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Heredity and racial variation in the musculus palmaris longus

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... However, no variation associated has been confirmed. Some authors have suggested a possible association of agenesis of the PLM with a pattern of inheritance (THOMPSON, MCBATTS and DANFORTH, 1921;DANFORTH, 1924;MUNTONI, BROWN, SEWRY et al., 2002). However, it is still unclear what type of inheritance is involved or what are the supposed genes involved in this human muscle variation. ...
... For this, the individual subject was instructed to realize the opposition the first and fifth finger and sequentially perform wrist flexion (SCHAEFFER, 1909). If the muscle had not been visualized or palpable through this test, another test was conducted which consisted of the additional flexion of the fingers II to V, followed by wrist flexion and realization of opponency and flexion of the thumb on the other fingers (THOMPSON, MCBATTS and DANFORTH, 1921). ...
... Different authors agree on the influence of hereditary factors on the absence of the muscle (THOMPSON, MCBATTS and DANFORTH, 1921;DANFORTH, 1924;WEHBE, 1992;GARCIA, MARQUES, SANTOS et al., 2005). The first author who suggested the suppression of PLM as dependent of hereditary factors was Thompson, Mcbatts and Danforth (1921), by analysis of the phenotype in 102 families. ...
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Introduction: the aim of this study was to investigate the putative hereditary pattern related to the presence/absence of the palmaris longus muscle (PLM) in humans. Materials and Methods: we analyzed 99 individuals (56 women and 43 men) from 25 families living in the city of Jataí, southwestern of Goiás State, Brazil, who agreed to participate in the study by signing an approved consent form according to the University Research Ethical Committee. The tests to detect the presence/absence of PLM were performed in all subjects in both forearms by clinical examination. A careful analysis of all families phenotypes studied was performed. Results: Bilateral presence of PLM was detected in the majority of the population studied (75.76%). The unilateral absence of PLM was observed in 14.14% of subjects and bilateral absence in 10.1%. In 14 families both parents and 25 children had bilateral PLM and one child had unilateral absence of PLM. Parents Families (n=9) where one parent showed bilateral presence and the other unilateral/bilateral absence were observed children with both bilateral presences, unilateral or bilateral absence of PLM. Cases where both parents showed unilateral absence of PLM with children showing bilateral absence or presence of PLM were also observed. Conclusion: The presence of PLM appears to be dominant over its absence. It is suggested that the genotype for the absence of muscle is recessive while for the presence is dominant but with variable expressivity for the phenotype of unilateral or bilateral presence of the muscle.
... Those who are having any deformities or injury in the upper extremity were strictly excluded from the present study. In this present study, the prevalence of presence or absence of PL was determined by series of tendon examination techniques described by Schaeffer's test, [9] Thompson's fist, [10] Mishra's 1 st test, [11] Pushpakumar's two finger sign [12] [ Figure 1a-d] and our modified Schaeffer's technique [ Figure 2]. ...
... [16] Identification of PL is very important to clinicians for its tendon to be used as a graft in various surgical procedures and during administration of medicine/corticosteroids in carpal tunnel to relieve pain due to carpal tunnel syndrome/ arthritis [17] and in median nerve wrist block. [18] According to the literature there are various methods [9,10,12,18,19] to identify the tendon of PL, each having its own identifying techniques. The most commonly and traditionally followed method is Schaffer's test. ...
... [9] Next to Schaffer's test, Mishra's 1 st test [11] is widely supported because of its appliance in those patients with median nerve palsy also, in whom the opposition of thumb is not possible. [7,20,21] The techniques of Schaeffer's test, [9] Thompson's fist, [10] Mishra's 1 st test, [11] Pushpakumar's two finger sign [12] have been used in this study to demonstrate the presence or absence of PL. Even though these clinical tests mentioned mostly provides correct information of the presence or absence of the tendon, sometimes a weakly developed tendon which is present can be mistaken as absent. ...
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Background: The knowledge of Palmaris longus (PL) is a growing interest for its wide role in reconstructive plastic surgeries as a donor tendon for transfer or transplant. The prevalence of the PL agenesis has been well-documented by many authors in different ethnic groups or populations. Many conventional tests for determining the presence of the PL has been described, but lamentably there are many discrepancies in confirming its presence or absence. Slight modifications of the prevailing methods can still give authenticate results. Aim: This prospective study was conducted to determine the incidence of unilateral and bilateral agenesis of PL and its association with sex and side of the limb in the Andhra population of India. Materials and Methods: A total of 942 subjects of both sexes belonging to 18-23 years were used to access the PL using various tendon examination techniques including our modified Schaeffer's test. The data collected were analyzed by Pearsons χ2test using SPSS software. Results: Overall agenesis of muscle in both sexes was 264 (28.0%), out of which 40.2% was seen in females and 14.7% in males with the ratio of 3:1. The unilateral agenesis was seen in 70.5% and bilateral agenesis in 29.5% subjects. The left side agenesis was seen in 51.6% and right side in 48.4% subjects. Conclusions: The prevalence of bilateral and unilateral agenesis was more common on left side with a greater likelihood in the female subjects. The proposed technique could bring better results in all subjects and can be implemented in manual examination of PL.
... he prevalence of palmaris longus agenesis among various ethnic groups is widely variable. [1][2][3][4][5] Awareness of this prevalence in the treated population is of great clinical importance when one attempts use it as a donor tendon for transfer in orthopedic and reconstructive surgery of Turkiye Klinikleri J Med Sci 2010;30(5) 1561 The Prevalence of the Palmaris Longus Agenesis: A Study in Afghan Population A AB BS S T TR RA AC CT T O Ob b j je ec c t ti i v ve e: : Pal ma ris lon gus (PL) is a struc tu re of ten used in re cons truc ti ve sur gery mainly in the set ting of ten don graf ting. The pal ma ris lon gus age ne sis va ries de pen ding on the race/eth ni city. ...
... 14 Most of the stu di es re por ted that fe ma les lacked the pal ma ris lon gus ten don on the left si de more. 2,4,7,12,15 Furt her mo re so me of the se stu di es sho wed that bi la te ral ab sen ce was mo re com mon when com pa red to uni la te ral ab sen ce. 2,4,7 Ho we ver, so me ot her stu di es de mons tra ted that the re we re no sig nifi cant dif fe ren ces in the pre sen ce of the pal ma ris lon gus ten don bet we en gen ders or left and right sides. ...
... 2,4,7,12,15 Furt her mo re so me of the se stu di es sho wed that bi la te ral ab sen ce was mo re com mon when com pa red to uni la te ral ab sen ce. 2,4,7 Ho we ver, so me ot her stu di es de mons tra ted that the re we re no sig nifi cant dif fe ren ces in the pre sen ce of the pal ma ris lon gus ten don bet we en gen ders or left and right sides. 3,8,16 Re sults of this study re ve a led that bi la te ral absen ce was sta tis ti cally mo re com mon when compa red to uni la te ral ab sen ce. ...
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Objective: Palmaris longus (PL) is a structure often used in reconstructive surgery mainly in the setting of tendon grafting. The palmaris longus agenesis varies depending on the race/ethnicity. Awareness of the prevalence in the treated population or ethnic group is important. The prevalence of palmaris longus agenesis has, to the best of the authors' knowledge, not been reported in Afghan population. Material and Methods: Four-hundred and thirty healthy Afghan subjects (215 males and 215 females) were clinically examined for the presence or absence of palmaris longus. The examination entailed observation of the volar aspect of the wrist, looking for the palmaris longus tendon using Schaeffer's test and Mishra's second test. Results: PL tendon was found to be absent unilaterally in 7.7% and bilaterally in 14.2% of study participants. The overall prevalence of absence of PL (unilateral or bilateral) was 21.9%. Bilateral absence of PL was statistically more frequent than the unilateral absence. The prevalence of absence of PL was statistically similar between the genders and the sites. Conclusion: The prevalence of the palmaris longus agenesis in the Afghan subjects was found to be much higher than the reported average prevalence in the Asian population.
... According to some authors unilateral absence is more common in the non-dominant hand due to less usage and is more common in females [17]. Some studies report that absence of Palmaris longus is associated with other anatomical anomalies like anomalous superficial arch, absence of plantaris [16,18]. ...
... Five tests were used to check the presence or absence of Palmaris longus muscle.in Thompsons's, the subject is asked to make a fist, then flex the wrist and finally the thumb is opposed and flexed over the fingers [18]. In Schaeffer's test the subject is asked to oppose the thumb to the little finger and then flex the wrist [19]. ...
... Individuals with bilateral or unilateral absence of Palmaris longus show no functional deficits which confirm the fact that the significance of Palmaris longus lies in orthopedic and reconstructive surgeries [22]. Absence of Palmaris longus differs among populations and ethnic groups [18]. It is found to be 1.02% in Ugnadan, 3.4% in Japanese population, 4.6% in Chinese population, 6.7% among Nigerians, 14% in Brazil, 20.2% among Indians, 24% among North Americans, 26.6% in Turkish population, 38.6% among Bahrain population [23]. ...
... Most of the reconstructive hand surgeries and plastic surgeries need preoperative documentation of the presence or absence of PL tendon. Till date, five clinical tests, namely Standard test (Schaeffer's test) [7], Thompson's test [8], Mishra's test I [9], Mishra's test II [9] and Pushpakumar's ''two-finger sign'' method [10], have been described in the literature to look for the presence of PL. In the context of a developing nation, where many of the patients are illiterate and come from the lower socio-economic status, our patients find them difficult to comprehend. ...
... Standard test (Schaeffer's test) [7]: As described earlier. 2. Thompson's test [8]: The individual is asked to make a fist followed by flexing the wrist, and finally, the thumb is opposed and flexed over the fingers. 3. Mishra's test I [9]: ...
Article
Palmaris longus has an invaluable role in reconstructive surgeries of hand and is the most common source of tendon grafts in tendon transfer surgeries. Various clinical tests are available to check for the presence of the tendon but are often difficult to use due to their complex nature. We suggest a rather simple test, which we have found very useful in our practice. In this cross-sectional study, we compared our proposed test with the most commonly used Standard test (Schaeffer's test) to know about its sensitivity in a cohort of randomly selected 200 patients. We found our test to be more sensitive than the Standard test. The average time duration from instructions to elicitation of the test was also found less. No individual asked to repeat the instructions for the proposed test. Our proposed test to evaluate the presence of palmaris longus tendon is very simple and easy-to-understand manoeuvre with good sensitivity. It would be extremely useful in the preoperative planning in most of the reconstructive surgeries, should the palmaris longus tendon be harvested.
... To confirm or refute the presence of a PLM, the following 5 tests were done: Thompson's [16], Shaffer's [15], Pushpakumar's [12], Mishra's 1 [8], Mishra's 2 [8]. For increased accuracy, palpation was performed in every case. ...
... Its superficial location and easy accessibility and the fact that the muscle is fully developed at birth and can be used as tendon donor muscle in any age group, makes it one of the most frequently used donor muscles in surgery. Therefore, all the information about possible variations and frequency of the muscles' prevalence has significance in orthopaedics, plastic, and reconstructive surgery [16,17]. ...
Article
Background: The palmaris longus muscle (PLM) is a slender, fusiform muscle which lies on the flexor surface of the forearm. Its agenesis is considered the most frequent anatomic variation in the human body. Agenesis of PLM shows strong racial and ethnic variability. The aim of this study was to examine the prevalence of agenesis of PLM in Dercen, an isolated Hungarian village in Ukraine. Materials and methods: Five hundred forty-eight persons were examined by Thompson's, Shaffer's, Pushpakumar's, Mishra's 1, and Mishra's 2 tests to confirm or refute the presence of a PLM. All the examined subjects were of Hungarian ethnic origin. Results: The overall prevalence of absence of the palmaris longus was 52.92%. During the examination, unusual results appeared regarding the agenesis of PLM in the elder population of village. Further tests among elder population shoved that in people born before 1945 the agenesis rate of PLM was higher than 70%, and in villagers born after 1945 the agenesis rate drops by 23%. Conclusions: In the light of historical events of the country, we can say that the unexpected change of the PLM agenesis rate in 1945 was caused by invasion of soviet army and deportation of local men from their homeland.
... [1] Bu tendon, ekstansör indisis proprius, ekstansör digiti minimi, plantaris tendonu, ayak başparmak uzun ekstansörleri ile birlikte, genellikle eldeki çeşitli rekonstrüktif girişimlerde tendon grefti olarak kullanılmaktadır. [2] Bu çalış- [1,3] olarak palmaris longus (PL) tendonu yokluğunun sıklığı ve bu durumun elin kavrama ve çimdikleme kuvvetlerine olan etkisi araştırıldı. ...
... Bu farklılıklar daha çok ırka dayalı faktörlerle ilişkili bulunmuştur. [3,7,9] Klinik uygulamalarda PL tendonu greft olarak sık kullanılan bir tendondur. [2] Bununla birlikte, bu bölge anatomisine hakim olmayan cerrahlar tarafından yapılan girişimler sonrasında istenmeyen komplikasyonlarla karşılaşılabilmektedir. ...
Article
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Objectives: In this study, we investigated the incidence of missing palmaris longus (PL) tendon and its effect on grip and pinch strengths. Patients and methods: The presence of the PL tendon was investigated in 365 healthy male students (mean age 23 years; range 19 to 33 years) of Police College in Malatya. The grip and pinch strengths of each participant were measured using a Jamar dynamometer and pinch gauge, respectively, according to the recommendations of the American Society of Hand Therapists. Results: The PL tendon was absent in 124 participants (34%). Of these, 82 individuals (22.5%) had bilateral involvement. The tendon was missing in the right hand in 103 cases (28.2%), and in the left hand in 103 cases. Unilateral absence was found in 42 cases (11.5%). Grip and pinch strengths of the hands having the PL tendon were greater than those in which the PL tendon was missing, but this did not reach significance (p>0.05). Conclusion: The incidence of missing PL tendon was higher than reported in previous studies. The use of this tendon in reconstructive hand surgery will not result in significant decreases in grip and pinch strengths of the hands.
... A total of 1000 cases, 500 women and 500 men were enrolled in this trial. The age range of cases was [18][19][20][21][22][23][24][25][26][27][28][29][30] According to the results of all three tests, no significant difference was found between unilateral and bilateral tendon agenesis rates in men and women (Table 2). ...
... 9 In trials conducted in Europe and North America, the prevalence was reported between 5.5 and 24%. [20][21][22][23][24][25] On the other hand, rates between 4,6 and 17.2% were detected in the Asian population. [26][27][28][29][30] In our country, considerably different results were obtained in two different trials conducted up to this date. ...
Article
Objectives: The primary goal of this trial was to show the compatibility between a new test technique (Hiz-Ediz test) for detection of palmaris longus muscle (PLM) agenesis, which we recently developed, and the former tests, the Schaeffer and Mishra's second tests. Materials and methods: One thousand cases were enrolled in this trial. Schaeffer's test, Mishra's second test and Hiz-Ediz tests were applied to all cases. Examinations were performed to determine differences between genders and both hands. Consistency between all three tests was investigated. Results: In the Hiz-Ediz test, PLM agenesis was determined in 15.1%. No significant difference was found between the rates of unilateral and bilateral tendon agenesis determined by three tests (p>0.05). When the consistency of the three tests was evaluated using the kappa test, full consistency was determined between Mishra's second and the Hiz-Ediz test; however, full consistency was not determined between the Schaffer's and the other two tests. But, no statistical difference was found between the three tests. Conclusion: Our results indicate that the prevalence of PLM agenesis is consistent with the available data. The Hiz-Ediz test can be applied easily and safely to determine and to visualize the PLM agenesis, when compared to the Mishra's second test and the Schaeffer's test.
... Riemann et al. [7] found the muscle absent in 281 of 2205 specimens (12.5 %). Thompson et al. [8] found the muscle missing in about 16% of males and 24% of females, these figures being based on studies of cadavers [8]. ...
... According to a study by P. Thejodhar et al. [16] there appears to be considerable divisional (racial), ethnic and regional variation in the frequency with which the muscle is absent. The prevalence of absence of the Palmaris longus has been extensively studied following the first report of its absence in1559 [8,25]. Some of the figures that indicate the distribution of the muscle in different population and races are mentioned in the table 5 [17][18][19][20][21][22][23][24]. ...
Article
Background: Palmaris longus muscle has received a growing interest for its role in constructive surgery. Since the agenesis of Palmaris longus shows a strong racial variation, it is important to investigate its distribution on the Ethiopian students and compare the results with others.Methods: a cross sectional descriptive study was conducted in 712 subjects comprising of 504 males and 208 females to assess the distribution of Palmaris longus in the freshman students of Gondar College of Medicine and Health Sciences ,University of Gondar, Ethiopia in 2010. Results: The overall prevalence of absence both unilaterally and bilaterally in the two sexes was 15.3%. The bilateral absence was 8.1%. Unilateral absence was 7.2%. The distribution of unilateral absence on the right and left were 3.5% and 3.7% respectively. In 9 subjects the tendon of Palmaris longus was found duplicated unilaterally. In other ten individuals an overlapping and laterally deviating tendon of Palmaris longus muscle towards the tendon of flexor carpiradialis muscle were observed.Conclusion: Results of this finding suggested that the prevalence of Palmaris longus agenesis is similar as reported in standard anatomy texts but considerably differ from findings obtained from studies that are conducted in other black African populations.
... Thompson's test: fist is made, then flexed, finally the thumb is opposed and flexed over the fingers [27]. ...
... Finally Soltani et al. found that bilateral presence of the PLM occurred the most, followed by unilaterally absence of the PLM while bilaterally absence of the PLM occurred less [34]. Thompson et al. reported that men were more prone to have a bilateral and unilateral absence of the PLM, but this was not statistically significant [27]; other authors reported the incidence of agenesis to be higher in women [1,26,34]. ...
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The Palmaris longus muscle can be absent unilateral or bilateral in about 22.4% of human beings. The aim of this study is to investigate whether the presence of the Palmaris longus muscle is associated with an advantage to handgrip in elite tennis players compared to recreational athletes. Sixty people participated in this study, thirty elite tennis players and thirty recreational athletes. The presence of the Palmaris longus muscle was first assessed using different tests. Grip strength and fatigue resistance were measured by an electronic hand dynamometer. Proprioception was registered by the Flock of Birds electromagnetic tracking system. Three tests were set up for measuring proprioception: joint position sense, kinesthesia, and joint motion sense. Several hand movements were conducted with the aim to correctly reposition the joint angle. Results demonstrate a higher presence of the Palmaris longus muscle in elite tennis players, but this was not significant. Maximal grip strength was correlated with gender and only on the dominant side; it was also correlated with age. Fatigue resistance showed only on the non-dominant side; a significant difference in elite and recreational athletes. In proprioception there was no correlation with elite and recreational athletes or the presence of the Palmaris longus muscle.
... [4] PL is commonly clinically assessed by the Standard test also known as Schaffer's test which includes opposition of the thumb to the little finger, while flexing the wrist against resistance. [5] Other tests include Thompson's test, [6] Mishra's tests (1 and 2) [7] and Pushpakumar's methods (1 and 2). [8] All the tests are based on making the tendon taught by eliciting its weak flexor action and making it prominent, leading to its identification by vision and/or palpation. ...
... All of the previously described clinical tests except Mishras test 1 [7] require the patient to flex the fingers and/or the wrist. This commonly leads to a prominence of the flexor carpi radialis in most cases and flexor digitorum superficialis in some cases in addition to Schaeffer's test/Standard test: [5] The patient is asked to oppose the thumb to the little finger and then flex the wrist, resulting in palmaris longus prominence (arrow) Figure 4: Thompson's test [6] showing the patient making a fist, flexing the wrist and finally opposing the thumb over the flexed fingers, reaching the little finger to make the tendon of palmaris longus prominent (arrow) Figure 5: Mishra's test-1: [7] Passive hyperextension of the metacarpophalangeal joint by the examiner while the patient actively flexes the wrist, which makes the tendon of palmaris longus prominent (arrow) Figure 6: Mishra's test-2: [7] The tendon of palmaris longus stands out prominently (arrow) when the thumb is fully abducted with the wrist in slight flexion the PL. The prominence of these tendons can be confused with the PL. ...
Article
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The palmaris longus (PL) tendon can be assessed with clinical tests whose reliability varies. Herewith, two new tests are described – the ‘Bunched Finger’ test and ‘Hooked Finger test’ that are simple and visualise the PL tendon easily and prominently.
... Subjects who are having any deformities, diseases or injury in the upper extremity were excluded. In this study, the presence or absence of PL was determined by series of tendon examination techniques described by Schaeffer's test (standard test) (Schaeffer, 1909), Thompson's fist (Thompson et al., 1921), Mishra's 1st and 2nd test (Mishra, 2001) and Pushpakumar's two finger sign (Pushpakumar et al., 2004). Each subject was initially asked to do the standard test. ...
... The following five tests were used to confirm or refute the presence of a PLM: 1. The Thompson's: the subject is asked to make a fist, then flex the wrist and finally the thumb is opposed and flexed over the fingers [11], 2. The Shaffer's: the subject is asked to oppose the thumb to the little finger and then flex the wrist [10], 3. The Pushpakumar's: the subject is asked to fully extend the index and the middle finger, the wrist and other fingers are flexed and finally the thumb is fully opposed and flexed [8], 4. The Mishra's 1: metacarpo-phalangeal joints of all fingers are passively hyperextended by the examiner and the subject is asked to actively flex the wrist [7], 5. The Mishra's 2: the subject is asked to abduct the thumb against resistance with the wrist in the slight palmar flexion [7]. ...
Article
The Palmaris longus muscle (PLM) is a slender, fusiform muscle which lies on the flexor surface of the forearm. Its agenesis is considered the most frequent anatomic variation in the muscular system of the human body. The PLM has little functional use to the human upper limb. It is evidenced by former epidemiological studies that the agenesis of the PLM has a strong racial and ethnic variability. The purpose of this study was to assess the prevalence of the PLM agenesis and its pattern in Hungarian students. In the present study 385 students of three Hungarian educational institutions were examined. Five standard tests were used to check the presence of a PLM. The PLM was considered to be present if it could be visualized or palpated in at least one of the five tests, and it was considered absent when it could not be palpated or visualized in any of the tests. The overall rate of the Palmaris longus muscle agenesis was 32.2%. The bilateral agenesis was 18.7%, while the unilateral 13.5%. The agenesis rate on the right and the left hand was 7.27% and 6.23% respectively. The prevalence of the PLM agenesis was found to be very similar in the Hungarian populations in Transcarpathia, Ukraine and Slovakia, as well as in Turkey. Our results suggest a genetic relationship between the Turkish and the Hungarian populations.
... Reports have shown that the PL may be absent, duplicated, triplicated, reversed or pre sented as a digastric muscle with various inser tions. It has been observed from various studies that the PL is inserted into the fascia of the fore arm, the hypothenar eminence, the tendon of the flexor carpi ulnaris muscle, the abductor pollicis brevis, into the carpal tunnel or Guyon's canal, the pisiform bone and the scaphoid bone (Lalit et al., 2014 pulations (Pushpakumar et al., 2004;Thompson et al., 1921;Mishra, 2001;Reimann et al., 1994;Gangata, 2009;Hiz et al., 2011). Since there are many other bulky muscles in the forearm to flex the wrist, its absence does not seem to have any functional loss on the biomechanical functions of the wrist region. ...
... Subjects who had any deformities, diseases or injury in the upper extremity were excluded from the present study. The presence or absence of PL was determined by series of tendon examination techniques described by Schaeffer's test (standard test) (Schaeffer, 1909), Thompson's fist (Thompson et al., 1921), Mishra's 1st and 2nd test (Mishra, 2001) and Pushpakumar's two finger sign (Pushpakumar et al., 2004). Each subject was initially asked to do the standard test for assessment of the Palmaris longus tendon. ...
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The prevalence of right-handedness in the general population is between 85 and 92%. This study was done to determine the relation of the Palmaris longus agenesis and the hand dominance. This study included 732 subjects (362 male and 370 female). They were initially asked to do the standard test (Schaeffer's test) for the assessment of the Palmaris longus tendon. Four tests (Thompson's test, Mishra's tests I and II, Pushpakumar's "two-finger sign" method) were done for confirmation of the absence of the tendon in the subjects.Then the subjects were asked to hand dominance. The data collected were analyzed by chi square test using SPSS software. Right hand dominance was recorded in 663 (91.4%) subjects. In right-handed subjects, the agenesis of Palmaris longus tendon was in 27 (4.1%) on the right side and in 44 (6.6%) cases on the left side. In left-handed subjects, this muscle was absent on the left side in four (6.5%) and on the right side in four (6.5%) cases. Although, bilateral absence of Palmaris longus tendon was more common in right handed subjects (20.2% in right-handed subjects, and 14.4% in left-handed subjects) but there was no significant difference. Our results show that hand dominance wasn't associated to agenesis of Palmaris longus muscle. [Jashni HK, Rahmanian K, Jahromi AS. Relation of Palmaris Longus agenesis with hand dominance. Life Sci J
... • Standard test (Schaeffer's test) : the participant was made to steady their forearm at 90 degrees and asked to oppose the thumb to the little finger with the wrist partially flexed (18). • Thompson's test : the participant is asked to make a fist, then flex the wrist and finally the thumb is opposed and flexed over the fingers (22). • Mishra's test I : the metacarpophalangeal joints of all fingers are passively hyperextended by the examiner and the participant is asked to actively flex the wrist (11). ...
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This study was designed to find a possible correlation between the presence of the palmaris longus and function of the fifth flexor digitorum superficialis. We examined 300 participants to assess the absence of palmaris longus and flexor digitorum superficialis function by several clinical tests. Overall absence of palmaris longus, was seen in 157 participants (52.3%). Overall deficiency of flexor digitorum superficialis was noted in 100 participants (33.3%). In 15 participants (5%) we noted bilateral absence of palmaris longus and flexor digitorum superficialis deficiency. Five participants (1.7%) had unilateral absence of palmaris longus and flexor digitorum superficialis deficiency on the same, left or right hand. Bilaterally presence of these muscles we noted in 95 participants (31.7%). We believe that there is no connection between absent palmaris longus and absent function of flexor digitorum superficialis. We found a much higher prevalence of muscles absence individually and jointly than in other studies.
... Thompson test -Every student was asked to make a fist then flex the wrist and finally the thumb was opposed and flexed over the fingers. [16] ...
... A study on a sample of 610 participants both males and females, age ranging from 20 years to70 years old taken randomly by convenience method from the various races of Malaysian population was conducted. Among the wide range of tests that are used to identify the palmaris longus, the two most traditional and easy tests which are Schaeffer's test [31] and Thompson's test [32] were used for the present study. ...
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Abstract: Palmaris longus (PL) is the most variable muscle in the human body. The anatomy of PL is of interest due to its role in reconstructive plastic surgeries as a donor for transplant. The present study was conducted to determine the incidence of unilateral and bilateral agenesis of PL. A total of 610 participants 287 males and 323 females belonging to 20 – 70 years were used to access the PL tendon using tendon examination techniques, Schaeffer’s test and Thompson’s test. The collected data were processed, computed and analyzed by using SPSS software version 22.The agenesis of PL with gender and ethnicity were assessed using Chi-square tests with a statistical significance of p < 0.05 The participants are 184 Malays, 167 Chinese, 167 Indians and 92 from other races. The overall absence of palmaris longus was found in 62 (10.2%) of cases, unilateral absence in 46 (7.5%) of cases and bilateral absence in 16 (2.6%) of cases. The agenesis was 11.1% in males and 9.3% in females. Malay race had the highest prevalence of agenesis of PL with 10.3%, followed by the Indian race with 9.0% and the Chinese race with 7.2%.
... L'absence unilatérale est de 13,18 % et l'absence bilatérale est de 11,38 %. Cette répartition est en accord avec les données de la littérature dans la population caucasienne [6,14,49,50]. Seul Erić décrit un taux d'absence plus élevé [10,51] (Tableau VI). ...
Article
Le muscle long palmaire, également appelé palmaris longus (PL) dans la nomenclature internationale, est décrit comme un fléchisseur accessoire et inconstant du poignet. Sa variabilité est très élevée selon les espèces et au sein des différentes populations humaines. Lorsqu’il est présent son tendon peut servir de greffon. Les patients se demandent alors si la fonction de leur poignet ne va pas se trouver altérée par ce prélèvement chirurgical. Ils s’inquiètent également de l’absence congénitale de leur PL si le chirurgien ne peut en disposer. Le but de cette étude est donc de comprendre le rôle du PL dans la flexion de poignet et de savoir si un sujet possédant un PL présente une force de flexion de poignet différente d’un sujet qui n’en a pas et donc de pouvoir rassurer éventuellement nos patients.
... Mishra's 1st test, passive hyperextension of the metacarpophalangeal joints was done along with mild active flexion of the wrist [12]. In Thompson's test, a fist was made followed by flexing the wrist against resistance with the thumb flexed over the fingers [13]. ...
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The Palmaris longus is one of the most variable muscles in the body which flexes the wrist and tenses the palmar fascia. It is used as a source of tendon graft. It has been seen that there is association between prevalence of Palmaris longus with race, sex and body side. The prospective study was conducted during May-June 2015 to determine the incidence of the absence of the Palmaris longus in Nepalese population in the Eastern Region using three common clinical tests among patients attending OPD of Nobel Medical College and Hospital, Biratnagar, Nepal. The overall incidence of absence was 11.8% with bilateral absence at 3.5% and unilateral absence at 8.2%. The overall difference between dominant and non-dominant and males and females was statistically significant (p < 0.05). The study findings are similar with most studies done in the Asian population. The incidence of absence of Palmaris longus was more in non dominant hand. One of the explanation in favor of above findings is that the dominant hand is more involved in manual activities and hence less likely to degenerate due to disuse as compared to the non dominant hand.
... No significant statistical difference was found between absences of PL and gender or body side [11]. It is observed that the overall results from various previous studies by different authors regarding agenesis of PL bilateral absence occurs in 8% to 16% of individuals, with unilateral absence occurring in 4% to 14%.While in most of the standard textbooks of hand surgery stated that prevalence of absence of PL is around 15% [12]. The prevalence of absence of PL in the Chinese populace was 4.6% (bilateral 1.2% and unilateral 3.3%) [13]. ...
... 1]. These variations may be assessed by several clinical tests and these tests are more superior to the other according to some studies [2][3][4][5][6][7][8]. A recent study showed that different tests may suggest different results when the presence of Palmaris Longus is assessed by them [9]. ...
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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.
... The presence of the absence of the PL may have been estimated to be caused by dominant gene. 25 However, in 53 families, in which PL was present bilaterally in both parents, 6 of the 200 children revealed unilaterally absence of PL. In further support of this data is the fact that in 45 families, in which PL was present in one parent bilateral while in the other absence on unilateral or bilateral, 39 of the 168 children revealed bilaterally absence of the PL. ...
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Objectives: The prevalence of the absence of the Palmaris longus (PL) muscle varies considerably among different ethnic groups from 1.02% to 63.9%. The aim of this study was to determine the overall prevalence of PL absence in Turkish population and to correlate it with age, gender, hand dominancy, body side and familial tendency. Methodology: A total of 670 (339 males and 331 females) subjects from 115 families were investigated. The absence of PL, age, gender, laterality and hand dominance were recorded and analyzed statistically. Results: The overall prevalence of absence of PL was 32.2% in Turkish population. The overall prevalence of the absence of the PL in males and females was 26.2% and 38.3%, respectively. The prevalence of the absence of the PL was 3.6% on the right side and 5.8% on the left side. Conclusion: Rates of PL absence in Turkish population are much higher than other populations of the world previously reported. The absence of PL was statistically significantly more common in females than males. Bilateral absence of PL was statistically more frequent than unilateral absence. The prevalence of absence of PL was not correlated by hand dominancy.
... In cases of ambiguity we used Mishra's Test I & II [13] and Pushpakumar et al.'s two-finger sign' test [17]. We used the following tests before we declared palmaris longus as absent: Thompson et al.'s test [22], Gangata test [8], Oudit et al.'s four-finger sign [15], Lotus test and Bhattacharya et al.'s test [3]. The presence of the flexor digitorum superficialis of the little finger was tested by asking the patient to flex the little finger with the rest of the fingers positioned in extension at the inter-phalangeal joints to negate the action of flexor digitorum profundus ( Figure 1). ...
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Introduction: Palmaris longus and flexor digitorum superficialis of the little finger are highly variable anatomically. The tendons vary in different parts of the globe and different regions of the same country. Many studies have negated an association between the tendons. However, most of the studies have a sample size of less than 500 subjects. Aims and objectives: The aim was to study the tendons in the Indian population and study the association, if any between the tendons and to test functional significance of the tendons using the Michigan Hand Outcomes Questionnaire. Methods and material: It was a single centre cross-sectional study with a sample size of 1500 in the age group of 20–60 years. The subjects were tested for the presence of the tendons and their functionality was assessed by Michigan Hand Outcomes Questionnaire. The data was tabulated and was assessed using SPSS 13.0 software. Results: Palmaris longus was bilaterally absent in 10.9% and flexor digitorum superficialis of the little finger was bilaterally absent in 42% of the cases. There was a statistically significant association between the tendons when considered bilaterally. The tendons did not have any bearing on the functionality as assessed by the Michigan Hand Outcomes Questionnaire. Conclusions: There is significant variability in the palmaris longus and flexor digitorum superficialis tendon to the little finger not only in the different countries but in different regions of the same country. However despite the various clinical and medicolegal aspects concerning both the tendons, they do not have much bearing on the functionality of the hand.
... One of the examined students (a 22-year--old female) showed an unusual pattern of muscles in her left forearm (Fig. 1). During a more detailed visual examination and palpation done while the patient was performing the Thompson's et al. [23], Schaeffer's [20], Pushpakumar's et al. [14], Mishra's 1, Mishra's 2 [11], Gangata's [7] and Hiz-Ediz et al. [9] tests, it was established that the patient had hypertrophy of the PLM. The muscle appeared as a strong protrusion under the skin of the left forearm. ...
Article
The palmaris longus muscle (PLM) is considered to be a phylogenetically degenerate muscle. For many authors, this may be the cause of its great variability. The loss of function in the PLM makes it an important muscle in plastic and reconstructive surgery. During a study of PLM agenesis rate in the Hungarian population, a 22-year-old female showed an unusual pattern of muscles in her left forearm, which was found to be a hypertrophied PLM. The hypertrophied muscle was causing symptoms of median and ulnar nerve compression.
... Th ompson et al. 4 found that the inheritance of the PL is of similar nature as the inheritance of polydactyly. Parents with unilateral absence may have children with a lack of the muscle in one or both arms, whereas parents with the bilateral lack of the muscle can have children with a lack of the muscle in one hand. ...
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Palmaris longus is a very variable muscle in the human body, but it is often used as an applicable tendon graft. We report on diff erences between one pair of identical twins regarding the existence of the palmaris longus, which were detected accidentally during examination of the presence/ absence of this muscle in Caucasian population. In one of the twins, the palmaris longus was present at both forearms, while the other twin was lacking this muscle at both forearms. On search of the available literature, we found no articles about distinctions in the presence or absence of the palmaris longus in twins.
... Schaeffer's Test: Student is asked to hold forearm at 90 degree, than to oppose the thumb with little finger and wrist is flexed (Fig 1-a). 15 2. Thompson (Fig 1-b). ...
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INTRODUCTION: The palmaris longus (PL) is a tendinous superficial flexor of forearm. It basically, anchor skin and fascia of hand resist the horizontal shear force in distal direction. It also helps in tightening of palmar aponeurosis. Along with other flexor muscle it also helps in flexion of wrist joint. The incidence of absence of palmaris longus is in great variation from 1.5 to 63.9%. Its variation of absence has attracted many researchers globally. The aim of the present study is to know occurrence of absence of PL in Nepalese population. MATERIAL AND METHODS: This is a cross sectional descriptive observational study conducted among 270 medical students (MBBS, BDS) at Universal College of Medical Science, Bhairawaha in year the 2018-2019. Ethical approval for study was taken from institutional review committee (IRC). Four tests-Schaeffer's Test, Thompson's Fist, Mishra's Test and Puspa Kumar's two finger sign were used to see the absence/presence of Palmaris longus. A semi-structured proforma was used to collect the data. RESULTS: Out of 270 students, there were 145 (53.7%) females and 125 (46.3%) males. Age of the subject range from 19-23 years with a mean age of 19.91 years. The overall absence of palmaris longus was seen in 40 students (14.8%) which included 18 males (14.4%) and 22 females (15.2%). Bilateral absence of palmaris longus was seen in 10 students (3.7%) whereas unilateral absence of palmaris longus was seen 14 males (11.2%) and 16 females (11.03%). CONCLUSION: This present study concluded that overall absence of palmaris longus was seen in 14.8% subjects. Gender wise distribution showed that 14.4% males and 15.2% had the absence of palmaris longus. Thus, sound knowledge about this variation is important in planning graft surgeries.
... Thompson's test: the subject is asked to make a fist, then flex the wrist and finally the thumb is opposed and flexed over the fingers (Thompson et al., 1921). ...
Article
In elite athletes, the palmaris longus (PL) presence has a potential contribution to hand strength, smaller reaction time, better shooting speed and power. The aim of this study was to investigate the prevalence of PL in elite competitive artistic gymnasts and its impact on grip strength compared to a control group of moderately active non-athletes. This prospective study included 370 subjects divided in two groups (170 elite artistic gymnasts and 200 moderately active non-athletes, students of medicine). The study consisted of two clinical sets of examination: a search for the clinical presence of PL was initially conducted followed by the assessment of maximal grip strength. Standard and six additional tests were performed to confirm PL tendon absence. Maximal grip strength was measured bilaterally with an electronic hand dynamometer. Bilateral absence was more common than unilateral, predominately noted on left side in both study groups. Unilateral PL absence was correlated to decreased grip strength in students, while the opposite was found in gymnasts. The mean value of grip strength in some age groups was higher on the side where the PL was absent. The results of our study show that the presence of the PL doesn`t affect the hand grip strength in gymnasts. Due to the low incidence of unilateral PL absence, further large-sampled research is warranted to assess PL contribution to hand grip strength and to other hand functions that could be of significant importance for athletes and non-athletes.
... Interestingly, variations in PL are distinctly heritable. Thomson et al. hypothesized that partial or complete absence of the muscle is due to a single dominant gene, which acts as an inhibitor of its development, but this inhibition is frequently incomplete due to modifying conditions such as sex and side [46]. ...
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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.
... This distal part is the very part of the tendon which is searched for during clinical testing for PL detection (Fig. 2). While its presence is usually easy to detect using validated clinical tests [9,25,33,37,43], its size cannot be predicted on clinical exam. In reconstructive surgery, the length and the width of a tendon graft are essential for a successful function restoration. ...
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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.
... The palmaris longus muscle (PL) has been extensively investigated in adults [14] and the number of published studies in different populations has been increasing in the recent years, but only a few published papers reported PL presence and variation in fetuses [2,3,5,8,10]. Thompson et al. [11] explored hereditary characteristics of PL in 102 families with a total of 231 children and they concluded that absence of the PL muscle is autosomal dominant with incomplete penetrance and lateral variability. The PL muscle develops from the superficial layer of the flexor mass of the forearm [7]. ...
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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.
... It is well recognized that prevalence of absence of the palmaris longus muscle shows population variation (Thompson et al., 1921;Reimann et al., 1944;Machado and Di Dio, 1967;Ceyhan and Mavt, 1997;Sebastin et al., 2006;Abu Hassan and Jabaiti, 2008;Kapoor et al., 2008;Mbaka et al., 2008;Gangata, 2009), but the literature is conflicting on the relationship between prevalence of absence of this muscle and sex and body side in different populations (Wehbe, 1992). ...
... To date, a variety of clinical tests is used to identify the presence of PL [9,11,19,23,25,28]. These tests have advantages and disadvantages. ...
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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.
... A basic neurological examination was performed to assess muscle power, stretch reflexes, sensations both superficial and deep, and the presence of PL tendon (PLT). The existence or absence of the PLT was reported in both hands for which Allen's test, standard test (Schaeffer's test), [19] Thompson's test, [20] Mishra's test I, Mishra's test II, [21] and Pushpakumar's "two-finger sign" method test [22] were performed [ Figure 1]. ...
... Subjects who are having any deformities, diseases or injury in the upper extremity were excluded. In this study, the presence or absence of PL was determined by series of tendon examination techniques described by Schaeffer's test (standard test) (Schaeffer, 1909), Thompson's fist (Thompson et al., 1921), Mishra's 1st and 2nd test (Mishra, 2001) and Pushpakumar's two finger sign (Pushpakumar et al., 2004). Each subject was initially asked to do the standard test. ...
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The Palmaris Longus (PL) muscle is a weak flexor muscle with wide prevalence of agenesis in world. This study was conducted to determine the prevalence of agenesis of PL in a southern population of Iran. A total of 732 subjects aged 7-86 years were selected randomly. The participants were primarily asked to do the standard test (Schaeffer's test). Four tests were done for confirmation of the absence of the tendon in the subjects. The overall agenesis of muscle in both genders was 30.7±1.7%. This prevalence was more in females than in males (38.6 Vs. 22.7%, p<0.001). The bilateral agenesis was seen in 19.5% and left and right sided absences were 6.8% and 4.4%, respectively. There were significant differences between total and bilateral agenesis with age groups (P = 0.016 and P = 0.017). The agenesis of PL was higher than it reported in literature. The prevalence of bilateral absent was more common in present study adversely to the report in text that it was more on left side hand.
... 3. Thompson's Test: The patient makes a fist and then a flexion movement of the wrist, after that, he/she put his/her thumb over the other fingers (Thompson, 1921) (Fig. 3). ...
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The palmaris longus muscle (PLM) lies on the anterior region of the forearm, it is considered one of the most variable muscles in the human body, and its agenesis is the most frequent anatomic variation. The aim of this study was to evaluate the frequency of the PLM tendon in Chilean adults and also, to verify the agenesis symmetry according to sex. For this, we have analyzed the presence of the PLM tendon in 200 Chilean individuals, 114 female and 86 male. In this study, three different tests were used: Schaeffer's Test, Mishra's First Test and Thompson's Test. The obtained data were tabled and analyzed. It could be observed that 91% of the individuals had the PLM muscle tendon in at least one of the forearms and 80% in both forearms. The unilateral agenesis was found in 11% of the cases (5% on the right side and 6% on the left side) and bilateral agenesis was found in 9% of cases. When analyzing the frequency of the muscular tendon according to sex, we could observe that the PLM is more commonly found in men (82.56%) than in women (78.07%) (p>0.05). Besides, we could observe that the agenesis is most frequent on the left side in women however, no significant statistical difference could be observed when the symmetry according to sex was analyzed (p>0.05).
Article
This study was carried out to document the percentages of palmaris longus muscle amongst Nigeria for anthropological purposes. Three thousand (3,000) Nigerian subjects comprising 6000 extremities out of which 1932 (3864 extremities) were males and 1068 (2136 extremities) were females were inspected for the frequency of agenesis (absence) of the palmaris longus muscles. The presence or absence of palmaris longus was determined by physical examination of the palmaris longus tendon at the wrists of both hands. The muscle was made visible by opposing the thumb on the little finger and slightly flexing the wrist joint (in vivo examination). The frequency of agenesis of this muscle based on sex, side of the body and the overall incidence were determined. From the study, the muscle was found to be absent in 0.16% of the males on the right side and 0.19% of the females on the right side. On the left side, it was absent in 0.21% of males and 0.09% of females. On the average, percentage of agenesis was 0.18% in males and 0.14% in females. Thus the percentage was higher in males than females. The overall percentage of agenesis in Nigerians was 0.17%. This percentage is much lower than other populations. Bilateral absence was found in one male subject. There was no case of bilateral agenesis in females. The result is also reliable for anthropological studies involving Nigerians .It could be a useful guide to clinicians who may want to localize the median nerve amongst Nigerians.The tendon can still be counted on by surgeons treating Nigerian patients for use as a donor tendon, which will be present in a vast majority of Nigerian patients.
Article
Aim: To study the parameters that can help release the median nerve and its branch, the anterior interosseous nerve from entrapment neuropathies and various other lesions warranting surgical correction and infective and traumatic disorders of adjacent structures of the region. Materials and methods: Sixty four upper limbs belonging to South-Indian population were carefully dissected using the Cunningham’s Manual of Practical Anatomy, the axillary region was exposed, the cords of brachial plexus were traced and median nerve was identified with its relation to axillary artery. The upper limbs used were all disarticulated. The median nerve was further traced and exposed in the arm and forearm. Acromion process and medial epicondyle were considered as prominent bony landmarks for median and anterior interosseous nerves respectively. Measurements were taken using a non-stretchable thread and scale with the arm consistently placed in supine position. Results: The formation of the median nerve by the union of the lateral and medial roots was 11.83±2.36 cm and 11.58±2.057 cm on the right and left sides respectively located distal to the acromion process. The distance between the origin of the anterior interosseous nerve and the medial epicondyle was 8.946±1.084 cm on the right side and 8.875±1.109 cm on the left side. Conclusion: The knowledge of the level of union of two roots of median nerve and the origin of anterior interosseous nerve can be of use to surgeons and anatomists while marking the median nerve on the surface and also releasing the median and anterior interosseous nerves to relieve from various entrapment syndromes. The present study provides data that can facilitate easy identification of the prominent landmarks of the nerve during surgical procedures.
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Background: The palmaris longus is a degenerating weak flexor muscle in the anterior of the forearm. Many techniques for clinically determining the presence of the palmaris longus have been described. Ethnic variations in the prevalence of the absence of the palmaris longus are well known. Objectives: This study considered the prevalence of absence of the palmaris longus muscle tendon in the north of Iran. Patients and methods: The presence of the palmaris longus was clinically determined in 562 men and women from the Guilan population, using the standard technique (Schaeffer's test). In subjects with an absent palmaris longus, three other tests (Thompson, Pushpakumar and Mishra tests) were performed to confirm the absence. Results: The overall prevalence of right, left, bilateral and total absence of the palmaris longus were 4.1%, 5.2%, 3.9% and 13.2%, respectively. There was no significant difference in its absence with regard to the body side or gender (P > 0.05). Conclusions: This study demonstrated that the presence of the palmaris longus muscle tendon in the Guilan population was considerably higher than the absence of the palmaris longus tendon. The overall prevalence of right, left, bilateral and total absence of the palmaris longus was not significantly different between men and women. The prevalence of the left-absent palmaris longus was more common in the present study.
Article
Introduction: Ethnic variations in the prevalence of absence of the palmaris longus (PL) are well known. Many techniques for clinically determining the presence of the PL have been described. Studies have also attempted to correlate its absence with other anatomical anomalies. However, most studies have been done in Caucasian populations. Materials and Methods: The presence of the PL was clinically determined in 329 normal Chinese men and women using the standard technique. In subjects with an absent PL, 4 other tests were performed to confirm absence and an Allen's test was done to assess the palmar arches. All subjects were examined for the presence of the flexor digitorum superficialis (FDS) to the little finger. Results: The overall prevalence of absence of the PL was 4.6%. All techniques were equally effective in determining the absence of the PL. There was no significant difference in its absence with regard to the body side or sex. Absolute deficiency of FDS to the little finger was seen in 6.4%. No correlation could be detected between the absence of the PL and FDS of the little finger. Conclusions: The prevalence of absence of the PL and absence of FDS to the little ringer in a Chinese population is much lower compared to previous reports in the literature. There is no association between absence of the PL and absence of the FDS to the little finger. Although all techniques of examining for the absence of the PL are equally effective, the method suggested by Mishra seems the best as it was easily understood by subjects and can be used even when thumb abduction is not possible.
Article
Background: To document the course of the median nerve in the distal forearm in palmaris longus (PL) deficient forearms and elucidate features that help distinguish it from the PL. Methods: In the cadaveric study, 56 cadaveric forearms were dissected and the location and course of the median nerve were documented. In the clinical study, 20 healthy subjects with absent PL were examined with provocative tests to elucidate the PL (Schaeffer’s test and Thompson’s test), and modified Durkan’s and Phalen’s tests. In the imaging study, one subject with a clearly visible and palpable median nerve was further evaluated with MRI with a superficial fiducial marker. Results: Cadaveric dissection revealed that the median nerve was deep to the antebrachial fascia and superficial to the FDS tendons in the distal forearm. In 9 specimens without a PL, the median nerve was the most superficial structure deep and lay draped over the FDS tendons. In the clinical study, PL absence was bilateral in 4 subjects and unilateral in 16. The nerve was visible and palpable in 4 forearms and palpable but not visible in 20 forearms. In all 24 forearms, the nerve was palpable as a lax, mobile, cord-like structure that could be rolled over the taut FDS tendons. Tinel’s and Durkan’s signs were positive in 11 subjects. In the imaging study, MRI confirmed that the palpable structure was the median nerve. Conclusions: Unlike the PL, the nerve is non-contractile and remains flaccid on provocative testing. It is usually palpable and may also be visible in thin forearms. Careful scrutiny may reveal it to be distinct from, and draped over underlying FDS tendons. These findings may help avoid inadvertent median nerve harvest in place of a PL tendon graft.
Article
Palmaris longus (PL) is a fusiform muscle with a short belly and a long tendon that crosses superficially over flexor retinaculum. It flexes wrist and tenses palmar aponeurosis. The absence of PL prevalence varies from 0.6 % to 63.91 % in the literature. The existence of PL on the right hand is more common compared to the left hand. Thus, we aimed to determine the prevalence of PL in the Turkish population and the relation of PL absence with sex and handedness in this study. We evaluated 1050 students of Sakarya University between ages 18-28 who participated in the study (525 males, 525 females). After completing a questionnaire including handedness, the volunteers were examined on both hands using some standard tests to find out PL absences. Pearson chi-square and Fischer's exact tests were used for statistics in SPSS 22 software. It was determined that 937 subjects were right-handed (89.2 %), 70 subjects were left-handed (6.6 %) and 43 subjects were ambidextrous (4.1 %). The presence of bilateral PL was found in 653 subjects, while the absence of bilateral PL was defined in 186 subjects. The absence of PL on right and left hand was detected respectively on 108 (10.3 %) and 103 (9.8 %) subjects. Left-handedness was more common in males (7.2 %) than females (6 %). PL was absent in 397 (37.8 %) subjects unilaterally and bilaterally. The study showed that our population has similar prevalence of PL absence with literature. Moreover, there was no correlation statistically between the absence of PL and sex or handedness.
Article
Despite their relatively low prevalence in the population, anomalous muscles of the forearm may be encountered by nearly all hand and wrist surgeons over the course of their careers. We discuss 6 of the more common anomalous muscles encountered by hand surgeons: the aberrant palmaris longus, anconeus epitrochlearis, palmaris profundus, flexor carpi radialis brevis, accessory head of the flexor pollicis longus, and the anomalous radial wrist extensors. We describe the epidemiology, anatomy, presentation, diagnosis, and treatment of patients presenting with an anomalous muscle. Each muscle often has multiple variations or subtypes. The presence of most anomalous muscles is difficult to diagnose based on patient history and examination alone, given that symptoms may overlap with more common pathologies. Definitive diagnosis typically requires soft tissue imaging or surgical exploration. When an anomalous muscle is present and symptomatic, it often requires surgical excision for symptom resolution.
Article
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.
Article
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.
Article
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
Article
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.
Article
Objectives The aim of this study was to determine normative electrophysiological reference values of median sensory nerve conduction studies among security guards with the palmaris longus tendon (PLT). Methods Sensory nerve conduction studies of the median nerve using antidromic and orthodromic methods were conducted in the upper limbs of 101 healthy male security guards between the ages of 21 and 42 years. The presence of the PLT was recorded in both hands using a standard test. A scatter plot was used to determine the correlation between different parameters using the ortho and antidromic methods. Results The mean age (years), weight (kg), height (cm), and BMI (kg/m2) were 28.77 ± 5.14, 70.53 ± 11.28, 171.71 ± 7.12, and 23.91 ± 3.45, respectively. In the median nerve (sensory) by antidromic method, the mean distal latency (DL) was 2.65 ± 0.33 ms and 2.64 ± 0.37, SNCV (sensory nerve conduction velocity) was 53.45 ± 5.28 m/s and 53.84 ± 5.68 and the amplitude was 27.33 ± 12.38 µV and 29.41 ± 12.97 in the left- and right-hand wrist, respectively. By orthodromic method the DL was 2.54 ± 0.53 ms and 2.51 ± 0.44, SNCV was 55.93 ± 6.09 m/s and 55.93 ± 5.24 and the sensory nerve action potential amplitude was 12.00 ± 8.82 µV and 11.72 ± 6.24 in the left and right hand, respectively. Spearman correlations were used to determine the variables influenced by hand sidedness. Conclusions The normative reference parameters of sensory nerve conduction velocity of the median nerve were established by both methods using a standardized technique.
Chapter
A small muscle originating from the radius usually inserts on the fibrous sheath of the tendon of the flexor carpi radialis. It can be attached to the fascia of the forearm, the tendon of the flexor carpi ulnaris, the flexor retinaculum, the pisiform bone, the scaphoid bone, the short abductor of the thumb, the fascia and muscles of the hypothenar eminence, one of the flexor tendons, or near the metacarpophalangeal joint. The slips very frequently connect the superficialis with the flexor pollicis longus or flexor digitorum profundus, as muscular slips occasionally pass between the superficial and deep flexors of the fingers. The flexor digitorum profundus generally originates from the upper three-quarters of the anterior and medial surfaces of the body of the ulna and the interosseous membrane of the forearm. Brachioradialis origin can also extend proximally as far as the insertion of the deltoid, with which it is sometimes connected.
Aus der Myologie, 1879, I
  • Anatomie
Anatomie. Aus der Myologie, 1879, I., 21-40.
Arbeit., 3 " Mitt. 1894, III
  • Morphol
Morphol. Arbeit., 3 " Mitt. 1894, III., 459-490.