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For me it is usually about the muscle belly rather than the origin or insertion.
If you follow the muscle proximally you will see that the origin is rather complicated. You can see it attaching to the scaphoid, the trapezium and also you can see a large part of it blending with the flexor retinaculum (transverse carpal ligament).
Due to the complexity of the origin I suspect this is why I don’t see it fail very often. Also it is a small muscle so lacks the grunt to tear itself easily.The distal insertion is more simple as it attached to the proximal Px of the thumb. Again, I don’t see too much happening here.
Pathology I do see is muscle atrophy as part of a median nerve dysfunction where it becomes small, echogenic and atrophic along with opponent pollicis and the superficial head of flexor pollicis brevis (SEE THE WEBINAR ON THENAR EMINENCE MUSCLES) .
I also have seen DOMS injuries in people with manual jobs. I remember one case of a DOMS in a baker who had been kneading bread all day!
It can also have compressive trauma injuries and lacerations.
When you get 1st MCP joint OA and synovitis I also see the inflammatory change involve the Abductor pollicis and opponent pollicis muscles where they become swollen, tight and painful.
Steve.
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