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Prevalence of Absence of Palmaris Longus Tendon in Nepalese Population

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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.
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ORIGINAL ARTICLE
PREVALENCE OF ABSENCE OF PALMARIS LONGUS TENDON IN NEPALESE
POPULATION
ABSTRACT
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.
KEY WORDS Palmaris longus, flexor, forearm
1. Department of Anatomy, UCMS, Bhairahawa, Nepal
2. Kathmandu University, Dhulikhel Hospital, Kavre, Nepal
For Correspondence
Dr. Nitasha Sharma
Department of Anatomy
Universal College of Medical Sciences
Bhairahawa, Nepal
E-mail:sharmanitasha8868@gmail.com
Journal of Universal College of Medical Sciences (2019) Vol.07 No.01 Issue 19
33
PREVALENCE OF ABSENCE OF PALMARIS LONGUS TENDON IN NEPALESE POPULATION
Nitasha Sharma,Bikash Parajuli, Niraj Pandey, Ram Prakash Shah
1 2 1 1
Nitasha Sharma, Bikash Parajuli, Niraj Pandey, Ram Prakash Shah
DOI: https://doi.org/10.3126/jucms.v7i1.24683
t
thumb above other finger and wrist is flexed agains
16
3. Mishra's Test: Student is made to do passive
hyperextension of metacarpophalangeal joint with active
wrist flexion (Fig 1-c).
17
4. Puspakumar's two finger sign: Student are made to
nd rd th
extend 2 and 3 digits ,flex 4 and fifth digit with first
digit fully opposed and flexed(Fig 1-d).
If PL is not visible in all test, it will be taken as absent in that
subject.
Figure 1 (a-d). Showing different clinical tests done for
palmaris longus
The data were entered in excel worksheet and analysed in
SPSS versio2.0.Chi-Square test was used .P-value less than
0.05 was considered statistically insignificant.
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%) (Fig. 2).
Figure 2. Pie chart showing overall absence of palmaris-
longus
INTRODUCTION
The palmarislongus (PL) is a, tendinous superficial flexor of
1
forearm. Superficial muscles of forearm includes flexor carpi
ulnaris, palmaris longus, flexor carpi radialis and pronator
teres. Palmaris longus is a thin spindle shape long slender
tendinious muscle between flexor carpi ulnaris and flexor
2-6
carpi radialis. PL originated from medial epicondyle of and
3
epicondyle ridge of humerus with common flexor tendon. PL
further runs downwards as a long slender tendon passing
anterior through the transverse carpal ligament and insert into
7,8
flexor retinaculum and palmar aponeurosis. Its nerve supply
1,3
is by median nerve and arterial supply is by ulnar artery.
Palmaris longus 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
9
muscle it also helps in flexion of wrist joint.
The knowledge of PL is a growing interest for its wide role in
reconstructive plastic surgery orthopedics as well urosurgery
5 6
as transfer or transplant graft , lip augmentation or escalation
7 8
,ptosis correction , management of facial paralysis and
4
urinary incontinence.
The incidence of absence of palmaris longus is in great
9 10
variation from 1.5( Korean) to 63.9% (Turkish) population.
Its variation of absence has attracted many researchers
globally. However, most of the studies have been done in
11
Caucasian populations. The aim of the present study is to
know occurrence of absence of PL, clinically in Nepalese
population and to compare the result of this study globally
12,13
which will help surgeons and orthopedicians in our regions.
MATERIAL AND METHODS
A cross sectional descriptive observational study was
conducted among 270 medical students (MBBS, BDS) at
Universal College of Medical Science, Bhairawaha which
include 145 male and 127 female in year the 2018-2019.
Exclusion criteria were students not willing to participate in
the study.
Ethical approval for study was taken from institutional review
committee (IRC) of Universal College of Medical Science
th
vide their letter no.ucms/irc/189/18 dated 8 Dec 2018.In the
study, the prevalence of presence and absence was determine
by series of tendon examination test.
14
1. 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's Fist: Student is made to close the fist, with
Journal of Universal College of Medical Sciences (2019) Vol.07 No.01 Issue 19
34
ORIGINAL ARTICLE
PREVALENCE OF ABSENCE OF PALMARIS LONGUS TENDON IN NEPALESE POPULATION
Nitasha Sharma,Bikash Parajuli, Niraj Pandey, Ram Prakash Shah
ab
cd
resistance (Fig 1-b).
Out of 270 students, 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%).
Out of 125 male students 18 (14.4%) students had absence of
palmaris longus, 9 (7.2%) students had absence of palmaris
longus in left hand and 5 (4%) students had absence of
palmaris longu in left hand. Bilateral absence of palmaris
longus was seen in 4 (3.2%) males.
Among 145 female students 22 (15.2%) students had overall
absence of palmaris longus where 9 (6.2%) students had
absence of PL on left hand and 7 (4.8%) students had absence
of PL on right hand. Bilateral absence of PL was seen in 4.1%
females.
Table 1. Showing frequency of absence of PL by its
lateralization
Table 2. Showing frequency of absence by gender
distribution
DISCUSSION
Palmarislongus is often described as one of the most variable
muscles in the human body and is classified as a
phylogenetically retrogressive muscle i.e a short belly with a
18
long tendon.
The palmarislongus tendon is often considered the ideal donor
for tendon grafts for replacement of the long flexors of the
19
fingers, and of the flexor pollicislongus tendon.
The palmaris longus muscle is well developed in the animal
species, which tolerates more weight on the upper limbs than
other species. But in the human species, in which the role of
the upper limbs in toleration of body weight has been
decreased, the palmaris longus muscle is less developed and
20
uncompleted.
Absence of the palmaris longus muscle has been the subject of
studies performed by many researchers in living and deceased
people, and the occurrence percentage was variable in
different populations and races.
Various clinical anatomy textbooks report around 15%
21
absence of palmaris longus muscles. However, this figure
13
differs in various regions of the world.
The overall prevalence of absence of palmaris longus our
study was found to be 14.8% subjects which is similar to the
10 22
findings by Ali et al , Berhe T et al Bilateral agenesis was
12
seen in 3.7% cases consistent with the finding by Jha R et al.
It was found that the overall absence of PL was more common
in females (15.2%) as compared to males (14.4%) which was
23
in accordance with the findings by Lamichhane PS et al.
Unilateral absence of PL was almost equally prevalent in both
the sexes. Absence in the Left side was more common in males
(7.2%) whereas right side absence was slightly more common
in females (4.4%). This finding may be due to the fact that the
dominant hand is more involved in manual activities and
therefore it is less likely to degenerate due to disuse as
compare to the non dominant hand.
The only limitation of this study was that the presence of a
palmaris longus muscle was determined by clinical exam,
which can be examiner dependent, rather than ca-daveric
dissection. To minimize this issue, four different tests were
used to detect the palmaris longus muscle.
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 for graft surgeries.
Journal of Universal College of Medical Sciences (2019) Vol.07 No.01 Issue 19
35
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ORIGINAL ARTICLE
PREVALENCE OF ABSENCE OF PALMARIS LONGUS TENDON IN NEPALESE POPULATION
Nitasha Sharma,Bikash Parajuli, Niraj Pandey, Ram Prakash Shah
Absent of PL in
Right Side
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Journal of Universal College of Medical Sciences (2019) Vol.07 No.01 Issue 19
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ORIGINAL ARTICLE
PREVALENCE OF ABSENCE OF PALMARIS LONGUS TENDON IN NEPALESE POPULATION
Nitasha Sharma,Bikash Parajuli, Niraj Pandey, Ram Prakash Shah
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p class="Pa9"> Introduction: In the recent years palmaris longus muscle tendon (PLMT) has become an extensively and intensively studied muscle all over the world. The main reason for this is the importance of PLMT which was recognized with development of plastic and reconstructive surgery. The possibilities of PLMT use has become bigger and bigger each day Objectives: The study aimed to evaluate the incidence of agenesis of palmaris longus muscle tendon among first year Filipino medical students at OLFU. Methods: This study was conducted at the Our Lady of Fatima University Medical Centre, Valenzuela City, Philippines. A semi-structured proforma was used to record the relevant data for the study. The Thompson’s test was used for assessing palmaris longus muscle tendon. After taking consent total of 503 first year Filipino medical students were involved. Results: Out of total 503 subjects, 170 (33.80%) were males and 333 (66.20%) were females. Percentage of frequency of agenesis of palmaris longus muscle tendon in both genders was 17.05%. There was no significant gender and laterality difference in the incidence of the agenesis of palmaris longus muscle tendon. That means there are equal chances of palmaris longus muscle tendon agenesis in both gender and the laterality. Conclusions: There was no significant gender and laterality difference in the incidence of the agenesis of PLMT. This means that there are equal chances of PLMT agenesis in both gender and the laterality. Journal of Gandaki Medical College Vol. 10, No. 1, 2017, Page: 17-20 </p
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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.
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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.
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The prevalence of the palmaris longus (PL) muscle varies more than any other muscle in the human body. Its absence across the world ranges between 1.5% and 63.9%. It presents with many different anomalies, discovered either clinically, intraoperatively or after anatomical examination of cadavers. This paper includes recent studies and reports about the presence and variations of the PL muscle, thereby illustrating the differences between ethnic groups, as well as emphasizing the different ways of finding it, during daily clinical and surgical practice.
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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.
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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.