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Objectives The tendon of the palmaris longus is commonly used as a tendon graft in many reconstructive surgeries. Palmaris longus absence (PLA) was found in 15% among individuals worldwide. In this prospective study, we aimed to conduct an incidence study in which physical examination methods were confirmed by ultrasonography in PLA, and to evaluate the relationship of absence with age, gender, laterality and dominant hand. Methods The study included 490 cases. They were initially tested to evaluated by physical examination using the Schaeffer's and Hiz-Ediz test for the assessment of the palmaris longus tendon. Additional ultrasonography was performed to confirm its absence in 129 wrists of 78 cases whose tendons could not be visualized or palpated. Results The incidence of tendon absence was 13% by physical examination methods. According to the final results when we added ultrasonography to physical examination methods, the incidence of unilateral, bilateral and overall absence of the palmaris longus were 5%, 9% and 11% respectively. There was no statistically significant difference between individuals with and without PLA in terms of gender, side, age and dominant hand (p = 0.796, p = 0.622, p = 0.397 and p = 0.187, respectively). However, bilateral PLA was statistically significantly higher than unilateral in both genders (p = 0.011). Conclusions We think that agenesis should be proven accurately by ultrasonographic examination for the final result before any surgical procedure with palmaris longus tendon. Furthermore measuring the diameter of the palmaris longus tendon by preoperative ultrasonography can be useful for surgeons who plan a procedure that requires specific measurements. WOS:000582827900001 2-s2.0-85094210936 PubMed: 33123771

Background The palmaris longus muscle is considered one of the most anatomically variable muscles in the human body. Localized swelling of the forearm due to hypertrophy of the palmaris longus muscle is rare. Case presentation Here, we report a rare case of a 24-year-old Arab man who presented with a painful mass on his forearm with symptoms of median nerve compression. A full radiological assessment was performed, and he was treated conservatively. Conclusion This case confirmed that a hypertrophied palmaris longus muscle can be the cause of swelling on the forearm and should always be considered in the differential diagnosis. With this report, we aimed to increase awareness regarding the unusual variations of palmaris longus muscle and the importance of using radiological investigations to establish a diagnosis.

BACKGROUND Palmaris longus is a member of superficial group of flexor compartment of forearm muscles. It is a weak flexor of wrist and tensor of palmar aponeurosis. Its absence does not affect the strength or grip. However, its anomalous variants may cause clinical syndromes. Also, its long tendon with short muscle belly favours its use in tendon grafts and repair. Since it is a highly variable muscle, its variations must be studied. The aim of the study is to evaluate the different variations in palmaris longus muscle in cadavers and its possible clinical implications. MATERIALS AND METHODS This study was conducted in the Department of Anatomy of Madurai Medical College, Madurai. 30 formalin preserved cadavers were dissected during the period 2015-2018. A total of 60 upper limbs were studied. Both female and male cadavers of all age groups were included. Specimens damaged during dissection were excluded. The anterior compartment of forearm in all specimens were dissected step by step as per the directions given in Cunningham’s manual of dissection. The palmaris longus muscle was identified by tracing out its origin and insertion. Anatomical variations encountered in the due course were documented and analysed using chi square test for statistical significance. The prevalence and significance of variations from the other studies done so far have also been studied. RESULTS Bilateral absence of palmaris longus along with palmar aponeurosis which is a rare occurrence was observed in a female cadaver. Bilateral duplication of palmaris longus was noted in one male cadaver. Duplication is more common in males. Absence is more common in females. In general, Variations are more common in females. CONCLUSION With variations of palmaris longus being more common, adequate knowledge about its prevalence and significance is needed in multiple medical specialities for its reconstructive use and clinical syndromes caused by it at times. Therefore, diagnosing and treating them appropriately is very important.

A case report to describe the occurrence of Dupuytren's disease in the wrist leading to compression of the palmar cutaneous branch of the median nerve. A 60-year-old male presented with a lump on the volar aspect of the left wrist with reduced sensation in the thenar eminence. Intra-operatively this was found to be a nodule integrated within the palmaris longus tendon and positioned superficially to the palmar cutaneous branch of the median nerve. Histological findings were consistent with Dupuytren's disease and the patient's symptoms improved post excision of the nodule. Although Dupuytren's nodules occur rarely in the wrist, they should be considered as part of the differential diagnosis of wrist lumps and they have the potential to impact on nearby neural structures. Keywords: Dupuytren's disease, Wrist, Nerve compression, Palmaris longus, Palmar cutaneous branch of the median nerve

Background: Ulnar collateral ligament (UCL) reconstruction is the current gold standard of treatment for overhead athletes with a symptomatic, deficient UCL of the elbow who have failed nonoperative treatment and wish to return to sport (RTS) at a high level. The palmaris longus and hamstring tendons are common graft choices, but no study has analyzed the existing literature to assess whether one graft is superior to the other. Purpose: To systematically report on the outcomes of UCL reconstruction using palmaris and hamstring autografts. Study Design: Systematic review; Level of evidence, 4. Methods: A combination of the terms “ulnar collateral ligament,” “valgus instability,” “Tommy John surgery,” “hamstring,” and “palmaris longus” were searched in PubMed, Embase, and the Cochrane Library. RTS and return-to-same-level (RSL) rates, patient-reported outcomes, and complications were included for analysis. We used the modified Coleman Methodology Score and risk-of-bias tool for nonrandomized studies to assess the quality of the included studies. Results: This review included 6 studies (combined total of 2154 elbows) that directly compared palmaris and hamstring graft use in UCL reconstruction. Follow-up ranged from 24 to 80.4 months, and the mean patient age across all studies was 21.8 years. The mean RSL across all studies and grafts was 79.0%, and the mean RTS was 84.1%, consistent with results previously reported in the literature. The mean RTS and RSL rates for the palmaris graft group were 84.6% and 82%, respectively; the hamstring graft group showed mean RTS and RSL rates of 80.8% and 80.8%. Meta-analysis revealed no significant difference in RSL between the 2 graft groups (odds ratio, 1.06; 95% CI, 0.77-1.46). The combined complication rate of the included studies was 18.2%, with failure rates ranging from 0% to 7.1%. Conclusion: Results of this review indicated that both palmaris and hamstring tendon grafts are viable options for primary UCL reconstruction. Graft choice should be determined by a combination of patient and surgeon preference.

Purpose We present a case of a bilateral reversed palmaris longus muscle and a systematic review of the literature on this anatomical variation. Methods Routine dissection of a 90-year-old male cadaver revealed a rare bilateral reversed palmaris longus. This was documented photographically, and length and relation to anatomical landmarks were recorded. This finding stimulated a systematic review of the literature on the reversed palmaris longus variation, from which measurements were collated and statistical analysis performed to determine the prevalence, average length, relationship to side and sex, and to discuss its clinical and evolutionary implications. Results The average length of the muscle belly and tendon of reversed palmaris longus was 135 mm and 126 mm, respectively. Statistical analysis revealed no disparity in presentation due to sex and side; however, bilateral reversed palmaris longus has only been reported in males. A high proportion (70.8%) of reversed palmaris longus were discovered in the right upper limb compared to the left. Conclusion Variations in palmaris longus are purported to be as a result of phylogenetic regression. Clinically, patients with this variant may present with pain or swelling of the distal forearm, often as a result of intense physical exertion related to occupation or sport. Clinicians should be aware of this muscle variant as its presence could lead to confusion during tendon allograft harvesting procedures in reconstructive and tendon grafting surgery.

Introduction Posterolateral rotatory instability is the most frequent form of elbow instability. This clinical entity, described by O’Driscoll et al. in 1991, concerns young subjects following elbow trauma. Diagnosis is founded on symptomatology and positive posterolateral rotatory instability test. Treatment is based on reconstruction of the ulnar bundle of the lateral collateral ligament. The present study assessed medium-term clinical and radiological results in lateral ligamentoplasty for posterolateral elbow instability. Materials and methods A retrospective continuous single-center series included 19 cases: 11 male, 8 female, operated on between 1995 and 2010; mean age was 37.8 years (range, 20–63 years). Surgery consisted in lateral ulnar collateral ligament reconstruction by autologous palmaris longus tendon graft following Nestor et al. (1992). Results Eighteen patients were assessed at a mean 61 months’ follow-up. Mean time off work was 3.2 months (range, 2–7 months); all patients returned to work. No revision surgery was required. Mean range of motion in flexion, extension, pronation and supination was respectively 135°, 8°, 84° and 76°. Instability test was systematically negative at follow-up. Mean Mayo Clinic and Quick-DASH scores were respectively 90 (range, 60–100) and 21 (range, 0–63). All patients were satisfied or very satisfied with their result. Conclusion Lateral ulnar collateral ligament reconstruction by autologous palmaris longus tendon graft provided reliable and lasting results. We consider it to be the reference treatment for chronic instability, and sometimes in acute post-traumatic instability. Level of evidence IV.

Musculus Palmaris Longus is one of the most variable anatomical structures in the human body. Despite being biomechanically active, it is vastly considered to have no impact on the functionality of the upper extremity in the general population. The aim of this study is to examine the relation between playing capability of young musicians and morphology of Musculus Palmaris Longus and to compare it with the relation between manual capability of non-musicians and morphology of their Musculus Palmaris Longus. 42 forearms of 21 healthy individuals (11 musicians and 10 non-musicians) were subjected to Shaeffer’s test and ultrasound imaging and tested by dynamometer for hand grip strength and the first and fifth finger opposition before and after exertion. No difference in morphology pattern was observed between the groups. In the musicians, a substantial loss of a hand grip strength of the left hand compared to the right hand after exertion, regardless of lateralization, was observed. A disproportion in exhaustion of the musician’s hands with unilateral absence of Palmaris Longus was observed – the difference in grip strength between the dominant and non-dominant hand before and after exertion increased over eight times more than in the musicians with bilateral presence. There is no difference in Palmaris Longus morphology between either the musicians or non-musicians. Regardless of lateralization, the musician's left hand in musicians seems weaker and therefore more prone to misuse related injuries. Palmaris Longus may play a role in musicians in balancing muscular exhaustion.

Post traumatic loss of segment of the central tendon of extensor expansion is common in crush injury of the hand. Central tendon forms the inherent part in the dynamics of extensor expansion mechanism. When a segmental loss of central tendon occurs, usually the reconstruction of the tendon is done with autogenous Palmaris longus tendon as it is more expendable. In this particular clinical scenario, the absence of Palmaris longus tendon was dealt with partial removal of Flexor Carpi radialis tendon which proved to be effective. The outcome following surgery was reasonable. Post operatively Hyperbaric oxygen therapy was given to improve the survival of crushed tissue. [Hand Microsurg 2020; 9(3.000): 167-170]

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.

Background: Ethnic variations in the prevalence of the absence of the palmaris longus (PL) tendon are well known. Studies have also attempted to correlate its absence with other anatomical anomalies. However, most studies have been done in Caucasian populations. The present study was undertaken to know the occurrence of absence of palmaris longus in Indian population. Materials and Methods: The presence of the PL tendon was clinically determined in 385 normal Indian men and women using the standard technique. In subjects with an absent PL tendon, three other tests were performed to confirm its absence. All subjects were also examined for the presence of the flexor digitorum superficialis (FDS) in the little finger. Results: The overall unilateral absence of the tendon was 16.9% and the bilateral absence was in 3.3% in our population. There was no significant difference in its absence with regard to the body side or sex. The overall prevalence of the weak FDS in the little finger irrespective of the presence or absence of the PL tendon in our study was 16.10%. If we compare the deficiency of the FDS in the little finger with the absence of the PL tendon, the overall incidence is 4.15% and is statistically significant, while the sexwise distribution of the weak FDS with absent PL tendon was statistically significant in males and in females it was statistically insignificant. Conclusions: The prevalence of the unilateral absence of the PL tendon in an Indian population is comparable to the western population but a bilateral absence is significantly less. In patients with an absent PL tendon, the FDS of the little finger is weak, especially in males.

Background: The agenesis of Palmaris longus (PL) tendon varies with each Ethnic group of the population across the world. Literature review suggests Asians have the least prevalence of absence of Palmaris longus tendon whereas Turkish and Africans have the highest incidence. Lots of studies have been done to report the incidence of agenesis of the PL, and its association with hand-dominance, gender, laterality and hand grip strength with varying results. There has been no study conducted in the Mysorean population. Methods: 248 consecutive adults attending the outpatient department of orthopedics in JSS were included in this study. Patients were included based on selection criteria. Three tests were done to confirm the absence of PL by two independent observers including one senior author. The hand grip was recorded based on the mean value of three readings in each hand using a dynamometer. The results were statistically analyzed. Results: Females had a higher incidence of agenesis of PL. Right-hand dominant individuals had a higher rate of agenesis of PL. Unilateral agenesis was more common than bilateral agenesis. Conclusion: Absence of PL does not affect the hand grip strength of the patient. The PL tendon is an extremely useful donor tendon and may be sacrificed during reconstructive surgeries. [Hand Microsurg 2018; 7(3.000): 115-124]

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.

Introduction: Palmaris longus (PL) is one of the most variable muscles in our body and is vestigial functionally. Its long tendon and its superficial location make it an ideal source for tendon harvesting. Variations such as absence, duplication and reversal have far reaching clinical impact. The aim of this study is to estimate the presence, variants and nerve supply of the PL. Materials and Methods: Upper extremity of 24 cadavers was dissected and PL was examined. The results were compared to other studies on the PL and literature survey was carried out. Results: Thirty nine specimens showed normal morphology and four showed complete agenesis. Other morphological variations seen included - reversed, hybrid, fusiform, fleshy and bifurcated tendon of insertion. Conclusion: Every surgeon must be aware of the variations of the versatile but temperamental PL. Prior knowledge of the layout of the muscle helps in planning intricate surgeries to which this tendon is put use to.

Background Palmaris longus, being the most variable muscle of the upper extremity is generally considered important morphologically rather than functionally. The palmar aponeurosis represents the distal part of the tendon of Palmaris longus. Case Details We report here a unique case of palmaris longus presenting variation distally as its tendon divides to gain multiple attachments with the fascia covering the abductor pollicis brevis, flexor retinaculum and the tendon of flexor carpi ulnaris. In addition, it also continues as palmar aponeurosis as its normal course. Conclusion Presence of this kind of variation might result in compression of the median and ulnar nerves and may aggravate the complications in case of inflammation of palmar aponeurosis thus mimicking the manifestations of Dupuytren's contracture.

Flexor digiti minimi is a muscle of hypothenar eminence. It flexes the little finger at metacarpo­ phalangeal joint. During routine Anatomical dissection, an extra muscle was noticed in the flexor compartment of right forearm of a male cadaver. The identified muscle took origin from medial aspect of the Palmaris longus tendon just proximal to the wrist joint. When traced distally this muscle joined the fibers of the Flexor digiti minimi, and finally got inserted to palmar aspect of base of proximal phalanx of 5th digit. In its course, the muscle crossed median nerve and Ulnar artery. Because of this reason, this variation has the potential to cause compression of the structures mentioned above and is of interest to clinicians.

Background The frontalis sling procedure is a useful approach for correcting severe blepharoptosis. However, blepharoptosis often recurs after corrective surgery using the tensor fascia lata. Good results without recurrence after a modified Fox method were obtained using the palmaris longus tendon. This study examined the safety and validity of the surgical method using the palmaris longus tendon through long-term follow-up observations. Methods To reduce the rate of recurrence, the highest point on the pentagon of the Fox method was fixed to the frontalis fascia and frontalis muscle. It was fixed once again to the area 1 cm above the highest point. This approach remarkably reduces the incidence of recurrence by fixing the pentagon of the Fox method not only to the palmaris longus tendon but also to the frontalis fascia and again to the frontalis muscle. A modified Fox method using the palmaris longus tendon was used to treat 16 eyelids of 10 patients. A senior surgeon performed the procedure in all cases under local anesthesia. Results The mean follow-up period was 51 months (range = 18–86 months). There was no case of blepharoptosis recurrence and a good field of view was secured after surgery. Long-term follow-up revealed that the visual field had been well secured with a mean MRD1 of 3.1 mm. The eyelids were well maintained without any postoperative adverse reaction such as exposure keratitis. Conclusion The palmaris longus tendon as useful donor material does not lead to recurrence of blepharoptosis, which is often encountered when the tensor fascia lata is used. The modified Fox method using the palmaris longus tendon can be an effective and valid surgical approach that produces both immediate and long-term results.