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Postoperatively, the patient made a full recovery with reduced pain and significantly improved hand function.

Anomalous and accessory muscles in the palm are anatomical curiosities until they become symptomatic.

Hypertrophy of the index intrinsic muscles was suggested.

The swelling increased in size and his overall hand function decreased, so surgical exploration was planned.

A tendon ran proximally from this accessory muscle belly into the forearm.

The accessory muscle was excised from the FDS tendon and the accessory tendon was sutured end to side on the existing FDS tendon.

His grip strength was compromised and had reduced abduction of his index finger. No intrinsic muscle rupture was detected and no mass lesion was detected.

We present the case of a 28 year old male mechanic who presented with a painful swelling over his right thenar eminence following a road traffic accident.

The patient’s right hand was gripping the steering wheel when he was involved in a low velocity head on collision.

During surgical exploration and release of the muscles, an anomalous fusiform muscle was found originating from the tendon of the FPL, heading to the ring finger and flexing the distal interphalangeal joint.

The accessory muscle was divided and improved the flexion contracture.

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