Linburg-Comstock variation: MRI findings in a traumatic injury

Functional anatomic variants present a diagnostic challenge in the evaluation of hand pain. The Linburg-Comstock variation (LCV) is a connection between the flexor pollicis longus and the index and/or middle finger flexor digitorum profundus tendons. This variant connection can cause pain, termed "Linburg-Comstock syndrome," particularly in patients who perform repetitive hand-related activities such as musicians and manual laborers. Surgical correction of LCV relieves pain and facilitates enhanced precision, ease, and dexterity when gripping items. Magnetic resonance imaging (MRI) characterization prior to repair can reduce operative time and improve cosmesis. However, studies have not yet characterized the MRI findings in traumatic injuries to the LCV. We report a case of a 49-year-old woman with bilateral LCV who suffered an injury to the left wrist resulting in a partial tear of the LCV tendon. We discuss the MRI findings and how post-contrast imaging increased the conspicuity of the injured tendon. Surgical excision of the LCV led to an improvement in symptoms, and this case highlights the importance of recognizing LCV as a pain generator.