Bilateral isolated absence of flexor pollicis longus tendon: report on a rare case management


  • Ivan Mucharry Dalitan Resident of Orthopaedic Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Oryza Satria Consultant of Orthopaedic Hand and Microsurgery, Fatmawati Central General Hospital, Jakarta, Indonesia
  • Karuniawan Purwantono Consultant of Orthopaedic Hand and Microsurgery, PGI Cikini Hospital, Jakarta, Indonesia



congenital isolated absence, flexor pollicis longus, tendon transfer



In human, the flexor pollicis longus (FPL) is an important muscle for function of the hand. Thumb aplasia and hypoplasia represent a large spectrum of deficiencies. One of the variants of type I thumb hypoplasia is the absence or hypoplastic of FPL tendon without deficiency of other thenar muscle. Although rare, we found several literatures reporting the cases. In treating pediatric thumb disease especially for this condition, we have to carefully diagnose the problem to set our goal of treatment.


We presented a case of 8-year-old male with bilateral inability to flex both thumbs at the interphalangeal (IP) joint. His parents realized this condition after he was involved in school activity. On physical examination, we concluded that the patient has absence of FPL and proceeded for reconstruction with tendon transfer from 4th flexor digitorum superficialis (FDS) and dorsal capsule release.


We performed surgery and postoperatively observed the active movement of IP joint. The treatment improved the active flexion of the IP joint around 60 degrees.


The absence of IP crease is one of the clear signs of FPL absence or hypoplasia. The usage of dorsal capsule release and tendon transfer in treating FPL absence or hypoplasia without any other thenar anomalies is proven to be adequate and feasible


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