitis by increasing compartment volume relative to the fixed retinacular envelope.
| Muscle | |
|---|---|
| Attachment | First extensor compartment to the base of the first metacarpal |
Thumb CMC abduction and extension; forms the volar border of the anatomical snuffbox
The APL is the most common tendon to have multiple slips, an anatomical variant that is relevant in first compartment surgery. In addition, a fibrous septum often divides the first compartment into separate APL and EPB tunnels. Extra slips or an unreleased EPB subcompartment are common causes of persistent or recurrent de Quervain symptoms after surgical decompression, so each tunnel must be identified and released. The Finkelstein test tensions these tendons and reproduces de Quervain pain.
Incomplete release of APL slips or a separate EPB subcompartment during first compartment decompression producing persistent or recurrent radial wrist pain requiring revision surgery.
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