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Prevalence of the absence of Palmaris longus muscle in the students of Kathmandu University

Authors:
  • Kathmandu University School of Medical Sciences (KUSMS), Nepal
Dilip K. Mehta et al / International Journal of Biomedical Research 2015; 6(12): 953-957. 953
IJBR (2015) 6 (12) www.ssjournals.com
International Journal of Biomedical Research
ISSN: 0976-9633 (Online); 2455-0566 (Print)
Journal DOI: 10.7439/ijbr
CODEN: IJBRFA Original Research Article
Prevalence of the absence of Palmaris longus muscle in the students of
Kathmandu University
Dilip K. Mehta*1, Rajeev Shrestha2, Dil I. Mansur1, Shobha Shah3, Retina Shrestha3 and
Binod Timalsina1
1Department of Anatomy, Kathmandu University School of Medical Sciences, Chaukot, Nepal
2Department of Pharmacology, Kathmandu University School of Medical Sciences, Chaukot, Nepal
3Students of Human Biology, School of Sciences, Kathmandu University, Dhulikhel, Nepal
*Correspondence Info:
Mr. Dilip K. Mehta
Lecturer
Department of Anatomy,
Kathmandu University School of Medical Sciences, Chaukot, Nepal
Fax no.: 00977-11-490707
E-mail: dilipmehta@kusms.edu.np
Abstract
Background: Palmaris longus muscle is one of the superficial muscles of flexor compartment of forearm. Its main function is
to anchor the skin and fascia of the hand. It is a weak flexor of the hand at wrist and tenses the palmar aponeurosis. It is one of
the most variable muscles and is phylogenetically classified as a retrogressive muscle. The agenesis of Palmaris longus ranges
from 0% to 63% with an overall 16% unilateral and 9% bilateral. It is very useful in orthopedics, cosmetic, plastic and
reconstructive surgery.
Objective: To determine the occurrence of unilateral and bilateral agenesis of Palmaris longus muscle in right and left
forearms in the students of Kathmandu University.
Materials and methods: The study was carried out on 1020 randomly selected normal students (570 male and 450 female)
with an age ranging from 18 to 25 years. The volar aspect of the wrist was inspected to find out the presence or absence of
Palmaris longus tendon in its usual anatomical position by performing different tests.
Result: The present study showed overall agenesis of Palmaris longus in 27.65% cases. Overall agenesis in male and female
was 28.42% and 26.67% respectively. Unilateral and bilateral agenesis were 77.16% and 22.84% respectively in male whereas
67.50% and 32.50% respectively in female. Left sided and right sided agenesis were 55.20% and 44.80% respectively in male
whereas 53.09% and 46.91% respectively in female.
Conclusion: Palmaris longus is absent unilaterally in 20.20% and bilaterally in 7.45% of the population with an overall
absence of 27.65%.
Keywords: Agenesis, flexor compartment, palmar aponeurosis, Palmaris longus, retrogressive muscle
1. Introduction
Palmaris longus is a slender, fusiform muscle. Its
origin is from medial epicondyle of humerus, and from
adjacent intermuscular septa and deep fascia. It converges on
a long tendon which passes superficial to the flexor
retinaculum to become a flat sheet incorporating into palmar
aponeurosis. Its arterial supply is by a small branch from the
anterior ulnar recurrent artery. It is innervated by median
nerve. It is a phylogenetically degenerate
metacarpophalangeal joint flexor. Its main function is to
anchor the skin and fascia of the hand.[1] It is a weak flexor
of the hand at wrist and tenses the palmar aponeurosis.[2] It
also protects the median nerve which passes deep to the flexor
retinaculum.[3,4] It is functionally more active in non-human
primates.[5] It is fully developed at birth.[6]
It is one of the most variable muscles and is
phylogenetically classified as a retrogressive muscle.[7] The
prevalence of absence of the Palmaris longus was first
reported in 1559.[8] It is often absent on one or both
sides.[1,9] It is one of the most variable muscles in the human
body.[1,9,10] Its variation depends on race, sex, and sides.
The agenesis ranges from 0% to 63% with an overall 16%
unilateral and 9% bilateral.[11,12] On an average 10%
agenesis has been accepted universally.[13]
Palmaris longus has got a great clinical importance.
It is usually applied in reconstructive surgeries, commonly
used by hand surgeons for tendon transfers, second stage
tendon reconstruction, pulley reconstruction as well as tendon
grafts,[14] for restoration of lip and chin defects by plastic
Dilip K. Mehta et al / Incidence of absence of Palmaris longus muscle 954
IJBR (2015) 6 (12) www.ssjournals.com
surgeons and by ophthalmologist in ptosis correction.[3,4] In
various combinations it is also used to repair oncologic
defects of head and neck, arthritis of the thumb.[15] Despite
the clinical importance of Palmaris longus, a very few
researches have been done in Nepal. Therefore, the present
study was performed to determine the incidence of unilateral
and bilateral agenesis of Palmaris longus and its association
with sex and side of the limb in the students of Kathmandu
University, Dhulikhel, Nepal. This study would be very
useful in orthopedics, cosmetic, plastic and reconstructive
surgery.
2. Material and methods
2.1 Study population and sample size
The present study was cross-sectional and
descriptive. The study was carried out on 1020 randomly
selected normal students of various disciplines from
Kathmandu University. Of the 1020 students, 570 were
female and 450 were male, with an age ranging from 18 to 25
years. This study was performed after the approval of
Institutional Review Committee, Kathmandu University
School of Medical Sciences, Dhulikhel, Nepal. Verbal
informed consent was obtained from each participant after
explaining the objectives and methods of the study.
Participants with a history of injury, disease or abnormality of
the upper limb or upper limbs were excluded from the study.
2.2 The procedure to exam the presence or absence of
palmaris longus
The volar aspect of the wrist was inspected to find
out the presence or absence of Palmaris longus tendon in its
usual anatomical position just ulnar to the flexor carpi radialis
tendon. The test was performed by asking the participant to
make opposition of the thumb and the little finger while
flexing the wrist. During this test, if the tendon of the muscle
was not visualized then four additional tests were performed
to confirm its absence. Each test was performed one after
another on both the forearms of each student. The tests are as
follows:-
I. 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]
II. Standard (Schaeffer’s) test –
The student was asked to oppose the thumb to the
little finger and then flex the wrist.[8]
III. Mishra’s test I –
The metacarpo-phalangeal joints of all fingers were
passively hyperextended by the examiner and the student was
asked to actively flex the wrist.[17]
IV. Pushpkumar’ “two finger sign” method –
The student was asked to fully extend the index and
middle finger, the wrist and other fingers are flexed and
finally the thumb is fully opposed and flexed.[18]
2.3 Statistical analysis
Data was recorded in MS Office Excel 2013. The
incidence of agenesis of Palmaris longus was analyzed by
using SPSS v20. Correlation and percentage score were used
to assess the association of its unilateral and bilateral agenesis
of Palmaris longus in both sexes. The prevalence of unilateral
or bilateral absence was presented with a 95% confidence
interval. The association between absence of the Palmaris
longus and body side, sex was assessed using chi-square tests.
Statistical significance was set at P<0.05.
3. Results
Table 1: Gender wise distribution of Palmaris longus agenesis and its lateralization
Gender
No
Agenesis (%)
Agenesis
(%)
Unilateral
Agenesis (%)
Bilateral
Agenesis (%)
Left sided
Agenesis (%)
Right sided
Agenesis (%)
n = 1020
n = 282
n = 206
Male
408 (71.58)
162 (28.42)
125 (77.16)
37 (22.84)
69 (55.20)
56 (44.80)
Female
330 (73.33)
120 (26.67)
81 (67.50)
39 (32.50)
43 (53.09)
38 (46.91)
Total
738 (72.35)
282 (27.65)
206 (73.05)
76 (26.95)
112 (54.37)
94 (45.63)
χ2 = 0.387
df = 1
p value = 0.534
OR = 0.916
CI = 0.694 - 1.208 (95%)
χ2 = 3.268
df = 1
p value = 0.071
OR = 1.627
CI = 0.958 - 2.762 (95%)
χ2 = 0.089
df = 1
p value = 0.766
OR = 0.918
CI = 0.524 - 1.609 (95%)
χ2 = Pearson Chi-square value, df = degree of freddom, p value significant at <0.01, OR = Odds Ratio, CI = Confidence
interval
The present study showed overall agenesis of
Palmaris longus in 282 (27.65%) cases out of total 1020
cases. Overall agenesis in male was 162 (28.42%) out of 570
male and 120 (26.67%) female out of 450 female. Unilateral
and bilateral agenesis were 125 (77.16%) and 37 (22.84%)
respectively in male whereas 81 (67.50%) and 39 (32.50%)
respectively in female. Left sided and right sided agenesis
were 69 (55.20%) and 56 (44.80%) respectively in male
whereas 43 (53.09%) and 38 (46.91%) respectively in female
(Table 1).
Dilip K. Mehta et al / Incidence of absence of Palmaris longus muscle 955
IJBR (2015) 6 (12) www.ssjournals.com
Table 2: Frequency of absence of Palmaris longus
Gender
Number
Bilateral
agenesis
Agenesis in
left forearm
Agenesis in
right forearm
Unilateral
agenesis
Overall
Agenesis
Male
570
37 (6.49 %)
69 (12.10 %)
56 (9.82 %)
125 (21.93 %)
162 (28.42 %)
Female
450
39 (8.67 %)
43 (9.56 %)
38 (8.44 %)
81 (18.00 %)
120 (26.67 %)
Bilateral agenesis in male and female was 6.49% and
8.67% respectively. Left forearm and right forearm agenesis
of male were 12.10% and 9.82% respectivley. Female
forearm of left and right sides showed agenesis in 9.56% and
8.44% respectivley. Unilateral agenesis was seen in 21.93%
male and 18% female. Overall agenesis in male and female
was 28.42% and 26.67% respectively (Table 2).
4. Discussion
The prevalence of the agenesis of Palmaris longus
muscle is reported about 15% in most classical anatomy
textbooks.[1,19,20] However, this figure varies considerably
in various geographical locations across the globe (Table No
3).
Table: 3 Prevalence of congenital absence of Palmaris longus tendon in various studies
S.
No.
Authors
Year
Cases
studied
Unilateral
Agenesis (%)
Bilateral
Agenesis (%)
Overall
Agenesis (%)
01
Ceyhan and Mavt [11]
1997
7000
20.71
43.24
63.95
02
Mobarkesh et al [21]
2008
64
21.80
7.80
29.60
03
Baral et al [28]
2009
24
9.70
7.70
17.40
04
Devi Sankar et al [22]
2011
942
19.74
8.28
28.02
05
Kocabiyik et al [27]
2012
24
20.83
29.16
50.00
06
Morais et al [23]
2012
740
14.30
12.20
26.50
07
Karim and Al-Taee [29]
2012
300
11.00
7.30
18.30
08
Adejuwon et al [24]
2012
564
12.94
13.65
26.59
09
Ali et al [30]
2012
516
8.72
7.56
16.28
10
Hussain and Hasan [31]
2012
400
16.70
7.75
24.45
11
Saxena [25]
2013
426
18.31
8.21
26.52
12
Kose et al [32]
2013
240
14.17
7.08
21.25
13
Berhe and Bekele [33]
2014
712
7.16
8.15
15.31
14
Tejaswi et al [26]
2014
266
16.92
10.52
27.44
15
Hojjatollah et al [34]
2014
732
11.21
19.53
30.74
16
Present study
2015
1020
20.20
7.45
27.65
In present study, the overall prevalence of absence of
Palmaris longus muscle was 27.65% which is approximately
similar with the study done by Mobarkesh et al.,[21] Devi
Shankar et al.,[22] Morais et al.,[23] Adejuwon et al.,[24]
Saxena[25] and Tejaswi et al.[26] We found 20.20%
unilateral agenesis which was approximately similar with the
study done by previous authors viz; Ceyhan and Mavt,[11]
Mobarkesh et al.,[21] Devi Sankar et al.,[22] Kocabiyik et
al.,[27] and Saxena.[25] The present study showed 7.45%
bilateral agenesis of Palmaris longus which was
approximately similar with the study done by Mobarkesh et
al.,[21], Baral et al,.[28] Devi Sankar et al.,[22] Karim and
Al-Taee,[29] Ali et al.,[30] Hussain and Hasan,[31]
Saxena,[25] Kose et al.,[32] and Berhe and Bekele.[33]
The prevalence of the agenesis of Palmaris longus
muscle was 20.20% (unilateral), 7.45% (bilateral) and
27.65% (overall) in the present study. These findings
coincided with the reports obtained by Mobarkesh et al.,[21]
Devi Sankar et al.,[22] and Saxena.[25] Many studies showed
that unilateral agenesis was more frequent than bilateral
agenesis.[21-32] The present study also showed similar result.
Left sided agenesis was found to be more common
than right sided in both male and female. Furthermore left
sided agenesis was more common in female than in
male.[11,22,23,25,30] Above findings were similar with the
present study except left sided agenesis of male which was
higher in male than female. The present study also showed
more common unilateral and bilateral agenesis in male than in
female (Table 2). Right sided agenesis was found to be more
than left sided agenesis in male by some
researchers.[21,26,29, 31,34] The present study contradicted
with this result because left sided agenesis of male was found
to be more in the present study. Left sided agenesis was more
in female and right sided agenesis was more in
male.[26,31,34] But left sided agenesis was more in both
male and female in the present study.
5. Conclusions
In the present study, Palmaris longus is absent
unilaterally in 20.20% and bilaterally in 7.45% of the
population with an overall absence of 27.65%. The rate is
higher than what is commonly mentioned in the literature. A
sound knowledge on the anatomy and variations of Palmaris
longus is great important for tendon grafts and reconstructive
surgery as well as for anatomists, orthopedicians and
biological anthropologists.
Dilip K. Mehta et al / Incidence of absence of Palmaris longus muscle 956
IJBR (2015) 6 (12) www.ssjournals.com
Acknowledgements
We are indebted to faculties and staffs of
Department of Anatomy, Kathmandu University School of
Medical Sciences for their commendable efforts. We are very
thankful to all the participants of the present study for their
kind cooperation during the study.
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