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Incidence of Palmaris Longus Agenesis in the Young Iranian Population

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Ann Mil Health Sci Res. 2017 June; 15(2):e62310.
Published online 2017 June 30.
doi: 10.5812/amh.62310.
Original Article
Incidence of Palmaris Longus Agenesis in the Young Iranian
Population
Manouchehr Safari,1Laya Ghahari,2, * and Kamran Hamzei3
1Department of Anatomy, Semnan University of Medical Sciences, Semnan, Iran
2Department of Anatomy, AJA University of Medical Sciences, Tehran, Iran
3Department of Anatomy, Iran University of Medical Sciences, Tehran, Iran
*Corresponding author: Laya Ghahari, Department of Anatomy, AJA University of Medical Sciences, Tehran, Iran. E-mail: l-ghahari@razi.tums.ac.ir
Received 2017 April 02; Revised 2017 May 16; Accepted 2017 June 03.
Abstract
Background: Palmaris longus (PL) is the most variable muscle in the body. The variation includes unilateral or bilateral agenesis,
duplication or Y-shaped tendon.
Methods: A total of 480 students within the age range of 18 to 23 years from Tehran medical institutions were randomly selected for
the current study. The Thompson test was used to support the Schaeffer test.
Results: PL muscle was absent bilaterally in 23% and unilaterally in 28.5% of the subjects with the distribution of 16.9% on the left
and 11.6% on the right hands. In females, the bilateral absence was observed in 34.16%, while 18.7% had unilateral absence with the
distribution of 5.8% on the left and 12.9% on the right.
Conclusions: It is believed that palmaris longus muscle is progressively disappearing in Iranian young people and could prove a
degenerative trend in the Iranian population.
Keywords: Palmaris Longus, Agenesis, Incidence
1. Background
Palmaris longus (PL), phylogenetically degenerated
weak accessory flexor of the wrist joint, have the short,
muscular belly and long tendon, which crosses the flexor
retinaculum and continues as palmar aponeurosis (1). It
is the most variable muscle in the body. The variation in-
cludes unilateral or bilateral agenesis, duplication, or in
the site of insertion. Although the function is very less, PL
receives the attraction of the surgeons for its use in recon-
structive plastic and hand surgery (2). It is also used to re-
pair ptosis, urinary incontinence, and the restoration of fa-
cial paralysis (1).
In males, PL muscle acts as a weak flexor of the wrist,
and aids in cupping of the palm (1). This characteristic
marks the probable evidence of retrogression of this mus-
cle. It also opposes strong shearing forces on the skin of the
palm during gripping, and aiding in cupping of the hand.
Hypothetically, the comparison of the relative length
of tendons and body could show the pathway of the de-
generation of PL; that is, the degeneration could be asso-
ciated with increased tendon length and decreased belly
from more primitive primates to those most derivate, that
is, great apes to modern humans (3).
According to Kapoor SK et al. (4), the agenesis of PL
muscle was observed in 15% of the general population, but
it is not applicable to all populations and varies among eth-
nic groups (5).
The current study aimed at determining the incidence
of unilateral and bilateral agenesis of PL in the young Ira-
nian population.
2. Methods
A total of 480 first- and second-year medical, dental,
and paramedical students from Tehran medical institu-
tions within the age range of 18 to 23 years were enrolled in
the study. Demographic data included age, gender, dom-
inant hand, race, and shape and the presence or absence
of PL muscle in the forearm. Presence or absence of PL
muscle was determined by the Schaeffer and the Thomp-
son fist tests. In the Schaeffer test, the standard test to de-
termine PL muscle, the examiner asked them to turn back
their thumb to little finger with semi-flexion at the wrist
(Figure 1). Subjects with any deformities or injur y in the up-
per extremity were excluded from the study. The Thomp-
son test was used to support the Schaeffer test and the ex-
aminer asked the subjects to turn back their thumb over
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Safari M et al.
clenched fist with flexion at the wrist (Figure 2). With these
tests, PL tendon was palpated and visualized at distal of the
forearm.
Figure 1. The Schaeffer Test
Figure 2. The Thompson Test
3. Results
The prevalence of the PL muscle was observed in 480
students. Among the males, PL muscle was absent bilat-
erally in 23% and unilaterally in 28.5% of the subjects with
the distribution of 16.9% on the left and 11.6% on the right
hands. In females, the bilateral absence was observed in
34.16%, while 18.7% had unilateral absence with the distri-
bution of 5.8% on the left and 12.9% on the right hands.
Another variation of the palmaris longus muscle is the
bifurcation of its tendon observed in wrist hand. In fe-
males, V-shaped tendon or bifurcation in tendon was 5.1%.
In males, this anomaly was 0.9% (Table 1).
Finally, of the 480 investigated subjects, PL muscle was
absent in 26.6%, while 47.9% had PL muscle on both hands.
However, there was a significant difference between male
and female subjects in the absence of PL. On the other
hand, many of the V-shaped anomalies were observed in
the female groups.
4. Discussion
Identification of the PL is very important to clin-
icians since its tendon is used as a graft in various
surgical procedures and during the administration of
medicine/corticosteroids in the carpal tunnel to relieve
pain due to carpal tunnel syndrome/arthritis.
According to the literature, there are various methods
to find the tendon of PL, each with its own identifying
techniques. The most common and traditionally followed
method is the Schaffer test as a standard test or model to
identify PL muscle (1,2,6-20).
The techniques of the Schaeffer and the Thompson’s
fist tests were used in the current study to prove the pres-
ence or absence of PL muscle.
Some authors suggested that the PL muscle absence
is more common in females (2,7,10,14), consistent with
the findings of the current study regarding the bilateral
absence. Unilateral absence occurred more often on the
left hand in males (6,12,21) and unilateral absence on the
right hand in the females (7,14,17). The current study re-
ported a similar prevalence in females and males in bilat-
eral absence, but recorded higher absence than the valid
reference (5) and other populations (4,9,10,12,14,17,19-21).
The authors agreed with the current study (2) and reported
higher figures than that of the current study records (7).
Another variation of the PL muscle is the bifurcation of
its tendon or the belly (23-25) and V shape anomaly in ten-
don (26). The current study recorded 2.3% variation in ten-
don 5% in females and 1% in males. Since the authors (24,
26) reported an abnormal case for tendon shape, the varia-
tion was not clear and it was not reported statistically.
Knowledge of the PL muscle variations and its normal
anatomy is useful. The tendon of PL muscle is a significant
anatomical landmark for surgical approaches in this area
and may cause compression of the median nerve (23).
According to Sebastin SJ (27) lack of any difference in
favor of the normal population may indicate the gradual
phylogenetic degenerative trend for this muscle; authors
believe that PL muscle is progressively disappearing in Ira-
nian young people and could prove a degenerative trend
in the Iranian population.
Footnote
Conflict of Interest: The authors declared no conflict of
interest.
2Ann Mil Health Sci Res. 2017; 15(2):e62310.
Safari M et al.
Table1. The Shape of the Palmaris Longus Muscle in the Study Subjects
TotalSample (N = 480) Males (N = 325) Females (N = 155)
Presence (normal) 71.11% 77.2% 60.71%
Presence (Y-shaped) 2.29% 0.9% 5.1%
Absence 26.6% 21.8% 34.19%
Table2. Prevalence of the Palmaris Longus Muscle in the Literature Review
Study Population (Author,
Date)
TotalSample
(N)
Male/Female
(N)
Age Bilateral
Absence
Unilateral
Absence (L)
Unilateral
Absence (R)
Bilateral
Presence
Caucasian population (20)
Thompson Mockford et al.,
2001
300 150/150 18 - 40 %8.6 %6.6 %9.6 %75.2
A Chinese population study
(19) Sebastin and Lim 2006
329 120/209 7 - 85 %1.2 %2.4 %0.9 %95.5
Indian population (4)
Kapoor Tiwari et al., 2008
500 236/264 6 - 65 %8 %6.2 %3 %82.8
Turkishpopulation (18)
Kose Adanir et al., 2009
1350 675/675 18 - 85 %15.04 %7.04 %4.51 %73.41
Yoruba population (17)
Mbaka and Ejiwunmi 2009
600 335/265 8 - 60 %6.7 %3.2 %2.5 %87.6
Indian population (21)
Agarwal 2010
385 195/190 20 - 24 %3.37 %11.16 %5.7 %79/74
The Northern, Serbia (15)
Eric, Krivokuca et al., 2010
800 400/400 18 - 75 %15.9 %13 %8.6 %62.5
Chilean Subjects (14) Alves
Ramírez et al., 2011
200 86/114 17 - 32 %9 %6 %5 %80
Pakistani population (10)
HUSSAIN 2011
610 378/228 18 - 74 %12.95 %4.91 %3.60 %78.54
East African population (12)
Kigera and Mukwaya 2011
800 391/409 12 - 70 %1.1 %2.3 %1 %95.6
Indian population (2)
Sankar Bhanu et al., 2011
942 450/492 18 - 23 %8.28 %10.19 %9.55 %71.98
A population of Saudi
Arabia (10) HUSSAIN 2012
400 200/200 21 - 25 %7.75 %9 %7.75 %75.5
Korean population (9)
Kyung Lee et al., 2012
269 149/120 18 - 30 %2.23 % 1.11 %0.74 %95.9
An orthopedic surgery
center in Iran (22)
Abdolahzadeh Lahiji et al.,
2013
1000 682/318 - %6.7 %5.9 %10.2 %77.2
Egyptian population (7)
Raouf, Kader et al., 2013
386 112/274 19 - 70 %31.1 %7.8 %11.9 %49.2
South African population
(6) Venter VanSchoor et al.,
2014
706 363/343 5 - 99 %11.9 %7.7 %6.9 %73.5
Young Iranian population
The current study,2017
480 325/155 18 - 23 %26.6 %13.3 %12.08 %47.91
References
1. Femi Akinlosotu FE, Omirinde JO. Prevalence of missing palmaris
longus muscle in the arm of secondary school children in ibadan.
Arch Bas App Med. 2015;3:89–92.
2. Sankar KD, Bhanu PS, John SP. Incidence of agenesis of palmaris
longus in the Andhra population of India. Indian J Plast Surg.
2011;44(1):134–8. doi: 10.4103/0970-0358.81448. [PubMed: 21713200].
3. Aversi Ferreira RAGMF, Bretas RV, Maior RS, Davaasuren M,
Paraguassu Chaves CA, Nishijo H, et al. Morphometric and statistical
Ann Mil Health Sci Res. 2017; 15(2):e62310. 3
Safari M et al.
analysis of the palmaris longus muscle in human and non human
primates. Biomed Res Int. 2014;2014:1–6. doi: 10.1155/2014/178906.
4. Kapoor SK, Tiwari A, Kumar A, Bhatia R, Tantuway V, Kapoor S. Clinical
relevance of palmaris longus agenesis: common anatomical aberra-
tion. Anat Sci Int. 2008;83(1):45–8. doi: 10.1111/j.1447-073X.2007.00199.x.
[PubMed: 18402087].
5. Snell RS. Clinical anatomy for medical students. 7 ed. Boston, United
States: Little, Brown and Company; 2007. 2007 p.
6. Venter G, Van Schoor AN, Bosman MC. Degenerative trends of the
palmaris longus muscle in a South African population. Clin Anat.
2014;27(2):222–6. doi: 10.1002/ca.22226. [PubMed: 23362128].
7. Raouf HA, Kader GA, Jaradat A, Dharap A, Fadel R, Salem AH. Frequency
of palmaris longus absence and its association with other anatomical
variations in the Egyptian population. Clin Anat. 2013;26(5):572–7. doi:
10.1002/ca.22186. [PubMed: 23339087].
8. Soltani AM, Peric M, Francis CS, Nguyen TT, Chan LS, Ghiassi A, et al.
The variation in the absence of the palmaris longus in a multiethnic
population of the United States: an epidemiological study. Plast Surg
Int. 2012;2012:282959. doi: 10.1155/2012/282959. [PubMed: 23213502].
9. Kyung DS, Lee JH, Choi IJ, Kim DK. Different frequency of the absence
of the palmaris longus according to assessment methods in a Korean
population. Anat Cell Biol. 2012;45(1):53–6. doi: 10.5115/acb.2012.45.1.53.
[PubMed: 22536552].
10. Mahmood T, Butt KA, Ahmed N, Shahid R, Hussain FN. Prevalence of
congenital absence of palmaris longus tendon in healthy volunteers,
a cross sectional study.Hand. 2012;79(610):12–95.
11. Hiz O, Ediz L, Ceylan MF, Gezici E, Gulcu E, Erden M. Prevalence of the
absence of palmaris longus muscle assessed by a new examination
test, (Hiz-Ediz Test)in the population residing in the area of Van.J Clin
Exp Invest. 2011;2(3):254–9. doi: 10.5799/ahinjs.01.2011.03.0050.
12. Kigera JW, Mukwaya S. Frequency of agenesis Palmaris longus
through clinical examination–an East African study. PLoS One.
2011;6(12):28997. doi: 10.1371/journal.pone.0028997. [PubMed:
22174943].
13. Eric M, Koprivcic I, Vucinic N, Radic R, Krivokuca D, Leksan I, et al.
Prevalence of the palmaris longus in relation to the hand domi-
nance. Surg Radiol Anat. 2011;33(6):481–4. doi: 10.1007/s00276-010-0751-
0. [PubMed: 21107568].
14. Alves N, Ramirez D, Figueiredo Deana N. Study of frequency of
the palmaris longus musclem in chilean subjects. Int J Morphol.
2011;29(2):485–9. doi: 10.4067/s0717-95022011000200030.
15. Eric M, Krivokuca D, Savovic S, Leksan I, Vucinic N. Prevalence
of the palmaris longus through clinical evaluation. Surg Radiol
Anat. 2010;32(4):357–61. doi: 10.1007/s00276-009-0573-0. [PubMed:
19816651].
16. Enye LA, Saalu LC, Osinubi AA. The prevalence of agenesis of palmaris
longus muscle amongst students in two lagos based medical schools.
Int J Morphol. 2010;28(3). doi: 10.4067/s0717-95022010000300029.
17. Mbaka GO, Ejiwunmi AB. Prevalence of palmaris longus absence–
a study in the Yoruba population. Ulster Med J. 2009;78(2):90–3.
[PubMed: 19568443].
18. Kose O, Adanir O, Cirpar M, Kurklu M, Komurcu M. The prevalence
of absence of the palmaris longus: a study in Turkish population.
Arch Orthop TraumaSurg. 2009;129(5):609–11. doi: 10.1007/s00402-008-
0631-9. [PubMed: 18418616].
19. Sebastin SJ, Lim AY. Clinical assessment of absence of the palmaris
longus and its association with other anatomical anomalies– a Chi-
nese population study. Ann Acad Med Singapore. 2006;35(4):249–53.
[PubMed: 16710495].
20. Thompson NW, Mockford BJ, Cran GW. Absence of the palmaris
longus muscle: a population study. Ulster Med J. 2001;70(1):22–4.
[PubMed: 11428320].
21. Agarwal P. Absence of the palmaris longus tendon in Indian popu-
lation. Indian J Orthop. 2010;44(2):212–5. doi: 10.4103/0019-5413.61863.
[PubMed: 20419011].
22. Abdolahzadeh Lahiji F, Ashoori K, Dahmardehei M. Prevalence of
palmaris longus agenesis in a hospital in Iran. Arch Iran Med.
2013;16(3):187–8. [PubMed: 23432173].
23. Christos L, Konstantinos N, Evagelos P. Revision of Carpal Tun-
nel Release due to Palmaris Longus Profundus. Case Rep Orthop.
2015;2015:616051. doi: 10.1155/2015/616051. [PubMed: 26075127].
24. Iqbal S, Iqbal R, Iqbal F. A bitendinous palmaris longus, aberrant
insertions and its clinical impact, a case report. J Clin Diagn Res.
2015;9(5):3–5. doi: 10.7860/jcdr/2015/12182.5954.
25. Kumar N, Patil J, Swamy RS, Shetty SD, Abhinitha P, Rao MK, et al. Pres-
ence of multiple tendinous insertions of palmaris longus: a unique
variation of a retrogressive muscle. Ethiop J Health Sci. 2014;24(2):175–
8. [PubMed: 24795520].
26. Alshaham A. Anomalous V shape palmaris longus tendon, two cases.
J Med Cases. 2010;1:68–70. doi: 10.4021/jmc114e.
27. Sebastin SJ, Lim AY, Bee WH, Wong TC, Methil BV. Does the absence of
the palmaris longus affect grip and pinch strength?. J Hand Surg Br.
2005;30(4):406–8. doi: 10.1016/j.jhsb.2005.03.011. [PubMed: 15935531].
4Ann Mil Health Sci Res. 2017; 15(2):e62310.
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