1	The Linburg Comstock Anomaly L C Bainbridge Consultant Hand Surgeon
2	Linburg and Comstock JHS(Am) 1979 79-83 Described 31% unilateral incidence and 14% bilateral 4 clinical cases with chronic tenosynovitis
3	Lombardi, Wood and Linscheid JHS(Am) 1988 325-8 33 patients with palmar pain 26 wrists explored All had hypertrophic synovium, half had a tendinous connection 13/17 with greater than 6 month followup were improved
4	Clinical Picture Simultaneous flexion of the index DIP joint with thumb IP flexion
5	The painful anomaly 7 patients over 8 years. All unilateral although 5 bilateral anomaly All post traumatic All seen by at least one other unit before diagnosis
6	Presentation Pain on activity Gripping Pulling Wrist movement under load Pain identified as volar Radial rahter than ulnar Passing up forearm Tearing in nature
7	Presentation Tenderness Distal 1/3^rd of forearm Between FPL and FDP (FCR and PL) Clinical tests Demonstrate anomaly Passive extension of index whilst maintaining active thumb flexion Pain relieved by local anaesthetic into wrist
8	Trauma Movements that cause finger extension from power grasp position 5/7 trolley/ cage/ roller injury 1 fall 1 pulling jelly shoes off a mould
9	Treatment Linscheid suggested steroid not effective 5/7 have been explored through a volar approach 3/5 had a definite anomalous tendon 2/5 had a specific piece of tissue thicker than synovium passing from FPL to FDP(II) and capable of transmitting force All had resection of the tissue
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11	Postoperative care Immediate Physio Differential movement of the thumb and index Full thumb flexion with passive and active index extension Full index flexion with active and passive thumb extension