ArticlePDF Available

Clinical assessment of agenesis of palmaris longus muscle and its association with gender, body sides in western Indian population

Authors:

Abstract and Figures

Background: Palmaris longus muscle is a degenerating superficial flexor muscle of forearm. Absence of palmaris longus in different ethnic groups has been frequently encountered in clinical practice. Aim & Objectives: Present study was done to determine the incidence of unilateral and bilateral absence of palmaris longus and its association with gender and sides of the upper limb in western Indian population. Methods & Material: The sample constituted 500 healthy subjects (250 males and 250 females) which were examined clinically by standard technique. In subjects with an absence of palmaris longus tendon, three other clinical tests were performed to confirm its absence. Results: Overall absence of palmaris longus was observed in 91 subjects (18.2%) out of which 48 (9.6%) had unilateral absence and 36 (7.2%) had bilateral absence. Frequency of unilateral (Males: 8.4%, Females: 10.8%) and bilateral (Males: 5.2%, Females: 9.2%) agenesis was higher in females. In males, unilateral (8.4%) agenesis was more common than bilateral (5.2%). In subjects with unilateral agenesis right side (5.2%) was more commonly involved than left side (3.2%) in males whereas in females left side (7.2%) was more commonly involved than right (3.6%). However in present study there was no statistical association observed between absence of palmaris longus and gender or body sides in western Indian population. Conclusion: Agenesis of palmaris longus, both forms unilateral and bilateral was fairly common in western Indian population in both gender. Females had higher incidence of agenesis than males with unilateral agenesis more common than bilateral.
Content may be subject to copyright.
Navgire VR et al: Clinical assessment of agenesis of palmaris longus muscle in western Indian population www.jrmds.in
Journal of Research in Medical and Dental Science | Vol. 2 | Issue 3 | July September 2014
65
Clinical assessment of agenesis of palmaris longus muscle and its
association with gender, body sides in western Indian population
Varsha R Navgire*, Pradeep K Pawar**
* Lecturer, ** Prof & HOD, Department of Anatomy, Terna Medical College, Nerul, Navi Mumbai, Maharashtra, India
DOI : 10.5455/jrmds.20142314
ABSTRACT
Background: Palmaris longus muscle is a degenerating superficial flexor muscle of forearm. Absence of palmaris
longus in different ethnic groups has been frequently encountered in clinical practice.
Aim & Objectives: Present study was done to determine the incidence of unilateral and bilateral absence of palmaris
longus and its association with gender and sides of the upper limb in western Indian population.
Methods & Material: The sample constituted 500 healthy subjects (250 males and 250 females) which were
examined clinically by standard technique. In subjects with an absence of palmaris longus tendon, three other clinical
tests were performed to confirm its absence.
Results: Overall absence of palmaris longus was observed in 91 subjects (18.2%) out of which 48 (9.6%) had
unilateral absence and 36 (7.2%) had bilateral absence. Frequency of unilateral (Males: 8.4%, Females: 10.8%) and
bilateral (Males: 5.2%, Females: 9.2%) agenesis was higher in females. In males, unilateral (8.4%) agenesis was
more common than bilateral (5.2%). In subjects with unilateral agenesis right side (5.2%) was more commonly
involved than left side (3.2%) in males whereas in females left side (7.2%) was more commonly involved than right
(3.6%). However in present study there was no statistical association observed between absence of palmaris longus
and gender or body sides in western Indian population.
Conclusion: Agenesis of palmaris longus, both forms unilateral and bilateral was fairly common in western Indian
population in both gender. Females had higher incidence of agenesis than males with unilateral agenesis more
common than bilateral.
Keywords: Palmaris longus, Indian population, Tendon anomalies
INTRODUCTION
Palmaris longus is a regressive muscle in higher
vertebrate phylogeny and is the most superficial flexor
muscle of forearm. It is degenerating muscle as it has
a short belly and a long tendon. The origin of muscle
is from medial epicondyle by a common flexor tendon
and from adjacent intramuscular septa and deep
fascia. The tendon passes in front of flexor
retinaculum and is continuous with the central part of
palmar aponeurosis for its insertion. It is supplied by
median nerve. It is a weak flexor of wrist and acts
anchor for skin and fascia of hand to tense palmar
aponeurosis by resisting horizontal shearing forces
which would tend to deglove the skin of the palm.
Palmaris longus muscle is one of the most variable
muscle in human body. Palmaris longus muscle is
fully developed at birth [1] and its absence is
hereditary but genetic transmission is not known [2].
Occasionally there is double palmaris longus tendon
or it can have multiple insertions or an associated
aberrant muscle [3]. Palmaris longus is often absent
on one or both sides and its prevalence of absence
varies in different ethnic group [4-6].The muscle is
reported to be present in 85% of individuals in one
Original Article
Navgire VR et al: Clinical assessment of agenesis of palmaris longus muscle in western Indian population www.jrmds.in
Journal of Research in Medical and Dental Science | Vol. 2 | Issue 3 | July September 2014
66
arm and in both arms is 70% [3]. Absence of palmaris
longus does not significantly affect function of wrist
but its tendon is very useful in various reconstructive
surgeries such as flexor tendon repairs, various
ligament repairs. It is also useful in restoration of lip
and chin defects [7], facial paralysis management [8],
ptosis correction [9, 10]. Palmaris longus tendon is a
tendon of choice for tendon transfers because it has
adequate length about 15 cm, diameter and
availability without producing a deformity [3].
MATERIAL AND METHODS
Total 500 healthy Indian subjects of western Indian
population were selected randomly. The individuals
having any deformities or injuries or previous surgery
to hand were excluded from this study. Age, gender of
each subject was recorded and subjects were
examined for presence or absence of palmaris longus
muscle by clinical tests. Associations between
unilateral or bilateral absences of muscles with
gender and body sides were recorded. Subjects were
examined by performing four different clinical
methods for assessment of palmaris longus tendon.
Initially subjects were examined by performing
standard test (Schaeffer’s test). Presence or absence
of palmaris longus tendon was accessed by clinical
inspection or palpation of tendon on volar aspect of
wrist as shown in fig.1. In cases where tendon was
not visualized or palpable, other three tests were
applied to confirm the absence of tendon. All tests
were equally effective in determining the absence of
tendon.
Fig.1: Schaeffer’s test
Schaeffer’s test: The subject was asked to oppose
thumb and little finger with wrist in slight flexion.
Thompson's test: The subject was asked to make a
fist and then flex the wrist with thumb flexed over
fingers.
Mishra's I test: Meta-carpophalangeal joints of all
fingers were hyper-extended by examiner and subject
was asked to actively flex wrist.
Mishra's II test: The subject was asked to abduct
thumb against resistance with wrist in slight flexion.
Pushpa kumar's "two finger sign" method: The subject
was asked to fully extend index and middle finger with
wrist and other finger in flexion and thumb was fully
flexed and opposed.
All statistical analyses were done by comparison of
proportions using Chi-square test. Results were
tested at 5% level of significance.
RESULTS
In present study females had higher incidence of
palmaris longus agenesis than in males whether
unilateral or bilateral. Unilateral agenesis was more
common than bilateral in females but difference also.
Unilateral involvement was more frequently
encountered in left side. All these differences between
male vs. female, unilateral vs. bilateral and left vs.
right were statistically not significant (p> 0.05)).
In males unilateral agenesis was more common than
bilateral however difference was statistically not
significant (p>0.05). In males incidence of unilateral
agenesis was more common in right side. This
difference is also statistically not significant (p>0.05).
There were no statistical associations observed
between palmaris longus absence with gender or
body sides in western Indian population.
DISCUSSION
Palmaris longus is one of the superficial flexor
muscles of forearm with clinical importance in
reconstructive surgeries. Incidence of absence of
palmaris longus muscle varies among different ethnic
groups, race, gender, region and side of body [4-6].
Association has been observed between absence of
palmaris longus and anomalous superficial palmar
arch and weak flexor digitorum superficial muscle [6].
According to literatures palmaris longus is absent in
about 15% of Caucasians and less frequently in other
populations [11, 1]. Some of the studies suggest that
Navgire VR et al: Clinical assessment of agenesis of palmaris longus muscle in western Indian population www.jrmds.in
Journal of Research in Medical and Dental Science | Vol. 2 | Issue 3 | July September 2014
67
apart from ethnic variation, its absence was more
common in women and bilateral absence was more
frequent and unilateral absence was more common
on left side [12, 1].
The findings in the present study like most of the
studies, reflects the incidence of palmaris longus
absence in Indian population. In present study, overall
agenesis of palmaris longus muscle was 18.2% in a
population of western India. Sankar KD et al [13]
reported overall agenesis of palmaris longus muscle
was 28% in Andhra population of India while Sharma
DK et al [1] reported 16.25% in caucasian subjects of
central India region. A study by Agrawal P [6] had
reported overall agenesis was 20.2% in Indian
population. In a similar study by Kapoor SK et al [14]
found that overall agenesis of palmaris longus muscle
was 17.2%. Previous studies on the overall incidence
of the palmaris longus muscle show a wide variation
from 16.25% to 28% in Indian population. In various
studies, overall absence of palmaris longus muscle
across the globe shown in table 1.
Table 1: Frequency Percentage (%) Distribution
Palmaris Longus Agenesis in Both Genders
No. of
Subjects
Overall
absence in
both gender
Overall
absence
in males
Overall
absence in
females
500
91 (18.2%)
34
(13.6%)
57 (22.8%)
Table 2: Frequency Percentage (%) Distribution of
Palmaris Longus Agenesis in Both Limbs
Absence of
PL
Bilateral
absence
Males
(250)
Right
13
(5.2%)
21
(8.4%)
13 (5.2%)
Left
8
(3.2%)
Females
(250)
Right
9
(3.6%)
27
(10.8%)
23 (9.2%)
Left
18
(7.2%)
Total (500)
Right
22
(4.4%)
48
(9.6%)
36 (7.2%)
Left
26
(5.2%)
In the present study unilateral absence was little more
common than bilateral (U/L: 9.6 %, B/L: 7.2%) which
was similar with the findings of Kapoor SK et al [14]
(U/L: 9.2 %, B/L: 8%), Sankar KD et al [13] (U/L:
70.5%, B/L: 29.5%), Sharma DK et al [1] (U/L: 10%,
B/L: 6.25%), Agrawal P [6] (U/L: 16.9%, B/L: 3.3%
Table 3: Frequency Percentage (%) Distribution of
Palmaris Longus Agenesis in Different Population
of the World
Sr. No
Different
population
Percentage
of
agenesis
PL (%)
Authors
1
Yoruba
population
6.7
Godwin OM,
Adedaya BE
2
East African
population
4.4
Kigera JWM,
Mukwaya S
3
Chinese
population
4.6
Sebastin et al
4
Gaziantep
Turkish
population
63.9
Ceyhan O, Mavt
A
5
Korean
population
4.1
Dong-Soo Kyung
et al
6
Nigeria
population
31.25
Oluyemi KA et al
7
Turkish
population
26.6
Ozkan Kose et al
8
Malaysian
population
9.3
Roohi SA et al
9
Northern
Ireland
Caucasian
population
25
Thompson NW
et al
Abbreviations: PL- Palmaris Longus, M- Males, F- Females, RT-
Right hand, LT- Left hand, U/L- Unilateral, B/L- Bilateral
In our study, the left side involvement was more
common than right (RT: 4.4%, LT: 5.2%) in unilateral
absence of palmaris longus muscle which was in
accordance with findings of Sankar KD et al [13] (RT:
48.4%, LT: 51.6%), Agrawal P [6] (RT: 11.38%, LT:
22.3%) while Sharma DK et al [1] reported unilateral
palmaris longus absence was more or less equal on
both sides (RT: 5.25%, LT: 4.25%).
Gender differences have been observed between
unilateral and bilateral absence of palmaris longus
muscle. In present study females had more incidence
of agenesis whether unilateral or bilateral which was
similar with the findings of Sankar KD et al [13] but
not in accordance with the findings of Agrawal P [6],
Sharma DK et al [1], Kapoor SK et al [14]. Sankar KD
et al [13] had reported that overall absence of
palmaris longus muscle in males and females was
14.7% and 40.2% respectively while bilateral absence
in males was 27.3% and in females was 30.3%. In a
similar study by Agrawal P [6] found that males had
more incidence of agenesis. Agrawal P had reported
unilateral absence in males was 19.48% and in
females was 14.21% while bilateral absence in males
and females was 5.12% and 1.6% respectively.
Sharma DK et al [1] found overall and unilateral
Navgire VR et al: Clinical assessment of agenesis of palmaris longus muscle in western Indian population www.jrmds.in
Journal of Research in Medical and Dental Science | Vol. 2 | Issue 3 | July September 2014
68
absence was more in males while bilateral was more
in females. They found overall absence in males and
females was 8.5% and 7.5% respectively while
unilateral absence in males was 5.75% and in
females was 4.25% while bilateral absence in males
and females was 2.75% and 3.5% respectively. In a
study by Kapoor SK et al [14] reported, male subjects
had a greater likelihood of unilateral agenesis, while
female subjects were more likely to have bilateral
agenesis.
Assessment of palmaris longus tendon was done by
clinical method in present study which may be
unreliable. Subjects with anomalous or weak palmaris
longus may show absence of palmaris longus on
clinical tests. A confirmatory evidence to avoid such
misinterpretations is done by doing Magnetic
resonance studies of forearm which will detect
anomalies of palmaris longus tendon and definitively
confirm agenesis. Such study may reveal yet
unrecognized variations and may alter the statistics of
agenesis given in standard texts and other studies
done hitherto. But such studies are often limited by
cost considerations for applying it to such a large
population and hence clinical examination remains
useful way of detecting agenesis of palmaris longus.
CONCLUSION
Agenesis of palmaris longus, both forms unilateral
and bilateral was fairly common in western Indian
population in both genders. Females had higher
incidence of agenesis than males with unilateral
agenesis more common than bilateral. In unilateral
agenesis, left side was more common than right in
females. In males unilateral agenesis was more
common than bilateral. In males right side was more
common than left.
REFERENCES
1. Sharma DK, Shukla CK, Sharma Vandana.
Clinical assessment of absence of palmaris longus
muscle and its association with gender, body
sides, handedness and other neighboring
anomalies in a population of central India. J Anat
Soc India 2012; 61(1): 13-20.
2. Wehbe MA, Mawr Bryn. Tendon graft donor sites.
J Hand Surg 1992; 17A: 1130-2.
3. Canale ST, Beaty JH. Flexor and extensor tendon
injuries in Campbell's operative orthopaedics. 11th
edition Mosby Elsevier publication, Philadelphia
2008, pg. 3886.
4. Reimann AF, Daseler EH, Anson BJ, Beaton LE.
The palmaris longus muscle and tendon; a study
of 1600 extremities. Anat Rec 1944; 89: 495-505.
5. Machado AB, DiDio LJ. Frequency of the
musculus Palmaris longus studied in vivo in some
Amazon Indians. Am J Phys Anthropol 1967; 27:
11-20.
6. Agrawal Pawan. Absence of the palmaris longus
tendon in Indian population. Indian J Orthop 2010
Apr-Jun; 44(2): 212-5.
7. Carroll CM, Pathak I, Irish J, Neligan PC.
Reconstruction of total lower lip and chin defects
using the composite radial forearmpalmaris
longus tendon free flap. Arch Facial Plast
Surg. 2000;2(1):53-6
8. Atiyeh BA, Hashim HA, Hamdan AM, Kayle DI,
Musharafieh RS. Lower reconstruction and
restoration of oral competence with dynamic
palmaris longus vascularised sling. Arch
Otolaryngol Head Neck Surg 1998; 124: 1390-2.
9. Kurihara K, Kojima T, Marumo E. Frontalis
suspension for blepharoptosis using palmaris
longus tendon. Ann Plast Surg 1984; 13: 274-8.
10. Naugle TC, Jr, Faust DC. Autogeneous palmaris
longus tendon as frontalis suspension material for
ptosis correction in children. Am J
Ophthalmol 1999; 127: 488-9.
11. Hentz VR, Chase RA. Divided flexor tendon. Hand
Surgery-A Clinical Atlas 2001; 364.
12. Schaeffer JP. On the variations of the palmaris
longus muscle. Anat Rec 1909; 3: 275-8.
13. Sankar KD, Bhanu PS, John SP. Indian J Plast
Surg 2011 Jan-Apr; 44(1): 1348.
14. Kapoor SK, Tiwari A, Kumar A, Bhatia R,
Tantuway V, Kapoor S. Clinical relevance of
palmaris longus agenesis: common anatomical
aberration. Anat Sci Int. 2008 Mar; 83(1): 45-8
Corresponding Author :
Dr. Navgire Varsha R,
C/o Dr. Pravin Bande,
203, Siddhivinayak Apartment,
Near Shreejikrupa building No 1,
Near Rutu Park,
Thane (West). 400 601
Navi Mumbai, Maharashtra, India
Date of Submission: 03/08/2014
Date of Acceptance: 05/09/2014
How to cite this article: Navgire VR, Pawar PK. Clinical
assessment of agenesis of Palmaris longus muscle and its
association with gender, body sides in western Indian
population. J Res Med Den Sci 2014;2(3):65-8.
Source of Support: None
Conflict of Interest: None declared
ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
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.
Article
Full-text available
Ethnic variations in the prevalence of the absence of the palmaris longus (PL) tendon are well known. Studies have also attempted to correlate its absence with other anatomical anomalies. However, most studies have been done in Caucasian populations. The present study was undertaken to know the occurrence of absence of palmaris longus in Indian population. The presence of the PL tendon was clinically determined in 385 normal Indian men and women using the standard technique. In subjects with an absent PL tendon, three other tests were performed to confirm its absence. All subjects were also examined for the presence of the flexor digitorum superficialis (FDS) in the little finger. The overall unilateral absence of the tendon was 16.9% and the bilateral absence was in 3.3% in our population. There was no significant difference in its absence with regard to the body side or sex. The overall prevalence of the weak FDS in the little finger irrespective of the presence or absence of the PL tendon in our study was 16.10%. If we compare the deficiency of the FDS in the little finger with the absence of the PL tendon, the overall incidence is 4.15% and is statistically significant, while the sexwise distribution of the weak FDS with absent PL tendon was statistically significant in males and in females it was statistically insignificant. The prevalence of the unilateral absence of the PL tendon in an Indian population is comparable to the western population but a bilateral absence is significantly less. In patients with an absent PL tendon, the FDS of the little finger is weak, especially in males.
Article
The palmaris longus (PL) is a vestigial or degenerating superficial muscle in the anterior compartment of forearm. It is variable in its structure, attachments and presence or absence in different individuals in various populations and even in one population among individuals. It is well known that individuals may have unilateral or bilateral absence of PL. The aims of this study were to determine the incidence of absence of PL and its association with gender, body sides, handedness and other neighboring anomalies like the absence of flexor digitorum superficialis (FDS) muscle to little finger, the incomplete superficial palmar arch (SPA) etc. in a population of central India; and to correlate the same with the other related studies. We examined 400 Caucasian subjects (200males and 200 females of a population of central India) aged 18–55 years. Total 65 (16.25%) subjects had overall absence of PL, out of which 25 (6.25%) presented bilateral absence and 40 (10%) presented unilateral absence so statistically unilateral absence was little more common than bilateral absence. Overall absence and unilateral absence of PL were little more common in males (M:8.5%,17:7.75% and M:5.75%,17:4.25% respectively) whereas bilateral absence was little more common in females (17:3.5%,M:2.75) however these associations with gender were not statistically significant. In unilateral PL absence, the right and the left sides were more or less equally affected (RT: 5.25%, LT: 4.75%) and no statistical significance was evident for this association with body sides. Out of 65 subjects with absence of PL only 5 were left handed and rest right handed so this association with handedness was also statistically insignificant. No correlation was evident between PL absence and other neighboring anomalies like absence of FDS to little finger, incomplete SPA etc. So the present study concluded with (i) The unilateral absence is statistically little more common than the bilateral absence (ii) There is no statistical association between the PL absence and gender, body sides, handedness and other neighboring anomalies like absence of FDS to little finger, incomplete SPA etc. in a population of central India.
Article
Each of 480 extremities from 120 cadavers was dissected. Particular attention was given to potential donors for tendon grafts. Both the palmaris longus and the extensor digiti minimi had an average length of 16 cm and an average width of 3 mm. The extensor indicis tendon averaged 13 cm in length and 3 mm in width. The plantaris and second toe extensors averaged 35 cm in length and 2 to 2.5 mm in width. None of these measurements correlated well with age, sex, or hand or foot size. There was, however, a high correlation between right- and left-side measurements in each specimen, in spite of some degree of anatomic variation for all the tendons studied. The palmaris longus was missing in 25% of the upper extremities, and the plantaris in 19% of the lower extremities dissected.
Article
The frequency of the Musclus palmaris longus was studied by observing its tendon in vivo in 379 Amazon Indians belonging to the following tribes: Tucano, Tariana, Tiriyo, Desana, Piratapuya, Macu and Arapaso. The muscle was not observed in 14 individuals (3.7% ± 1.0) either unilaterally or bilaterally and in 24 of 758 limbs (3.1% ± 0.6). No statistically significant difference was observed in the frequency of the muscle among the different tribes. Bilateral absence was significantly more frequent than the unilateral one; absence in females was more frequent than in males. The frequency of palmaris longus agenesis in Amazon Indians agrees with reported values for Negroids and Mongoloids and is considerably lower than that generally reported for the Caucasoids.
Article
In treatment of moderate to severe blepharoptosis in the Oriental, an excellent result can be obtained by frontalis suspension using free palmaris longus tendons. Postoperative functional training is unnecessary. Children of 5 or 6 with congenital upper eyelid ptosis are favorable candidates for correction by this method. In traumatic cases, the operation may be performed about six months after injury.
Article
In addition to a satisfactory esthetic appearance, oral competence is the ultimate goal in any lip reconstruction. It can be attained easily following repair of small lip defects. However, it seems elusive in most cases of reconstruction of large defects. Moderate defects of either the lower or upper lips can be repaired with local flaps resulting in adequate form and function. Large defects with total loss of the lower lip, however, are better reconstructed with distant composite flaps because locally available tissues in the cheeks and upper lip may be insufficient. Several authors1- 3 have described reconstruction of the lower lip with the composite radial forearm palmaris longus free flap using the tendon as a static sling. However, the vascularized palmaris longus tendon can be designed as well to create a new modiolus that could be suspended to the masseter muscle, achieving in a single operation simultaneously with soft tissue replacement a dynamic reconstruction with enhanced competence during mastication.