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.
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, where the extra slips may not all be released unless the surgeon specifically looks for them. Incomplete release of APL slips is a cause of de Quervain recurrence after surgical decompression.
Incomplete APL multi-slip release during first compartment decompression producing recurrent radial wrist pain requiring revision surgery to release all tendon slips.
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