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Purpose: The surgical treatment of carpal tunnel syndrome (CTS) has been enriched, by different minimally invasive techniques to decompress the median nerve at the wrist as the endoscopic approaches or modified open technique. However, controversy remains about their safety and complication rate. We present the results of our minimally-invasive technique to median nerve release at the wrist. Methods: The study was conducted in the department of Plastic and Reconstructive surgery GMC Srinagar. The patients who underwent treatment for carpal tunnel syndrome from March -2018 to Feb -2022 were the subjects of study. Results: The study included 63 patients, majority of patients were females (55 patients), and median age was 45 years. 16 patients had bilateral disease; right hand was predominantly involved. All the procedures were done under regional anesthesia under Tourniquet control. Average time taken was 15-20 minutes. Most patients returned to normal routine work in 2 to 3 weeks, with immediate and significant relief of symptoms. Complications were recorded in 3 patients, which included mild scar tenderness in two patients and minor hematoma in one patient. Follow up ranged from 6 months to 2 years. No patient required any repeat surgery for incomplete release of carpal tunnel. Conclusion: It is a simple, easy and effective technique, in a setup with limited resources, with all the advantages of an ECTR and having significantly reduced the complications of conventional open surgical techniques. [ABSTRACT FROM AUTHOR]

The palmaris longus muscle (PLM) is one of the most variable muscles in human body, presenting a wide range of morphological variants such as reversed course, biventer muscle, bifurcated tendon, or total agenesis. Their clinical impact is particularly important in the diagnosis and treatment of carpal tunnel syndrome and reconstructive surgery. We present a case of PLM including a previously undescribed combination of variations. A routine dissection of male cadaver aged approximately 60 years demonstrated a biventer muscle, with superior and inferior belly being interrupted by a long tendon. The inferior belly passed deep to the flexor retinaculum and its terminal tendon connected to the flexor digitorum superficialis tendon of the fifth finger. The clinical importance of variations found have been described separately, including unsuitability of biventer muscles for tendon reconstruction and increased risk for developing carpal tunnel syndrome in patients with a PLM tendon passing deep to the flexor retinaculum. In conclusion, as another variation of PLM is described, it is crucial to bear in mind the potential morphological types of the muscle in the diagnosis and treatment of patients, especially in surgery of the hand and forearm. [ABSTRACT FROM AUTHOR]

Background The absence of the palmaris longus (PL) varies with race. The presence of a functional flexor digitorum superficialis (FDS) of the little finger also varies widely. The aim of this study is to determine the prevalence of the absence of the PL and functional FDS of the little finger in the Indian population.

Background The absence of the palmaris longus (PL) varies with race. The presence of a functional flexor digitorum superficialis (FDS) of the little finger also varies widely. The aim of this study is to determine the prevalence of the absence of the PL and functional FDS of the little finger in the Indian population. Materials and Methods This is a prospective observational study conducted as a part of the Indian normative data project of the Indian Society for Surgery of the Hand. The presence of the PL was assessed by Schaeffer's test. The function of the FDS was assessed by the standard test and modified test and its function designated as absent, present independently, or present combinedly with the ring finger FDS. Results A total of 200 volunteers including 84 males and 116 females in the 21- to 60-year age group were examined. Of the 400 hands examined, the PL was absent in 26 upper limbs (6.5%). The PL was absent unilaterally in 12 individuals (6%) and bilaterally in 7 individuals (3.5%). Of the 400 little fingers examined, FDS function was absent in 72 fingers (18%), while 67 fingers (16.75%) had a common function and 261 fingers (65.25%) had an independent function. Only 2% had a bilateral absence of both the PL and functional FDS tendons and 5% had a unilateral absence of both tendons. Conclusion The PL and FDS of the little finger were more absent in the right side than in the left side, but the difference was not statistically significant. There was no significant association between the absence of the PL and the absence of the functional FDS of the little finger. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The palmaris longus (PL) contributes to the palmar fascia, wrist flexion, hand muscle balance, and pinch strength. Also, PL is used as a graft source. So, PL's presence is helpful for joint stability and grafting. On the other hand, joint hypermobility (JH) is associated with many complaints and disorders. Considering the adverse effects of JH and benefit-based evolution, the genesis rather than agenesis of PL can be expected in JH. Herein, it was hypothesized that PL might be together with JH, and individuals with PL may have higher scores of JH than those without. PATIENTS AND METHODS: Between June 2023 and October 2023, 200 participants (F/M: 1/1) were included in the study. The Schaeffer's test and the Beighton scores were used to assess PL and JH, respectively. The participants were divided into two bilateral groups according to the presence or absence of PL. Then, the groups were compared for demographics and Beighton scores. Subgroup analyses were also done by considering gender. RESULTS: No significant differences were found between PL (+) and PL (-) groups considering females+males in age (p=0.559), gender (p=0.517), weight (p=0.375), height (p=0.061), work status (p=0.229), Beighton score (p=0.893), and JH (p=1.0). No significant differences were found between PL (+) and PL (-) groups considering females only in age (p=0.871), weight (p=0.189), height (p=0.127), work status (p=0.200), Beighton score (p=0.727), and JH (p=1.0). No significant differences were found between PL (+) and PL (-) groups considering males only in age (p=0.370), weight (p=0.981), height (p=0.400), BMI (p=0.601), work status (p=0.145), Beighton score (p=0.757), and JH (p=1.0). CONCLUSIONS: According to the results of this study, no relationship was found between PL and JH. However, this is the first study on the topic and has some limitations. [ABSTRACT FROM AUTHOR]

The palmaris longus muscle is located in the forearm region. Its morphological variability was noted during standard anatomical dissection of the upper limb. The muscle was characterised by a normal course, i.e. originating from the medial humeral epicondyle and inserting into the palmaris aponeurosis, but a small additional tendon attached to the flexor retinaculum was observed in its distal part. An accessory palmaris longus muscle was also observed nearby. Interestingly, this accessory muscle was reversed, and the first part was not muscular, but tendinous, represented by 2 tendons originating from the common muscular mass attached to the medial epicondyle of the humerus; these later connected together, creating one muscle belly distally attached to the flexor retinaculum. This additional structure was innervated by a neural branch from the median nerve, and the ulnar artery was responsible for blood supply. The course of the median nerve is also clinically important because, before entering the carpal tunnel, it was located directly under the accessory palmaris longus muscle. In turn, the ulnar artery passed through a special hole created by the flexor digiti minimi brevis and flexor retinaculum, before passing under the palmaris brevis muscle. [ABSTRACT FROM AUTHOR]

Background: Medial ulnar collateral ligament (mUCL) injury can cause significant pain and alter throwing mechanics. Common autograft options for mUCL reconstruction (UCLR) include the palmaris longus (PL) and hamstring tendons. Allograft use may reduce donor site morbidity and decrease function related to PL autografts. Purpose: To compare varus stability and load to failure between a novel allograft for UCLR—knee medial collateral ligament (kMCL)—and a PL autograft in human donor elbow specimens. Study Design: Controlled laboratory study. Methods: A total of 24 fresh-frozen human elbows were dissected to expose the mUCL. Medial elbow stability was tested with the mUCL intact (native), deficient, and reconstructed utilizing the humeral single-docking technique with either a (1) kMCL allograft (n = 12) or (2) a PL autograft (n = 12). A 3-N·m valgus torque was applied to the elbow, and valgus rotation of the ulna was recorded via motion tracking cameras. The elbow was cycled through a full range of motion 5 times. After kinematic testing, specimens were loaded to failure at 70° of elbow flexion, and failure modes were recorded. Results: The mUCL-deficient elbows demonstrated significantly greater valgus rotation compared with the intact and reconstructed elbows at every flexion angle tested (10°-120°) (P <.001). Both kMCL- and PL-reconstructed elbows exhibited significantly higher mean valgus rotation compared with the intact state between 10° and 40° of flexion (P <.01). There were no significant differences in valgus rotation at any flexion angle between the kMCL and PL graft groups. When loaded to failure, elbows reconstructed with both kMCL and PL grafts failed at similar torque values (18.6 ± 4 and 18.1 ± 3.4 N·m, respectively; P =.765). Conclusion: Fresh-frozen and aseptically processed kMCL allografts demonstrated similar kinematic and failure properties to PL tendon autografts in UCL-reconstructed elbows, although neither graft fully restored kinematics between 10° and 40°. Clinical Relevance: Prepared kMCL ligament allografts may provide a viable graft material when reconstructing elbow ligaments while avoiding the potential complications related to PL autografts— including donor site morbidity. [ABSTRACT FROM AUTHOR]

Background Palmaris longus (PL) is a short-bellied muscle with a long tendon that merges with the palmar aponeurosis. It is supplied by the median nerve and acts as a tensor of the palmar aponeurosis and flexes the wrist. This tendon is commonly used for tendon transfers and as a donor for tendon graft. There are numerous clinical tests to detect the presence of PL like Schaeffer's test, Thompson's test, Mishra's test I, Mishra's test II, Pushpakumar's “two-finger sign” method, and AIIMS test. The principle of all these tests is to make the tendon prominent by eliciting its flexor action and then its identification by inspection and palpation.

Background: Palmaris longus (PL) is one of the most common muscles in the human body that has anatomical variants of surgical importance. Objectives: The purpose of this study was to find out the frequency of PL agenesis among Urhobo people in Delta State, Nigeria. Materials and Methods: This descriptive study adopted the cross-sectional design, conducted among 400 Urhobo subjects (182 males and 218 females) from the student population of Delta State University, Abraka, Nigeria, using the nonprobability convenience sampling technique. We performed Schaeffer’s test to detect the PL tendon in the subjects. If the tendon was still not visualized or palpable, two additional tests (Thompson’s and Pushpakumar’s tests) were conducted. Data analysis was conducted using the Statistical Package for Social Sciences Version 21.0. The findings were summarized in percentages, while the Chi-square test was used to assess the association of PL agenesis with laterality and gender. Statistical significance was set at a P-value of less than 5%. Results: The tendon of PL was present in 309 (77.25%) and absent in 91 (22.75%) subjects. The agenesis of this muscle showed a significant association with laterality (P = 0.001) but lacked sexual dimorphism bilaterally (P > 0.05). Conclusion: The tendon of PL is absent among some subjects of the Urhobo ethnic group (22.75%). These subjects, therefore, may require alternative tendon sources for reconstructive surgeries.

Abstract Purpose This study aims to compare results after open lunate excision alone and in combination with palmaris longus tendon ball arthroplasty for the treatment of late-staged Kienböck’s disease (KD). Methods This is a retrospective study using the prospectively collected data, and patients who had a discharge diagnosis of KD (stage IIIB based on Lichtman staging criteria) and underwent surgical treatment by lunate excision alone or in combination with palmaris longus tendon ball arthroplasty between January 2011 and December 2020 were included in this study. Variables of interest involved demographics, disease condition, operative procedure, and the outcomes evaluated at the last follow-up. Within and between comparisons were performed. Results Thirty-five patients underwent lunate excision alone, and 40 patients underwent the combination procedure. At the final follow-up, patients in both groups exhibited significant improvements compared to pre-operation, such as wrist flexion, wrist extension, carpal height ratio, PRWE score, Cooney score, and grip strength (all P

Background Palmaris longus (PL) is a short-bellied muscle with a long tendon that merges with the palmar aponeurosis. It is supplied by the median nerve and acts as a tensor of the palmar aponeurosis and flexes the wrist. This tendon is commonly used for tendon transfers and as a donor for tendon graft. There are numerous clinical tests to detect the presence of PL like Schaeffer's test, Thompson's test, Mishra's test I, Mishra's test II, Pushpakumar's "two-finger sign" method, and AIIMS test. The principle of all these tests is to make the tendon prominent by eliciting its flexor action and then its identification by inspection and palpation. Objectives The tests that are consistently easy to perform with good understandability would be easy to explain to the general population (patients). The aim of our study is to find out the accuracy and easy comprehensibility of various tests using compulsive postures for detecting PL tendon clinically. Materials and Methods This is a prospective study on 137 participants. All the patients were subjected to six clinical tests to detect the presence or absence of PL tendon. The results were recorded for both hands by a single observer. Results Of the 137 participants, 75 were males (54.74%) and 62 were females (45.26%). The mean age was 21 years. The AIIMS test showed the maximum number of tendons, that is, 113 (82.4%) in the right hand and 108 (78.8%) in the left hand. In view of the ability to comprehend the tests, 119 (86.9%) subjects understood Schaeffer's test very easily. Conclusion According to this study, the AIIMS test best demonstrates the PL tendon, and Schaeffer's test was the test most easily understood by the subjects. [ABSTRACT FROM AUTHOR]

Ulnar collateral ligament reconstruction (UCLR) is frequently performed among injured overhead-throwing athletes. One of the most common graft choices when performing a UCLR is the ipsilateral palmaris longus tendon (PL). The purpose of this study was to investigate the material properties of aseptically processed cadaveric knee collateral ligaments (kMCL) as a potential graft source for UCLR and compare them to the gold standard PL autograft. Each PL and kMCL cadaveric sample was subjected to cyclic preconditioning, stress relaxation, and load-to-failure testing, and the mechanical properties were recorded. PL samples exhibited a greater average decrease in stress compared to the kMCL samples during the stress-relaxation test (p < 0.0001). PL samples also demonstrated a greater average Young's modulus in the linear region of the stress–strain curve compared to the kMCL samples (p < 0.01). The average yield strain and maximum strain of kMCL samples were significantly greater than the PL, p = 0.03 and 0.02, respectively. Both graft materials had comparable maximum toughness and demonstrated a similar ability to deform plastically without rupture. The clinical significance of our result is that prepared knee medial collateral ligament allografts may provide a viable graft material for use in the reconstruction of elbow ligaments. [ABSTRACT FROM AUTHOR]

This study was performed to assess the clinical and radiographic results at a minimum of 2 years after ligament reconstruction suspension arthroplasty (LRSA) that comprised full trapeziectomy and suspensionplasty using the palmaris longus tendon and the Mini TightRope (Arthrex, Naples, FL) for advanced thumb carpometacarpal arthritis. We clinically and radiographically evaluated 26 thumbs in 26 patients who had undergone LRSA at least 2 years previously. The mean follow-up period was 35.9 months. We evaluated the subjective clinical outcomes (visual analogue scale and Quick Disabilities of the Arm, Shoulder, and Hand scores) and objective clinical outcomes (range of motion, pinch strength, grip strength, and trapezial space height ratio). At the final follow-up evaluation, the mean visual analogue scale score was 11.1 (standard deviation (SD) 13.4) and the mean Quick Disabilities of the Arm, Shoulder, and Hand questionnaire score was 9.39 (SD 10.1). The mean palmar and radial abduction were 62.3° (SD 11.8°) and 63.8° (SD 9.09°), respectively. The mean key pinch and grip strength were 3.92 (SD 1.07) kg and 19.7 (SD 7.77) kg, respectively. The mean trapezial space ratio was 0.21 (SD 0.10). The subjective clinical outcomes, range of motion, and pinch strength were significantly improved compared with preoperatively. LRSA for advanced-stage thumb carpometacarpal osteoarthritis relieves pain, improves range of motion and strength, and obtains favourable subjective patient-reported clinical outcomes. [ABSTRACT FROM AUTHOR]

We evaluated the frequency of absence of the palmaris longus tendon in the heterogeneous Israeli population. Nine hundred and fifty wrists were evaluated using a modified Mishra/Schaeffer technique (thumb/little-finger opposition with resisted wrist flexion), which was validated by ultrasound scanning. The geographical and ethnic origin of volunteers was documented. When physical examination was equivocal, any vague, superficial structure was subsequently identified as the median nerve by ultrasound. Physical examination reliably identified palmaris longus only when a structure was clinically obvious (visually or by palpation). There was bilateral absence of the palmaris longus in 21% and unilateral absence in 15% of participants. Frequency of bilateral absence varied between 4.5% and 30%, depending on geographical origin (p = 0.0007). The incidence of palmaris longus tendon varied significantly by geographical, but not by ethnic origin. Level of evidence: II [ABSTRACT FROM AUTHOR]

Background. Variable insertions of Palmaris longus (PL) muscle tendon is described by various authors. Presence of extra PL tendon is also described in literature. As autologus tendon grafting is a blooming arena of clinical research at present time, an additional tendinous slip of PL has promising scope for use as an autograft. Case Report. We report here bilateral bitendinous distal attachment of PL muscle encountered during routine cadaveric dissection. The additional PL tendon in a multitendinous insertion pattern with optimum length and thickness is indeed an additional advantage from the point of view of autograft harvesting. This has also importance in understanding the unusual, altered symptomatology in compressive conditions. Conclusion. Although relatively common, surgeons should be well aware of the various possible aversion of distal attachment of PL which might have significant impact in alteration of symptomatology of neurovascular compressions in the forearm and hand and while choosing an appropriate tendon autograft. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to compare results after open lunate excision alone and in combination with palmaris longus tendon ball arthroplasty for the treatment of late-staged Kienböck's disease (KD). Methods: This is a retrospective study using the prospectively collected data, and patients who had a discharge diagnosis of KD (stage IIIB based on Lichtman staging criteria) and underwent surgical treatment by lunate excision alone or in combination with palmaris longus tendon ball arthroplasty between January 2011 and December 2020 were included in this study. Variables of interest involved demographics, disease condition, operative procedure, and the outcomes evaluated at the last follow-up. Within and between comparisons were performed. Results: Thirty-five patients underwent lunate excision alone, and 40 patients underwent the combination procedure. At the final follow-up, patients in both groups exhibited significant improvements compared to pre-operation, such as wrist flexion, wrist extension, carpal height ratio, PRWE score, Cooney score, and grip strength (all P < 0.05). Compared to the excision group, combination procedure group had significantly longer surgical time (P < 0.001), more blood loss (P < 0.001) and exhibited better wrist flexion (P = 0.001), PRWE score (P = 0.001), Cooney score (P = 0.0034), and grip strength (P = 0.017). The excellent or good rate based on Cooney wrist score was not significantly different (87.5% vs 71.4%, P = 0.083). Conclusion: Lunate excision in combination with palmaris longus tendon ball arthroplasty is a better option than lunate excision alone for the treatment of stage III KD and can be considered as an operative option. [ABSTRACT FROM AUTHOR]

Nucki Nursjamsi Hidajat,1 Widya Arsa,1 Sanditya Fadli,2 Ira Nong,3 Dina Aprilya4 1Hand, Upper Limb and Microsurgery Division, Department of Orthopaedic and Traumatology, Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia; 2Department of Orthopaedic and Traumatology, Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia; 3Department of Orthopaedic and Traumatology, Wahidin Sudirohusodo General Hospital, Hasanuddin University, Makassar, Indonesia; 4Department of Orthopaedic and Traumatology, Siloam Agora Hospital, Jakarta, IndonesiaCorrespondence: Widya Arsa, Hand, Upper limb and Microsurgery Division, Department of Orthopaedic and Traumatology, Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung, 40161, West Java, Indonesia, Tel +6222-2034953, Fax +6222-2032216, Email widyarsa.unpad@gmail.comBackground: Distal radioulnar joint (DRUJ) instability results from the disruption of the triangular fibrocartilaginous complex consisting of DRUJ’s primary and secondary stabilizers. The gold standard of stabilization procedure remains ligament reconstruction that utilizes tendon grafts to reanimate the volar and dorsal radioulnar ligament (RUL) as the primary stabilizers of the joint. The palmaris longus (PL) tendon, the graft of choice in reconstructive surgery, is commonly used in DRUJ reconstruction. However, it can exhibit anatomic variations from agenesis to the variation in morphology, location, and attachment that is rarely encountered other than in cadaveric studies.Case Presentation: We present a case of a 14-year-old boy with ulnar-sided wrist pain and instability following an injury in a boxing match four months before admission. The clinical and radiological results suggested a DRUJ injury with extensor carpi ulnaris (ECU) tendinitis. A ligament reconstruction using the PL tendon graft was planned. Intraoperatively, the PL was found anomalous with dual distal attachments and a short graft length.Results: We performed Adams ligament reconstruction technique with some modifications to the original design. To overcome the under-sized graft, instead of passing it around the ulnar neck, we added one more bone tunnel on the ulna to enhance the construct stability by a tendon to bone healing.Conclusion: In reconstructive surgeries, surgeons should consider the other sources of grafts as graft variations exist. Otherwise, as in our case, modifications to the standard technique can be made.Keywords: DRUJ instability, palmaris longus, anatomical variation, tendon graft, ligament reconstruction

Introduction: The Palmaris longus muscle is one of the superficial flexor muscles of the forearm that flexes the hand on the wrist and makes the palmar aponeurosis tense for gripping. It is variable both in number and form like inverted, doubled, split, three-headed or absent palmaris longus. These variabilities may cause clinical features due to abnormal pressure on the median and ulnar nerves. Its tendon can be used as a graft in various transplant surgeries. Aims & Objectives: This study was conducted to observethe number of cadavers showing anatomical variations of palmaris longus muscle in the Pakistani population. Place and Duration of Study: This study was conducted in the Anatomy Department of FMHCM&D, Lahore. The duration of the study was January 2019 - January 2022. Material & Methods: Cadaveric dissected upper limb specimens with normal palmaris longus were listed in Group: A, upper limbs having reversed palmaris longus were listed in Group: B, while upper limbs with absent palmaris longus were listed in Group: C. The RPL (reversed palmaris longus) muscle is the structure that is tendinous proximally and muscular distally (opposite of normal palmaris longus).Results were tabulated and percentages calculated. Results: It was observed that out of 80 dissected cadaveric upper limbs,77 (96.25%) showed normal palmaris longus while a right cadaveric upper limb (1.25%) showed anomalous palmaris longus with the reversed tendon. Palmaris longus muscle was found absent in two cadaveric left upper limbs (2.5%). Conclusion: Our study highlighted the percentage of different anatomical variations of the Palmaris longus muscle in terms of its presence with reversed tendons as well as its absence in a few human cadaveric upper limbs. This information may help anatomists, radiologists, physiotherapists and plastic surgeons.

Abstract Background The flexor pollicis longus is the most vulnerable muscle in acute compartment syndrome of the forearm. Reconstruction of a dysfunctional flexor pollicis longus is occasionally necessary following compartment syndrome of the forearm. Case presentation A 42-year-old Japanese man injured his left forearm in a motor vehicle accident. Open radial shaft fracture and acute compartment syndrome of the left forearm was diagnosed. We performed a fascial release of the forearm and debridement of the involved myonecrosis of the flexor pollicis longus. At second-look operation (3 days after the initial release), we performed palmaris longus tendon transfer to the flexor pollicis longus tendon. At 6-month follow-up, the patient had no complaints and returned to his job. At 2-year follow-up, the patient had achieved 88% of pinch strength, compared with the contralateral hand, and scored 11.4 on the QuickDASH score. Conclusions Palmaris longus transfer performed immediately after injury is simple and does not require an additional surgical approach. Hence, early palmaris longus tendon transfer, which can provide satisfactory outcomes, could be considered as a potential choice for flexor pollicis longus reconstruction in patients with compartment syndrome of the forearm.

Abstract Background Acromioclavicular (AC) joint dislocation is common among shoulder injuries, and various surgical methods have been introduced for effective ligament reconstruction. Reconstruction of the coracoclavicular (CC) ligament in the anatomical position using autologous tendons is a recent surgical trend. This study is to report clinical and radiologic results of reconstruction of the CC ligament using an autologous palmaris longus tendon interweaved with Mersilene tape (PLMT) with a minimum 2-year follow-up. Methods This retrospective study analyzed 76 patients (mean age, 43.4 ± 11.2 years) with AC joint dislocation treated by reconstruction of the CC ligament with PLMT, from March 2004 to February 2017. The mean follow-up period was 28 ± 6.7 months (range, 24–66 months). The Visual Analog Scale (VAS) for pain assessment, American Shoulder and Elbow Surgeons rating scale (ASES), and Constant Score (CS) were used to evaluate clinical outcomes at the preoperative and the final follow-ups. CC and AC distances were measured using anteroposterior (AP) X-ray preoperatively and at the final follow-up for radiologic outcomes. Complications were also assessed. Results The mean preoperative VAS for pain, ASES, CS were 5.7 ± 0.7, 77.1 ± 6.2, and 61.5 ± 5.2, respectively. These scores at the final follow-up improved to 2.1 ± 0.5, 90.9 ± 4.3, and 94 ± 7.0, respectively (p = 0.043, p

Being aware of the variants of upper extremity anatomy is of utmost importance to a surgeon. This case report describes a patient who presented with two separate wrist masses. Operative exploration was planned, and both the structures were investigated. The distal mass was identified as a volar wrist ganglion, and the more proximal mass was identified as the muscle belly of a reversed palmaris longus muscle. Incidentally, it was noted that the patient had a patent, persistent median artery. Although many variants of the palmaris longus have been described, as have been cases of a persistent median artery, both have not been previously documented in a single patient. Although this is rare, having knowledge of possible anatomic variations is valuable for any surgeon operating on the upper extremity.

An interesting case of unusual unilateral variant of palmaris longus (PL) tendon of forearm was noticed by us. We found two bellies of PL as well as their different insertions. These observations will help in understanding morphological variations of this muscle and its clinical implications. PL is a fusiform muscle in the superficial flexor group of muscles of forearm. It originates from medial epicondyle of humerus by common flexor tendon. We found PL having one origin, i.e., from medial epicondyle from common tendinous origin of flexor muscles and then it divided to form two bellies having two long tendons distally. Understanding of presence or absence or anomalies of PL is not only important for medical professionals but also for evolutionary biologists. Awareness of anatomy and variations of flexor tendons is important for health care practitioners for the correct diagnosis and management of pain, disease, and trauma of forearm and hand. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to determine the intra-observer and inter-observer reliability of nine tests used for predicting the presence of palmaris longus muscle. Methods: Three observers tested the presence of palmaris longus muscle three different times on each of the 52 subjects’ right and left wrists. The interobserver agreement was evaluated using Cohen’s Kappa statistics. And the intraobserver agreement was evaluated using the Intraclass Correlation Coefficient. Results: Inter-observer agreements, defined by kappa, varied from 0.293 (slight) to 0.687 (substantial) (p<0.001 for all), while intra-observer agreements varied from 0.691(substantial) to 0.885 (almost perfect) (p<0.001 for all). Conclusions: Many of the current tests used for determining the presence of palmaris longus tendon have substantial interobserver reliability. As the testing experience of the observers improves, the agreement rates increase too. [ABSTRACT FROM AUTHOR]

Background: Understanding the median nerve's position relative to surrounding anatomy is essential; however, there are many variations among individuals. This study assesses differences in median nerve position with or without palmaris longus (PL). We hypothesize that PL presence alters median nerve position, resulting in a greater distance to the skin volar surface, a decreased distance to the radius volar surface, and an increased distance to the flexor carpi radialis (FCR)., Methods: 1193 wrist magnetic resonance imaging (MRI) studies were retrospectively reviewed from 2019 to 2023. One hundred adults ages 18 to 50 meeting criteria were included for a power > 80%: 50 wrist axial plane MRIs (distal radial-ulnar joint level) with PL and 50 without PL. Measurements included the distance from the median nerve center to the skin volar surface, radius volar surface, and FCR center. Statistical analysis included Fisher exact tests and Mann-Whitney U Test (median, ranges), with significance at P -value < 0.05., Results: Individuals with PL had a greater distance between the median nerve and skin volar surface. The presence of PL exhibited no discernable difference in the distance between the median nerve to the radius volar surface or the FCR center. Palmaris longus presence or absence did not affect the radial/ulnar positioning of the median nerve to the FCR center., Conclusions: PL presence results in a deeper median nerve position within the wrist in relation to the skin volar surface. This knowledge is crucial for musculoskeletal specialists, especially during volar approach wrist surgeries and when administering anesthetic or therapeutic injections to the median nerve., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Las lesiones crónicas del aparato extensor de los dedos son producto de una lesión inicial que no fue tratada o fue tratada inadecuadamente. Estas lesiones requieren de un adecuado y minucioso manejo para lograr un buen resultado funcional. Presentamos el caso de un paciente de 26 años con lesión traumática del aparato extensor del tercer dedo debido a un accidente de tránsito ocurrido 8 meses antes. Intraoperatoriamente, requirió abordar desde la zona I hasta la V de Verdan y reconstruir con autoinjerto de palmaris longus (PL). El paciente obtuvo un excelente resultado funcional a las 12 semanas, que persistía hasta los 9 meses de seguimiento.

Background: Acromioclavicular (AC) joint dislocation is common among shoulder injuries, and various surgical methods have been introduced for effective ligament reconstruction. Reconstruction of the coracoclavicular (CC) ligament in the anatomical position using autologous tendons is a recent surgical trend. This study is to report clinical and radiologic results of reconstruction of the CC ligament using an autologous palmaris longus tendon interweaved with Mersilene tape (PLMT) with a minimum 2-year follow-up.Methods: This retrospective study analyzed 76 patients (mean age, 43.4 ± 11.2 years) with AC joint dislocation treated by reconstruction of the CC ligament with PLMT, from March 2004 to February 2017. The mean follow-up period was 28 ± 6.7 months (range, 24-66 months). The Visual Analog Scale (VAS) for pain assessment, American Shoulder and Elbow Surgeons rating scale (ASES), and Constant Score (CS) were used to evaluate clinical outcomes at the preoperative and the final follow-ups. CC and AC distances were measured using anteroposterior (AP) X-ray preoperatively and at the final follow-up for radiologic outcomes. Complications were also assessed.Results: The mean preoperative VAS for pain, ASES, CS were 5.7 ± 0.7, 77.1 ± 6.2, and 61.5 ± 5.2, respectively. These scores at the final follow-up improved to 2.1 ± 0.5, 90.9 ± 4.3, and 94 ± 7.0, respectively (p = 0.043, p <  0.001, p <  0.001). The mean preoperative CC and AC distances were 16.49 ± 3.73 mm and 13.84 ± 3.98 mm, respectively. The final follow-up CC and AC distances were 9.29 ± 2.72 mm and 5.30 ± 2.09 mm, respectively (p <  0.001, p <  0.001). Although a slight re-widening of the CC distance occurred in 10 patients (13.1%), most patients regained full range of motion of the affected shoulder at the final follow-up.Conclusion: The CC ligament reconstruction with PLMT for the treatment of AC joint dislocation showed good clinical and radiological results. This technique could be a good alternative treatment for AC dislocations. [ABSTRACT FROM AUTHOR]

Introduction: The anatomical complexity of the upper extremity is reflected in the vast array of structural variation and anomalies that can be observed. Variations and developmental anomalies have been reported in the vasculature, innervation, or musculoskeletal structures of the limb. While anomalies tend to involve multiple structures, variations tend to be more subtle and restricted to individual structures with limited physiological impact. Case presentation: Routine dissection of the hands of a female cadaver revealed bilateral anatomical variations. Firstly, the palmaris longus had multiple distal tendinous insertions bilaterally. Secondly, Berrettini type nervous communications were observed bilaterally between the common digital branches of the ulnar nerves and medial common digital branches of the median nerves. Finally, vascular supply for both hands displayed a number of anomalies of the radial and ulnar arteries. In the right hand, there was a small midline anastomosis between the radial and ulnar arteries while it was absent in the left hand, leading to an incomplete superficial palmar arch. Conclusion: In both hands, the location and pattern of arterial supply rendered the vessels vulnerable to injury and occlusion. Absence of collateral blood supply between the ulnar and radial arteries in the left hand, as well as the superficial location of the superficial palmar radial arteries made the hands of this individual particularly susceptible to ischemic injury. Vascular abnormalities of this nature are routinely screened for prior to procedures of the hand. Anatomical variations of the vasculature, innervation and musculature of the hand and wrist are common. This case displays a unique accumulation of such variations in both hands of a cadaveric specimen.

Abstract 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.

Introduction: Palmaris longus is one of the most variable muscles present in the superficial layer of the anterior compartment of forearm and is phylo-genetically categorized as retrogressive muscle. It arises from the medial epicondyle of humerus and forms a long slender tendon which becomes flattened in palm to form palmar aponeurosis and helps in the flexion of hand at wrist. This muscle can be used in plastic surgery or reconstructive surgeries. The present study was carried out to find the prevalence of presence or absence of palmaris longus tendon in Nepalese population so that it would be helpful to provide a baseline data for surgeons to perform surgical procedures. Methods: This was a cross-sectional descriptive study conducted among 200 medical students after the approval from Institutional Review Committee. The presence or absence of tendon of palmaris longus was observed and confirmed on the flexor aspect of wrist by using Schaffer’s test and Thompson’s test. Results: The overall absence of palmaris longus was observed in 55 students (27.5%) with the prevalence of bilateral absence in 27 students (13.5%) and unilateral absence in 28 students (14.0%).The overall absence of palmaris longus was reported in 20 males (23.2%) and in 35 females (30.7%). Conclusion: Absence of palmaris longus (either unilateral or bilateral) was observed in about one fourth of the participants.

The Palmaris Longus (PL) is a slender; spindle shaped elongated muscle which is visible as a small tendon between other superficial muscles of the forearm, i.e., pronator teres, flexor carpi radialis and the flexor carpi ulnaris. The PL muscle is a highly variable muscle. However, the most common variation is its absence, which is more commonly seen on the left side. There is a wide scope of variation in the prevalence of absence of this muscle in different racial groups, which varies from 3.1% in some populations up to 63.9% in others. This study aims at finding out the prevalence of absence of the PL muscle among Palestinian population. To determine the prevalence of the absence of PL, a cross-sectional design utilizing the Schaeffer's test in a sample of 300 medical students at An-Najah National University with ages ranging between 18-22 years old was used. The overall prevalence of absence of PL muscle in our sample subjects was found to be 32%. Prevalence of bilateral absence was found to be 15.7 %, while the prevalence of unilateral absence of PL was found to be 16.3%. Unilateral absence of the PL muscle on the left side was 8.7 %, which was found to be a little more than that of the right side 7.7% among our 300 subjects. A significant gender-related difference in the overall prevalence of absence of PL on one or both sides, as well as in the prevalence of bilateral absence of muscle and in the prevalence of left-sided absence of muscle where all three indicators were more common in females. We recommend that our findings as well as the findings of other clinical studies be corroborated by conducting dissection studies. This is especially important in the absence of any accurate measurement of the specificity and sensitivity of these tests, while at the same time producing such a wide range of variation in their results in different populations. [ABSTRACT FROM AUTHOR]

Background. The variability in the prevalence of Palmaris longus (PL) agenesis has been well-documented in various ethnic groups and populations. Lamentably, there is no previous study in the literature has reported the prevalence of PL agenesis in the Indian American population. This study aimed to determine the prevalence of PL agenesis and its association with gender, body side and hand dominance in the Indian American population. Methods. In this cross-sectional study, a total of 600 subjects (300 males and 300 females) belonging to 18-45 years were accessed for the presence or absence of PL tendon, using a series of clinical tests. The association between the prevalence of PL agenesis and gender, limb laterality and hand dominance were determined by the Chi-square test. Overall agenesis of PL reached 15.33%, and unilateral agenesis (8%) was more common than bilateral absence (7.33%). Results. The PL agenesis was found lesser (p = 0.037) in females (14.33%) than the males (16.33%). The PL agenesis was significantly more often on the left side than the right (p = 0.02). In right-hand dominant subjects, the left-sided agenesis was signifi- cantly more common (p = 0.014) and in left-hand dominant subjects, the right-sided agenesis was greater (p > 0.05). Conclusions. Palmaris longus tendon agenesis in Indian American subjects was more analogous to the standard textbooks of hand surgery, but much higher than the other Asian and African populations. This comparison confirms that the prevalence of PL is race-dependent. The present study data may be valuable for tissue banks for harvesting the PL tendon allografts from Indian Americans which could be useful for surgeons during various reconstructive and tendon grafting surgery in Indian American patients. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: The aim of this research is to determine the frequency of surface anatomical variations of palmaris longus (PL) muscle in the population of North Cyprus and their association with gender, body side, and hand dominance. Materials and Methods: The presence of PL was determined in 1280 subjects (660 females and 620 males) using four testing methods; Schaeffer's test, the Thompson's test, Pushpakumar's test and the Bhattacharya's test. Where the presence of the PL could not be determined by any of these tests, palpation was performed as the final confirmatory test. Results: The overall frequency of absence was 17.4%. Female subjects showed a higher frequency of absence of 10.6% compared to males (6.8%). The absence was more likely to occur in the non-dominant hand. In those that had the PL, there were 28 (2.6%) cases of a split tendon and 3 cases (0.2%) of a laterally displaced tendon of the PL. Conclusion: The overall frequency of absence of PL in North Cyprus was 17.4% and absence is more likely to occur in females, on the left side and in the non-dominant hand. Other variations recorded are the split tendons and laterally displaced tendons. [ABSTRACT FROM AUTHOR]

The accessory palmaris longus is a rare anatomical variant in the wrist and forearm, which has been reported as the cause of carpal tunnel syndrome. This paper reports a case of the accessory palmaris longus incidentally found during carpal tunnel surgery. The paucity of awareness on the accessory palmaris longus in carpal tunnel surgery may lead to accidental iatrogenic injury to the median nerve or insufficient decompression of the median nerve. [ABSTRACT FROM AUTHOR]

Case: We present a case of a patient who suffered from wrist swelling and had symptoms of carpal tunnel syndrome. The patient underwent ultrasound and magnetic resonance imaging, in which signs of joint effusion and a fatty synovial lesion were presented. The treatment included open excision of the tumor. In addition, the palmaris longus muscle had an anatomic variation with proximal and distal tendon portions. The histopathological examination disclosed lipoma arborescens of the synovial membranes of the joints. Conclusion: The recognition of this entity and its characteristics are important not only for correct diagnosis but also for the appropriate treatment. [ABSTRACT FROM AUTHOR]

Background: Introduction: Isolated scaphotrapeziotrapezoidal (STT) joint osteoarthritis (OA) is a relatively common condition. Scaphotrapeziotrapezoidal arthrodesis is the traditional treatment, while excisional arthroplasty with the use of flexor carpi radialis (FCR) or polycarbon implants represents a promising alternative surgical management. The present study aims to assess a novel alternative technique of excisional arthroplasty with the use of palmaris longus (PL) tendon as interposition material. Materials: The present research is a retrospective observational study. Patients suffering from symptomatic isolated STT OA, without midcarpal instability and treated with excisional arthroplasty with the use of PL tendon as interposition material, were evaluated. Five patients (two males and three females) with mean age of 63.8 years [standard deviation (SD)=16.9] were included. The mean follow up was 56.4 months (SD=9.8). In order to quantify the clinical results, we used the preoperative and postoperative visual analogue scale (VAS) score at rest and during activity, abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH) score and postoperative ROM. Results: The postoperative VAS score at rest and during activity showed a decrease of 86.2% and 62.5%, respectively, when compared to the preoperative one. Regarding postoperative ROM at final follow-up, patients had a mean wrist flexion 71° compared to 78° of the contralateral hand, while the mean extension was found to be 57° compared to 66° of the contralateral side. Conclusions: The evaluated novel technique with the use of PL tendon as interposition material seems to offer satisfying results, while allowing to keep the FCR tendon intact. More studies comparing these techniques are of utmost importance to conclude which is the optimal treatment. [ABSTRACT FROM AUTHOR]

Purpose: The palmaris longus (PL) tendon present a high degree of variations; the commonest is its absence which could reach more than 40% in some populations. The PL tendon is highly relevant in hand reconstructive surgery; however, MRI variations of PL tendon have been exceptionally reported. To this, this study investigated PL tendon variations using MRI in a Lebanese population. Methods: This is a retrospective study of distal forearm MRI examinations to evaluate the presence, anatomical variations and morphometric of PL tendon. The outcomes were set as overall frequency, gender-based and side-base frequencies, correlations between prevalence and gender/side, morphological variants, thickness, and width of PL tendon. Results: The sample comprised 335 patients including a total of 339 MRI scans. The PL was present in 221 wrists (65.2%), and bilaterally in only one (25%) out of the 4 bilateral cases. All PL were located using the Axial T1 views. Univariate and multivariate analyses showed no correlation with side, gender, or Tesla power. The only morphological variation was a reversed PL in 2 cases (0.6%). The mean width was 4.24 ± 1.2 mm. The mean thickness was 2.75 ± 0.6 mm. Conclusion: As far as we know, this is the first study to report the total array of variations of PL tendon using MRI, and its prevalence in a Lebanese population. The mean width of PL tendon calculated with high quality MR imaging was found to be similar to that reported by cadaveric studies. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The palmaris longus muscle, and its tendon, is one of the most variable muscles in humans. Though it has been extensively researched in the adult population, its variations and development in the fetal period were rarely investigated. The aim of this meta-analysis is to conduct an evidence synthesis on PL variations and the prevalence of its agenesis during intrauterine development. Seven studies met the inclusion criteria comprising 497 fetuses and 1027 fetal limbs. The true and crude weighted prevalence rates were of 81.2% and 77%, respectively. The bilateral and unilateral prevalence estimates were of 62.2% and 15%, respectively. No significant differences were found for side-based and gender-based prevalence values. There were significant frequency differences between the studied populations (p < 0.0001).The Japanese population had the highest prevalence, the Turkish had the lowest and the European value was in between. Out of 494 studied muscles, 67 (13.5%) variations were noted. The weighted proportions of the commonest morphological variations were as follows: (a) bifid tendon in 10 (2%) cases, (b) inverted PL muscle in 9 (1.9%), muscle duplication in 6 (1.36%), and digastric muscle in 25 (5.1%). Prevalence values of the fetal PL were similar to those reported in adults; however, variations seem to be higher than in older populations. The true, crude, and ancestry-based prevalence presence rates of PL in fetuses were found to be similar to those of the adult population. [ABSTRACT FROM AUTHOR]

Introduction: The tendon of the palmaris longus is commonly used as a tendon graft in many reconstructive surgeries. Easy to access and at proximity to the hand, the palmaris longus tendon is considered as the optimal tendon source for hand reconstructive surgery. However, and besides its inconsistency, the size of the palmaris longus tendon is reported to show variability. The aim of this study is to look for the surgical adequacy of the palmaris longus tendon by conducting a quantitative synthesis on its length and width in human populations and its correlation with the forearm length. Methods: Twenty-four studies met the inclusion criteria including 1761 cadaveric limbs. Results: The results were as following: (a) the mean palmaris longus tendon length was of 13.9 ± 2.6 cm, (b) the mean ratio palmaris longus tendon length/forearm length was of 0.545 ± 0.06, (c) the weighted correlation value was of 0.686, and (d) the mean palmaris longus tendon width was of 4.0 ± 1.7 mm. Only five studies reported a palmaris longus tendon length of more than 15 cm. The palmaris longus tendon length was shown to vary between ancestries; the Japanese had the shortest while Malaysian the longest palmaris longus tendons. All studies but one reported a palmaris longus tendon mean width of more than 3 mm where the minimal mean palmaris longus tendon width was of 2.5 mm. Conclusion: While the requested length depends on the recipient site and/or type of reconstructive surgery, the palmaris longus tendon often met the required diameter for grafting. Our review demonstrated that while palmaris longus length varies between ancestries, its width is often adequate for grafting. In addition, the forearm length could be a good predictor of palmaris longus tendon length; such correlation could assist surgeons when planning to use palmaris longus tendon as a graft source. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Acromioclavicular (AC) joint trauma is a frequent sports injury. Modified Weaver Dunn (MWD) is a commonly used technique to address this injury. However, tendinous grafts (Autogenous Palmaris Longus or Semitendinosus tendons) are increasingly being used due to the biologic weakness of MWD., Methods: Three search was done until January 2024 with data extraction consisting of adverse events (infections and failures), Constant-Murley score, American Shoulder and Elbow Surgeons score, and postoperative coracoclavicular distance., Results: Four studies were included in this metaanalysis. Tendinous graft was shown to have statistically better ASES and Constant-Murley scores. Furthermore, there were no difference in adverse events, and postoperative coracoclavicular distance., Conclusion: The tendinous graft showed no differences in adverse events, and postoperative coracoclavicular distance when compared to modified Weaver Dunn. However, it showed higher postoperative ASES and Constant-Murley score without analysis of the minimal clinical important difference making the difference solely statistical., Level of Evidence: 3., Competing Interests: Royalties from a company or supplier; Disclosures; OSTEOCENTRIC TECHNOLOGIES, ENOVIS, ZIMMER-BIOMET, STRYKER, GLOBUS MEDICAL, INC. Stocks in: SHOULDER JAM, AEVUMED, OBERD, OTS MEDICAL, ORTHOBULLETS, ATREON, RESTORE 3D. Research support from a company or supplier as a PI; Disclosures; ENOVIS, ARTHREX. Royalties, financial or material support from publishers; Disclosures; WOLTERS KLUWER, SLACK ORTHOPAEDICS, ELSEVIER. Board member/committee appointments for a society; Disclosures; AMERICAN SHOULDER AND ELBOW SOCIETY, MID ATLANTIC SHOULDER AND ELBOW SOCIETY, SHOULDER 360, PACIRA., (© The Author(s) 2024.)

The palmaris longus (PL) tendon is used in surgical opponensplasty to restore functional hand movements in thenar paralysis. Although successful PL autologous tendon transfer has been attributed to an established synergistic relationship between the PL and abductor pollicis brevis (APB) muscles in vivo, this functional relationship may be dependent on the quality of their spatial relationship and properties of their constituent muscle fibers. The purpose was to compare the proportion of type I and type II muscle fibers in the APB based on its contiguous morphological relationship with the PL tendon for indirect insight into their functional synergy, contractile capacity, and digastric arrangement. Twenty‐four contiguous PL and APB specimens were harvested from the upper limbs (12 right and 12 left) of twelve formalin‐embalmed cadavers (mean age: 74 ± 10 years). The fiber type composition of these muscles was determined by labeling serial cross sections with myosin heavy chain (MyHC) type I and type II monoclonal antibodies. The PL consisted of a relatively heterogeneous fiber type composition irrespective of the presence of a discrete (type I: 41 ± 11%; type II: 55 ± 12%; hybrid: 4 ± 3%) or rudimentary (type I: 49 ± 10%; type II: 45 ± 9%; hybrid: 6 ± 4%) tendinous connection with the APB. The APB fascicles arranged contiguously with the PL through a discrete tendon had significantly greater proportions of type II fibers (41 ± 19%) compared to those with rudimentary PL connections (type II: 15 ± 8%). Therefore, the APB fascicles arranged in a digastric relationship with the PL may have the capacity to produce more powerful contractions than those with rudimentary PL tendons based on the known contractile properties of type II muscle fibers. Knowledge of the spatial relationship between the PL and thenar musculature prior to PL autologous tendon transfer may be a useful indicator of the quality of established synergy in vivo. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The effect of the absence or presence of the Palmaris longus tendon on pinch and grip strength was investigated in this study. Similarly, the effect of the presence or absence of the fifth superficial flexor digitorum on grip strength in the hand was studied. The aim of the present study was to assess the combined effect of these anatomical variations on pinch and grip strength. MATERIALS AND METHODS: In this cross-sectional study, 523 volunteers and their 1046 hands were enrolled. Each hand was assessed for the presence or absence of the Palmaris longus tendon and for variations in the fifth superficial flexor digitorum function. Then the grip and pinch power of the hands were measured with the Jammar Dynamometer. RESULTS: The presence or absence of Palmaris longus had no effect on grip strength in the individuals studied. Likewise, variations in fifth superficial flexor digitorum function had no effect on grip and pinch strengths. But the results of statistical testing showed the effect of the presence of Palmaris longus on pinch strength (25.38 lbs in hands with Palmaris present vs 24.43 lbs in hands without Palmaris). Pinch and grip power was higher in men than in women and in the right hand than in the left. CONCLUSION: Based on the findings of the present study, it seems that absence of the Palmaris longus tendon is associated with a reduction in pinch strength but has no effect on grip strength, and the variations in the fifth superficial flexor digitorum (flexor digitorum superficialis, or FDS) have no effect on pinch and grip strengths. [ABSTRACT FROM AUTHOR]

Palmaris longus (PL) is the most superficial flexor muscle of the wrist. Agenesis of this muscle does not result in disability but its presence plays a significant role in reconstructive plastic surgery as a donor tendon for grafting. The awareness of the incidence of PL occurrence in a population is therefore desirable. In the present study, 457 multiracial medical students (220 Malays, 198 Chinese and 39 Indians) of University of Malaya, Malaysia, ages between 18 to 22 years, were examined for the presence or absence of the PL tendon using Schaeffer's test. This study demonstrated the overall difference in occurrence rate of PL among the multiracial students which indirectly represent its overall pattern in Malaysian population, as the students originate from various states of this country. The data collected were then analyzed using non-parametric test to determine pattern of occurrence and incidence of agenesis of this muscle with regard to ethnicity, laterality, and gender. The highest incidence of unilateral and bilateral PL agenesis was observed in Indian students despite being the smallest race among the three groups studied. This study contradicts with previous findings that concluded Malays to be the group with the highest incidence of unilateral PL agenesis. This contradiction therefore justifies the need to construct a larger cohort study, which covers more diverse ethnic groups in Malaysia including the indigenous groups in Sabah and Sarawak to obtain the true incidence rate of PL agenesis in Malaysia. [ABSTRACT FROM AUTHOR]

Background: Palmaris longus tendon is often used as a donor tendon by surgeons in tendon grafts. It is one of the flexor muscles of the forearm and documented well for its variations in both morphology and number of tendons. Prevalence of absence of this muscle varies among the individuals of same population and individuals of various ethnic groups. The aim of this study was to assess the existence of Palmaris longus muscle within a group of students and its association with side of the limb and gender of the individual. Methods: Three hundred medical students of 150 males and 150 females with age group of 18–21 years were clinically assessed. The standard Schaffer's test was used for the assessment of PL tendon. If the tendon was not found in this test, the confirmation was done by other four tests. Results: Results of this study shows that an overall absence of palmaris longus muscle in both sexes was found to be 32%, out of which 21% absence was found in males and 43% absence found in females. Among the males, the unilateral agenesis was seen in 16% and bilateral agenesis in 4% and in females the unilateral agenesis was seen in 29% and bilateral agenesis seen in 14%. Conclusions: To conclude; in the present study, prevalence of Palmaris longus muscle agenesis was found to be more in female subjects on their left side. Surgeons who plan for tendon reconstructive procedures should know variations of Palmaris longus muscle and its clinical assessment. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Carpal tunnel syndrome (CTS) is the most frequently operated neurological disorder of the hand. Incidence of patients remaining symptomatic has been reported up to 30% after primary release. Revision surgery remains challenging although multiple surgical options have been described. In this case series a simple novel technique, the palmaris longus interposition, is described for the treatment of recurrent and persistent CTS. Patients who underwent PLI between October 2013 and 2018 and without underlying neurological or hand disorders severely affecting the operated hand were eligible for inclusion. All were preoperatively diagnosed with recurrent or persistent CTS based on clinical assessment. Eighteen patients with 20 operated hands consented to the study. Patient characteristics were retrospectively reviewed, including nerve conduction studies and ultrasound scans. Patients were postoperatively asked to classify their symptoms as resolved, improved, not improved or worsened. In addition, postoperative symptom severity and functional status were assessed using the Boston Carpal Tunnel Questionnaire. Ten hands showed recurrent symptoms while the other 10 showed persistent symptoms. The average follow-up was 15 months. No improvement was reported in 5 hands, whereas improvement or complete relief of symptoms was reported in 15 hands. The mean total score of the Boston Carpal Tunnel Questionnaire postoperatively was 2.29 and ranged between 1.26 and 4.32. These results suggest that using the palmaris longus tendon as interposition graft between the leaves of the flexor retinaculum may be a suitable technique for the management of patients with mild to moderate symptoms of recurrent and persistent CTS. Further research should investigate whether this technique has better outcome compared to other procedures. [ABSTRACT FROM AUTHOR]

Various clinical tests are used to evaluate the palmaris longus tendon, but their accuracy is unknown. We assessed the accuracy of clinical tests (Schaeffer's, Thompson's, Mishra-I, Mishra-II) against ultrasound as the reference standard. We hypothesized that Schaeffer's was most accurate and that examination can reliably assess the palmaris longus tendon's length. Ninety-six wrists were examined clinically and evaluated with ultrasound by radiologists who were blinded to examination results. We calculated diagnostic accuracy and agreement between length measurements. Sensitivity values were as follows: Schaeffer's 94%, Mishra-I 100%, Mishra-II 100%, Thompson's 72%. Specificity values were as follows: Schaeffer's 94%, Mishra-I 83%, Mishra-II 89%, Thompson's 91%. Intraclass correlation coefficient between palmaris longus tendon length measurement on examination and ultrasound was 0.54. Schaeffer's test accurately detected this tendon with >90% sensitivity and specificity, but clinical examination less reliably measured palmaris longus tendon length. Ultrasound may be a useful adjunct to assess potential graft length preoperatively. Level of evidence: I [ABSTRACT FROM AUTHOR]