Anatomical variation of the palmaris longus muscle: finding in zone V flexor injury

The palmaris longus is a muscle located on the anterior surface of the forearm, known for its significant anatomical variability. This ranges from its absence, the most common variant, to having multiple insertions or muscular bellies. The aim of the study is to highlight the uncommon anatomical variant diagnosed as an incidental finding and to contribute to the statistics of this type of pathology in our country. A case is reported involving a 14-year-old patient with no significant medical history who sustained a cut injury. Surgical exploration through the previous wound was conducted by the plastic surgery department at the General Hospital of Mexico (2023). The incidental finding revealed complete laceration of both tendons of the palmaris longus muscle, prompting the repair of both tendons. The bifid palmaris longus is a rare anatomical anomaly, not previously described in the statistics of our country. Therefore, the significance of reporting this anatomical variant as an incidental finding is noteworthy.

Prevalence of Palmaris Longus Muscle Agenesis Among Students Assessed Using Various Clinical Assessment Tests

Introduction: Since the lack of Palmaris Longus Muscle (PLM) has no effect on hand and wrist function, it is considered a non-essential muscle. However, its clinical relevance stems from its widespread application in reconstructive and hand surgery. In addition to gender differences, some sources assert that its absence is more prevalent in those genders who lack it in some way, that it is more prevalent when both eyes are missing, and that it is more prevalent when just one eye is present. Aim: The primary objective of this research was to find out how common PLM agenesis is among students of both genders. The secondary objective was to demonstrate that a classical test (Schaffer’s test) can be reliably compared to other tests such as Thompson’s test, Mishra’s test, AIIM’s test, and the Hiz-Ediz test. Materials and Methods: The study was a cross-sectional study carried out at the MAHSA University; A total of 224 cases, comprised of 126 (56.3%) females and 98 (43.8%) males. Each participant was requested to perform five clinical tests namely, Schaeffer’s test, Thompson’s test, Mishra’s test, AIIM’s test, and the Hiz-Ediz test. Results: The frequent agenesis of the palmaris longus in the right forearm of our study with the Schaeffer’s test was (20.5%) and Thompson’s and Hiz-Ediz tests had equal percentages of agenesis (22.3%) while Mishra’s test (22.8%), and AIIMs test (29.5%) of the participants. Moreover, Thompson’s test had the highest percentage of (70.5%) compared to other tests for detecting the presence of PLM in the left forearm. The second nearest test for PLM detection was Schaeffer’s test with a percentage of (67.4%). AIIMs test was able to detect PLM in (64.3%) of the participants and Mishra’s test and Hiz-Ediz tests had close percentages of (59.4%) and (57.6%) respectively for PLM detection. Conclusion: It can be concluded that Thompson’s test had a higher percentage among the tests to detect the presence of the PLM tendon in females while Schaeffer’s test was more significant in males. Thompson’s test had the best accuracy level and the highest percentage level of agreement with Schaeffer’s test compared to the other tests.

A Cadaveric Study of Palmaris Longus Muscle

Background: Aim: To assess the palmaris longus muscle.Methods:40 formalin fixed cadavers of both genders were included. Routine dissection of the upper limb was carried following the Cunnigham抯 Manual of Practical Anatomy. During the dissection of the anterior compartment of forearm, the Palmaris longus muscle was identified & carefully dissected.Results:Out of 40 cadavers, 22 were of males and 18 were of females. Morphology of Palmaris longus found to be normal in 18, agenesis in 6, fusiform in 4, hybrid in 6, bifurcated tendon in 5 and fleshy in 1 case. A significant difference was observed (P< 0.05).Conclusions:Surgeon must be aware of the variations of palmaris longus muscle. Morphology of Palmaris longus found to be normal, agenesis, fusiform, hybrid, bifurcated tendon and fleshy.

Hypertrophied reverse palmaris longus muscle: a rare cause of carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is usually secondary to compression or irritation of the median nerve in the fibro-osseous canal formed by the flexor retinaculum (transverse carpal ligament) and the carpal bones. The prevalence of CTS in the general population is about 7 to 19%. Several causes both local and systemic have been described, but CTS due to aberrant musculature are rare. Here we report a case of a middle-aged female with paresthesia of the hand and a positive Phalen’s test with nerve conduction study of the median nerve showing sensorimotor neuropathy. The patient underwent surgery for open CTS release where we found a hypertrophied reverse palmaris longus muscle attached to the palmar aponeurosis which was excised along with its proximal tendon. On post-operative follow up all the symptoms of CTS were completely resolved. Muscle abnormalities concern three muscles: the palmaris longus, the flexor digitorum superficialis of index, and the lumbricals. These muscles can be hypertrophied, bifid, duplicated, digastric, inverted or have an abnormal insertion, thus creating a mechanical restriction of the carpal tunnel. Surgical resection of abnormal muscle provides excellent functional recovery.

Prevalence of the palmaris longus and its impact on grip strength in elite gymnasts and non-athletes / Prevalencia del músculo palmar largo y el impacto en la fuerza de agarre en gimnastas de elite y no atletas

In elite athletes, the palmaris longus (PL) presence has a potential contribution to hand strength, smaller reaction time, better shooting speed and power. The aim of this study was to investigate the prevalence of PL in elite competitive artistic gymnasts and its impact on grip strength compared to a control group of moderately active non-athletes. This prospective study included 370 subjects divided in two groups (170 elite artistic gymnasts and 200 moderately active non-athletes, students of medicine). The study consisted of two clinical sets of examination: a search for the clinical presence of PL was initially conducted followed by the assessment of maximal grip strength. Standard and six additional tests were performed to confirm PL tendon absence. Maximal grip strength was measured bilaterally with an electronic hand dynamometer. Bilateral absence was more common than unilateral, predominately noted on left side in both study groups. Unilateral PL absence was correlated to decreased grip strength in students, while the opposite was found in gymnasts. The mean value of grip strength in some age groups was higher on the side where the PL was absent. The results of our study show that the presence of the PL doesn`t affect the hand grip strength in gymnasts. Due to the low incidence of unilateral PL absence, further large-sampled research is warranted to assess PL contribution to hand grip strength and to other hand functions that could be of significant importance for athletes and non-athletes.

La presencia del músculo palmar largo (MPL) en atletas de élite tiene el potencial de aportar mayor fuerza a la mano, un tiempo de reacción menor, mejor velocidad de tiro y potencia. El objetivo de este estudio fue investigar la prevalencia de MPL en las gimnastas artísticas competitivas de élite y su impacto en la fuerza de agarre en comparación con un grupo control de no atletas moderadamente activos. El estudio incluyó 370 sujetos divididos en dos grupos (170 gimnastas artísticas de élite y 200 no atletas moderadamente activos, estudiantes de medicina). El estudio consistió en dos series clínicas de examen: inicialmente se realizó una búsqueda de la presencia clínica de MPL, seguido de la evaluación de la fuerza máxima de agarre. Se realizaron pruebas estándar y seis pruebas adicionales para confirmar la ausencia del tendón del MPL. La máxima fuerza de agarre se midió bilateralmente con un dinamómetro de mano electrónico. La ausencia bilateral fue más común que unilateral, predominantemente observada en el lado izquierdo en ambos grupos de estudio. La ausencia unilateral de MPL se correlacionó con una menor fuerza de agarre en los estudiantes, mientras que en gimnastas se encontró lo contrario. El valor medio de la fuerza de agarre en algunos grupos de edad fue mayor en el lado donde el MPL estaba ausente. Los resultados de nuestro estudio muestran que la presencia de MPL no afecta la fuerza de agarre de la mano en gimnastas. Debido a la baja incidencia de ausencia unilateral de MPL, se justifica una investigación adicional de gran tamaño para evaluar la contribución de MPL a la fuerza de agarre de la mano y otras funciones de la mano que podrían ser de gran importancia para los atletas y no atletas.

Morphometric analysis of palmaris longus muscle belly and its tendon: a cadaveric study in north india

Background: The Palmaris Longus Muscle is the first option in tendon graft procedures, for it fulfills the necessarycriteria of length, breadth and easy surgical accessibility. Therefore, the present study was performed with thepurpose to determine the morphometry of PL in North Indian population.Materials and methods: Material for the present study consisted of 40 limbs of different age group andsex(28Males&12Females). The limbs were made available in the Anatomy department for dissection purpose atSGRDIMSAR, Amritsar, Punjab. The length and width of the PL-Muscle Belly(PL-MB) and PL-Tendon(PL-T) weremeasured with the help of digital Vernier caliper. The unpaired t test was used to study the significance of thedifferences in male and females and right and left PLM.Results: The mean MBL and MBW of the PL was more (6.195+1.788cm & 2.095+0.723cm) on right side than(5.895+1.748cm & 1.920+0.740cm) on the left side. The mean TL on left side (15.690+1.336cm) was slightly morethan the right side (15.625+1.489cm) whereas TW on right side (0.435+0.099cm) was found to be slightly morethan the left side (0.426+0.108cm). It was also observed that the mean MBL, MBW, TL and TW was more in malecadavers as compared to female cadavers.Conclusion: PLM has importance in medical clinic, surgery, radiological analysis and has great significancewhen used as a donor tendon in reconstructive surgeries. Thus there are advantages to know the length and widthof the PL tendon for being the ideal choice for tendon graft procedures.

A case of potentially lethal vascular variation in association with palmaris profundus muscle / 대한해부학회지

Arterial variations in upper limbs are often reported commonly. Superficial arterial variations accounting for 4.2% of all arterial variations are hazardous during any invasive procedures of the upper limb, from routine intravenous injections to surgeries. Arterial variations are usually associated with inverted or absent palmaris longus. Palmaris profundus, a rare anomalous variation of palmaris longus has been reported in carpal tunnel syndrome as its tendon was associated with median nerve in the carpal tunnel. The authors reported a unique variation in the upper limb arterial pattern—the presence of bilateral superficial brachioulnar artery associated with unilateral palmaris profundus muscle and an abnormal radicle of musculocutaneous nerve to the median nerve in the left side.

Variaciones del músculo palmar largo en la población de Caldas (Colombia) / Variations of the palmaris longus muscle in the population of Caldas (Colombia)

El músculo palmar largo es de los músculos más variables en su presentación en el cuerpo humano. El propósito del estudio fue determinar su grado de agenesia en una muestra de individuos del Departamento de Caldas (Colombia). Se evaluó la presencia del músculo palmar largo por visualización directa de su tendón, para lo cual se aplicó el test de Thompson, y cuando fue necesario se aplicó el Test de Schaeffer, en una muestra de 115 individuos de sexo femenino y masculino entre los 17 a 50 años de edad oriundos de Caldas. La agenesia global del palmar largo se encuentra en el 22,6 % de la población caldense, pero la agenesia bilateral sólo se presenta en el 8,69 % de los individuos, siendo mayor su presentación en las mujeres; mientras que la agenesia unilateral es más frecuente, por el orden del 13,91 %, guardando una proporción semejante entre hombres y mujeres. Aunque existe cierta concordancia con la mayoría de estudios realizados en otros países, nuestro estudio destaca dos hechos relevantes, que la agenesia global músculo del palmar largo tiene una de las frecuencias más elevadas de presentación, y que la agenesia unilateral, tanto derecha como izquierda, se encuentra entre los rangos más bajos. La agenesia global del músculo, bilateral y unilateral, es más común en las mujeres. Así mismo, la agenesia bilateral es más frecuente en las mujeres, con una presentación que duplica la de los hombres, mientras que la agenesia unilateral es proporcionalmente igual en ambos sexos.

The palmaris longus muscle is one of the most variable muscles in its presentation in the human body. The purpose of the study was to determine the degree of agenesis of this muscle in a sample of individuals in the Department of Caldas (Colombia). The presence of palmaris longus muscle by direct visualization of the tendon was evaluated by applying Thompson`s test and where necessary, Schaeffer`s test, in a sample of 115 individuals (female and male) between 17-50 years old, all natives of Caldas. The overall agenesis of palmaris longus muscle is in the 22.6 %, but bilateral agenesis occurs only in 8.69 % of individuals, being higher in women, while unilateral agenesis is more common in the order of 13.91 %, keeping a similar proportion of men and women. Although there is some agreement with most of the studies made in other countries, our study highlights two important events, the global agenesis of palmaris longus muscle has one of the highest frequencies of submission, and that the unilateral agenesis, both right and left is among the lower ranks. Bilateral and unilateral global muscle agenesis is more common in women. Likewise, bilateral agenesis is more frequent in women, with a presentation that doubles that of men, while unilateral agenesis is proportionally equal in both sexes.

A Study Of Palmaris Longus Muscle: Its Anatomic Variations With Embryological Significance And Clinical Importance

Background: In the present study, variations in the Palmaris longus and the clinical implications of these arediscussed.Aim: To study the variations in the Palmaris longus and to discuss the embryological basis, clinical and surgicalimplications of these variations.Materials and Methods: This study was conducted in Department of Anatomy of Hassan Institute of MedicalScience, Hassan, Dr B.R.Ambedkar Medical college, Bangalore and Sri Devaraj Urs Academy of Higher Educationand Research,Tamaka, Kolar. Thirty formalin fixed cadavers (60 upper limbs); 25 males & 5 female cadavers weredissected for the study and it was conducted over a period of three years, i.e., from 2011-2014. The cadavers withvisible trauma, pathology or prior surgeries were excluded from the study. Routine dissection of the upper limbwas carried out following the Cunnigham’s Manual of Practical Anatomy. During the dissection of the anteriorcompartment of forearm, the Palmaris longus muscle was identified & carefully dissected. At first, the origin wasconfirmed and then, it was traced towards its insertion. Any variations found were noted and photographed. Theresults were analysed and compared to previous studies.Results: Bilateral absence of palmaris longus was seen in one male cadaver and unilateral (right sided) absencein one female cadaver. Percentage of bilateral absence of palmaris longus is 3.3%. Total absence of palmarislongus is 5%. Right side absence is 3.3%, left side absence is 1.6%. Variations like split tendon of palmaris longuswas observed in a female cadaver on right side, bilateral split tendon with fleshy belly in a male cadaver,reversed belly of right side palmaris longus in a male cadaver .

Interobserver and intraobserver reliability of different methods of examination for presence of palmaris longus and examination of fifth superficial flexor function / 대한해부학회지

The palmaris longus is harvested as a tendon graft in various surgical procedures. Several tests are used to assess the presence of palmaris longus tendon. In the present study, we attempted to assess the interobserver and intraobserver reliability of five of the most famous methods and also the examination of fifth superficial flexor function. Two observers, who had been trained on the tests and had practiced them, examined 105 volunteers on two separate occasions and in 1-month interval the results were recorded. The reliability of each method was assessed with Kappa measurement. Kappa ranged from 0.541 (moderate reliability) to 0.813 (almost complete agreement) for palmaris. The highest interobserver and intraobserver reliability and also the best agreement with other tests were of Schaeffer. The lowest kappa was for Thompson and the others have good to excellent reliability. Kappa for interobserver and intraobserver reliability for the fifth flexor were 0.415 and 0.500 (moderate reliability), respectively. The tests that were assessed have good reliability except for Thompson that has a moderate one. It seems that the standard test (Schaeffer) is the best method for the assessment of the absence or presence of palmaris longus. The method used for the evaluation of fifth superficial flexor variations assessment has a moderate interobserver and intraobserver reliability.

Repair complex tissue defect of the palm of fingers by the super large vein flap with palmaris longus tendon / 中华显微外科杂志

Objective To investigate the clinical effect of super large venous flap with palmaris longus tendon for repairing the complex tissue defect of the palm of finger.Methods From May,2011 to October,2017,complex tissue defect of the palm of 15 fingers in 15 cases was treated by a super large vein flap with palmaris longus tendon.There were 10 males with 10 fingers and 5 females with 5 fingers.The age was from 19 years to 51 years (average,35.8years).Among these cases,machine injury was in 12 cases and crush injury was in 3 cases.Complex tissue defect of the palm of the finger with tendon defect occurred in all the cases.There were 3 thumbs,5 index fingers,3 middle fingers and 5 ring fingers.The area of skin defect was from 3.5 cm×2.0 cm to 7.5 cm×3.5 cm.The length of tendon defect was 2.0-4.0 cm.Phalangeal fractures occurred in 4 cases (2 cases of proximal phalanx,1 of middle phalanx,and 1 of distal phalanx).All the patients received the operation in one stage.The time between the injury and the operation was 1.5-3.0h(average,2.0 h).The time of the operation was 3.0-4.5 h(average,3.6 h).Regular followed-up was performed after operation.Results All flaps survived.Fourteen cases were followed-up for 6 to 12 months(average,7 months),and 1 case lost.The skin flap has soft texture,good elasticity,and no bloat.The color of skin flap was close to the normal skin.Sensory recovery reached S2 to S3,and the function and appearance of the finger were well restored.Conclusion The super large vein flap with palmaris longus tendon can be used to repair the complex tissue defect of the palm of fingers.The flap can get a satisfactory effect after surviving.It is an ideal method of repairing this kind of damage.

Morphology and morphometry of the tendons of the palmaris longus and radial carpal extensor muscles in humans / Morfología y morfometría de los tendones de los músculos palmar largo y extensores radiales del carpo en el hombre

The tendons of the palmaris longus (PL) and radial carpal extensor (RCE) muscles have extensive applications in surgery, yet despite their constant use, information about their morphological and morphometric characteristics remains limited. The aim of this study was to describe the morphological and morphometric characteristics of the PL and RCE muscle tendons and compare them to each other in 30 upper limbs of adult individuals with no apparent deformations from anatomy units at four universities in Chile. The anterior side and lateral margin of the forearm and the back of the hand as far as the tendon plane were dissected. The average length, width at origin level and at the level of the radiocarpal joint line of the PL muscle tendon were 125.48 mm ± 8.93, 4.76 mm ± 1.35 and 3.76 mm ± 0.91, respectively. The average length, width at the levels of origin and insertion of the extensor carpi radialis longus muscle tendon were 180.46 mm ± 15.03, 14.69 mm ± 3.72 and 7.76 mm ± 1.44 respectively, whereas for the extensor carpi radialis brevis muscle they were 115.23 mm ± 11.81, 9.53 mm ± 2.58 and 7.33 mm ±1.17, respectively. The most common origin of the tendons of the PL and extensor carpi radialis longus muscles was at the level of the middle third of the forearm, whereas the most common origin of the extensor carpi radialis brevis muscle tendon was at distal third level. The shape of the tendons of the PL and RCE muscles was broad and flat along their entire length. Simulating the longitudinal division of the tendons of the RCE muscles in two halves, the radial half of the tendons of both muscles has morphological and morphometric characteristics similar to the PL muscle tendon, such that it could be used as a graft in the case of agenesis of the PL muscle, or for tendon transfer where elongation of a tendon in the region is required.

Los tendones de los músculos palmar largo (PL) y extensores radiales del carpo (ERC) tienen extensas aplicaciones en cirugía, pero a pesar de su constante uso, es escasa la información respecto a sus características morfológicas y morfométricas. El objetivo de este estudio fue describir las características morfológicas y morfométricas de los tendones de los músculos PL y ERC y compararlas entre sí, en 30 miembros superiores de individuos adultos, sin deformaciones aparentes, pertenecientes a unidades de anatomía de cuatro universidades de Chile. Se disecó la cara anterior y el margen lateral del antebrazo, y el dorso de la mano, hasta llegar al plano de los tendones. Los promedios de longitud, anchos a nivel del origen y a nivel de la línea articular radiocarpiana del tendón del músculo PL fueron de 125,48 mm ± 8,93, 4,76 mm ± 1,35 y 3,76 mm ± 0,91, respectivamente. Los promedios de longitud, anchos a nivel de origen y a nivel de la inserción del tendón del músculo extensor radial largo del carpo fueron de 180,46 mm ± 15,03, 14,69 mm ± 3,72 y 7,76 mm ± 1,44, mientras que para el tendón del músculo extensor radial corto del carpo fueron de 115,23 mm ± 11,81, 9,53 mm ± 2,58 y 7,33 mm ±1,17, respectivamente. El origen más común de los tendones de los músculos PL y extensor radial largo del carpo fue a nivel del tercio medio del antebrazo, mientras que el origen más común del tendón del músculo extensor radial corto del carpo fue a nivel del tercio distal del antebrazo. La forma de los tendones de los músculos PL y ERC era ancha y plana durante toda su extensión. Al simular la división longitudinal de los tendones de los músculos ERC en dos mitades, la mitad radial de los tendones de ambos músculos presenta características morfológicas y morfométricas similares al tendón del músculo PL, por tanto, eventualmente podrían ser utilizadas para injerto en caso de agenesia del músculo PL, o para transferencia tendinosa, en caso de que se requiera un alargamiento de algún tendón de la región.

Anatomical Variation of Palmaris Longus: Tendinous Origin and Fleshy Insertion.

A tendinous origin and fleshy insertion of palmaris longus muscle was observed in the left forearm during routine dissection which was performed on adult male cadaver in the department of Anatomy, Dr. Rajendra Prasad Government Medical College. It was having long tendinous origin from the medial epicondyle of the humerus and the surrounding deep fascia. It was fusiform at the lower middle of the forearm. The fleshy muscular insertion was noted to the flexor retinaculum and few muscular fibers interdigitate with flexor carpi ulnaris muscle and palmar aponeurosis. The length of tendon was 19 inches and fleshy muscular length was 11inches. Themedian nerve and ulnar nervewas covered by this fleshy insertion. This palmaris longus variation is helpful for the surgeon and the radiologist, orthopaedic, plastic surgeon during any diagnosis of the forearm because this fleshy part of muscle can compress the median nerve and ulnar nerve or it can be mistaken as a tumor or ganglion during radiological or clinical examination.

Prediction of the presence of plantaris tendon through examination of palmaris longus tendon: is there a link? / Predicción de la presencia del tendón del músculo plantar mediante el examen del tendón del músculo palmar largo: ¿hay una relación?

The purpose of this study was to investigate the relationship between palmaris longus (PL) and plantaris (P) tendons and test the clinical usefulness of symmetry patterns between these tendons in Turkish population. This prospective study comprised a total of 240 adult patients (120 men and 120 women) who were admitted to our outpatient clinic with bilateral knee complaints that required bilateral knee MR examination during two years. Standard test (Schaefer's test, oppose the thumb to the little finger while flexing the wrist) was used to assess the presence of the PL tendon both with inspection and palpation. Knee MRI was used to determine the presence of P muscle belly on both sides. We have analyzed symmetric distribution pattern using Mc-Nemar test. The PL was absent unilaterally in 34 subjects (14.2%), while it was absent bilaterally in 17 subjects (7.1%). The P was absent unilaterally in 51 subjects (21.3%), while it was absent bilaterally in 10 subjects (4.2%). If PL was absent in one hand, the chance of having an ipsilateral P tendon was 70.6%. If PL was present in one hand, the chance of having an ipsilateral P tendon was 87.6%. The Mc-Nemar test for symmetry yielded a p value of 0.841 for ipsilateral PL and P muscles. A clear-cut link between Palmaris longus and plantaris tendons could not be demonstrated in this study. Both muscles show different variations independent from each other.

El propósito de este estudio fue investigar la relación entre los tendones del músculo palmar largo (MPL ) y músculo plantar (MP) y poner a prueba la utilidad clínica de los patrones de simetría entre estos tendones de la población turca. Estudio prospectivo realizado sobre 240 pacientes adultos (120 hombres y 120 mujeres) que ingresaron en la clínica por síntomas de dolor en la rodilla bilateralmente, quienes requerían un examen de RM de rodilla durante dos años. Se utilizó la prueba estándar (prueba de Schaefer, se oponen el pulgar hasta el dedo mínimo, mientras se flexiona la muñeca) para evaluar la presencia del tendón MPL tanto con la inspección y palpación. La RM de la rodilla se utilizó para determinar la presencia de vientre muscular plantar en ambos lados. Se analizó el patrón de distribución simétrica mediante la prueba de McNemar. El tendón del MPL estuvo ausente de manera unilateral en 34 pacientes (14,2%) y bilateralmente en 17 pacientes (7,1%). El tendón del MP estuvo ausente de manera unilateral en 51 pacientes ( 21,3 %) mientras que bilateralmente no estaba en 10 pacientes (4,2%). Si el tendón del MPL estuvo ausente en un lado, la probabilidad de tener un tendón del MP ipsilateral fue del 70,6 %. Si el tendón del MPL estaba presente en un lado, la probabilidad de tener un tendón del MP ipsilateral fue 87,6%. La prueba de McNemar - simetría produjo un valor p de 0,841 para los músculos PL y P ipsilaterales. Una relación directa claro entre los tendones de los músculos PL y P no se pudo demostrar en este estudio. Ambos músculos muestran diferentes variaciones independiente uno del otro.

Plexiform Neurofibroma from Palmaris Longus with Carpal Tunnel Syndrome.

Plexiform neurofibromas (NF) involving the palmaris longus tendon are rare diseases difficult to diagnose when the classical manifestations, e.g. skin pigmentation, sub cutaneous nodules, lisch nodules, family history, etc are absent. We report a case of 26 years male with plexiform NF of palmaris longus tendon which is a relatively rare site. Plexiform NF commonly involve the cranial nerves.

Bilateral reversed palmaris longus muscle with trifid insertion, a rare variation.

Normally the palmaris longus muscle originates from the medial epicondyle of the humerus from common flexor origin. In the middle of the forearm, the muscle belly forms a tendon which is inserted into the flexor retinaculum and the palmar aponeurosis. In our study after dissection of both forearms of a 45-year-old male cadaver we found a reversed palmaris longus muscle. This means that the palmaris longus muscle was tendinous in its proximal part and muscular in its distal part. The fleshy belly of muscle was passing over flexor retinaculum, was ensheathed by separate fascia. The muscle belly was spreading on both the sides of each palm for insertion which was trifid, that is centrally into palmar aponeurosis, laterally continuous with the fascia covering the thenar muscles and medially with Abductor digit minimi. It was having tendinous interconnection with the muscle mass of both the sides. Bilateral reversed palmaris longus muscle mentioned in the literature, was a surgical finding in a patient who suffered from edema and pain in the wrist. The overuse of the reversed palmaris longus muscle can lead to the muscle’s local hypertrophy. As per the literature a reversed palmaris longus muscle may cause a compartment syndrome with pain and edema in the wrist area, the carpal tunnel syndrome and Guyon’s syndrome. The variation is also useful to the hand surgeon, as the palmaris longus muscle is an anatomical landmark for operations in this area.

Free autogenous palmaris longus tendon transplantation in treatment of cicatricial ectropion / 中华医学美学美容杂志

Objective To investigate the method and effect of free autogenous palmaris longus tendon transplantation in the treatment of moderate and severe cicatricial ectropion.Methods The autogenous palmaris longus tendon was obtained through a small lateral proximal wrist band incision (lengths from 4 cm to 6 cm).The graft was properly sutured to the exposed tarsus and the attachments of inner and outer canthus.Local skin flap was rotated to cover the tendon and to repair the wound.Results Six man (8 eyes) with moderate and severe cicatricial ectropion were treated in our department,all case of ectropion were rectified after operation.The eyeballs were well contacted with lower eyelid and no recurrence of eetropion,epiphora and corneal exposure during 6 to 18 months' follow-up.The tension of the lower eyelid was abiding with satisfied effects.Conclusions The palmaris longus tendon is easy to obtain and there is no harm to the donor site.The cicatricial ectropion could be repaired with self-palmaris longus tendon transplantation with lasting effect and the recurrence rate is lower,which is well worthy popularizing.

Múltiples Variaciones Musculares y Neurovasculares en los Miembros Superiores: Presentación de Caso / Multiple Muscle and Neurovascular Variations in the Upper Limbs: Case Report

Se presenta un raro caso de múltiples variaciones en los miembros superiores de un espécimen cadavérico de 45 años de género masculino, del laboratorio de morfología de la Universidad Industrial de Santander (Bucaramanga-Colombia). Se observó variaciones musculares (presencia bilateral de cabezas adicionales del bíceps braquial y del musculo flexor largo del pulgar, agenesia del palmar largo derecho), nerviosas (anastomosis entre mediano y nervio musculocutáneo, y entre ulnar y mediano al nivel palmar superficial). Adicionalmente, presentó el origen de la arteria radial izquierda desde el segmento superior de la braquial. Estas diversas expresiones morfológicas determinan relevantes implicaciones clínicas y deben tenerse en cuenta en los diferentes abordajes quirúrgicos de los miembros superiores.

It is presented a rare case of multiple variations in the upper limbs of a 45 years old male cadaver specimen, ownership of the morphology laboratory of the Universidad Industrial de Santander (Bucaramanga, Colombia). Muscle variations were observed (presence of both additional heads of the biceps brachii and the flexor pollicis longus, agenesis of right palmaris longus), nervous variations (anastomosis between median and musculocutaneous nerve and between ulnar and median at superficial palmar level). Additionally it presented the radial artery origin from upper left segment of the brachial artery. These various morphological expressions determine relevant clinical implications and should be taken into account in the various surgical approaches to the upper limbs.

Agenesis of Palmaris Longus Muscle in Selected Population of School Children in Nigeria / Agenesia del Músculo Palmar Largo en una Población Seleccionada de Niños en Edad Escolar de Nigeria

The aim of this study is to evaluate the prevalence of agenesis of palmaris longus muscle tendon among school children in Ogun state, Southwestern Nigeria and also, to verify the symmetry of the agenesis of the muscle in relation to sex. The presence of the palmaris longus muscle tendon was determined in 564 individuals, 285 male and 279 female, with age varying from 2 to 20 years old. Four different tests were used; Schaeffer's test, Thompson's test, Mishra's test 1 and Pushpakumar's "two-finger sign" method. The data obtained were further analyzed statistically and the agenesis of palmaris muscle was found to be 26.7% (unilateral 13.0%; bilateral 13.7%). Prevalence was higher in female (32.3%) than male (21.4%) (P>0.05). Besides, we observed higher agenesis in the left side in female individuals. High prevalence of agenesis of palmaris muscle observed in the study population is similar to other previous reports in Southwestern Nigeria.

El objetivo de este estudio fue evaluar la prevalencia de agenesia del tendón del músculo palmar largo entre niños en periodo escolar del Estado de Ogun, sudoeste de Nigeria, y verificar además, la simetría de la agenesia del músculo en relación al sexo. La presencia del tendón del músculo palmar se determinó en 564 individuos, 285 hombres y 279 mujeres, con edades que variaban entre 2 y 20 años de edad. Se utilizaron cuatro ensayos diferentes; prueba de Schaeffer, prueba de Thompson, prueba de Mishra 1 y método de Pushpakumar "signo de dos dedos". Los datos obtenidos fueron analizados estadísticamente, donde se encontró que la agenesia del músculo palmar fue de 26,7% (13% unilateral; 13,7% bilateral). La mayor prevalencia fue en el sexo femenino (32,3%), siendo hombres (21,4%) (p> 0,05). Además, se observó mayor agenesia derespecto al lado en mujeres. La alta prevalencia de agenesia del músculo palmar largo observada fue similar a la encontrada en informes en el Suroeste de Nigeria.

Prevalence of agenesis of the palmaris longus muscle in Brazil and its clinics correlation

Introduction: The palmaris longus muscle it is considered one of the most variable muscles in the human body, and its agenesis is the most frequent anatomic variation. The aim of this study was to determine the prevalence of unilateral and bilateral agenesis of palmaris longus muscle for the subjects in the city of Jataí, Goiás. Material and methods: 740 subjects, 279 men and 461 women, in the age of 10-70 years old, were observed through clinical inspection in both forearms to absence of the tendon of palmaris. The data were described in percentage values and the absence of the muscle was analyzed statistically (Chi square test; P < 0.05). Results: The bilateral presence was identified in 73.5%, the absence on the left side in 7.8%, on the right in 6.5% and bilateral absence was observed in 12.2% of subjects. Among women and men the percentage values was 9.3%, 7.3%, 13.1% and 5.4%, 5%, 10.7%, respectively to agenesis in left side, in right side and bilateral agenesis. The unilateral/bilateral agenesis was more frequent in women (29.7%) than in men (21.1%; P < 0.05). Bilateral absence was 12.4% in right handed subjects and 9.1% in left handed subjects (P > 0.05). Left and right handed subjects showed absence of muscle similar in both forearms (P > 0.05). Conclusion: most subjects studied showed bilateral presence of palmaris longus muscle, the agenesis was significantly more common in women and with similar percentage in right and left handed subjects.