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CASE REPORT Table of Contents   
Year : 2003  |  Volume : 37  |  Issue : 2  |  Page : 13
Reverse palmaris longus muscle: a case report


Department of Orthopedics, Christian Medical College and Hospital, Ludhiana, India

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How to cite this article:
Rawat J S, John B. Reverse palmaris longus muscle: a case report. Indian J Orthop 2003;37:13

How to cite this URL:
Rawat J S, John B. Reverse palmaris longus muscle: a case report. Indian J Orthop [serial online] 2003 [cited 2019 Dec 10];37:13. Available from: http://www.ijoonline.com/text.asp?2003/37/2/13/48511

   Introduction Top


Palmaris longus is one of the most variable muscles of the human body, with morphological aberrations ranging from complete ageneses to duplication, triplication, variable location and accessory slips [3] . We came across a case of reverse palmaris longus attachment. Review of literature revealed only a few such cases reported so far.


   Case Report Top


A 46 years old male presented to us with inability to extend the thumb and fingers of his left hand. He noted this after he slept on his left side one night about six months prior to presentation. On examination he was unable to extend his left thumb and fingers, but wrist extensions was possible. There was no sensory deficit. Two nerve conduction velocity (NCV) studies carried out at an interval of six weeks showed severe axonal injury of the left posterior interosseous nerve in the supinator tunnel, with no signs of renervation.

At 10 months after injury the patient was taken up for a tendon transfer. Intra operatively we found the palmaris longus muscle with a reverse origin from the flexor retinaculum, which was hypertrophied and the insertion to the common flexor origin was tendinous [Figure 1]. The flexor carpi ulnaris was then transferred to the extensor digitorum communis and a slip from the same muscle was attached to the thumb extensor. Post operatively the limb was put in a cast with wrist and fingers in extension for five weeks followed by a dynamic extension splint for another week. He thereafter underwent physiotherapy and now has good extension of the fingers and thumb.


   Discussion Top


The palmaris longus muscle is believed to be functionally redundant. It is frequently used as a tendon graft and also as a tendon for transfer to the thumb to achieve opposition and abduction. [1] The muscle normally arises from the common origin of the flexor tendons with its tendon inserted across the front of the flexor retinaculum into the palmer aponeurosis. [2]

Reimann et al [3] studied 1600 cadaver extremities. The incidence of agenesis was 12.9%. The overall incidence of anomalies was 9.0% (46 in 530 consecutive arms) excluding agenesis. The authors found that the variations in position and form constituted one-half of these cases (23 in 46), where as accessory slips and substituted structures accounted for 32.6 % (15 in 46) of the cases. They observed the muscle belly may be, central, distal or digastric (proximal and distal muscle belly connected by a central tendon) in position. They may also be completely muscular from origin to insertion or only a fibrous strand.

Zeiss and Guilliam-Haidet [4] used MRI to demonstrate various muscular anomalies around the volar aspect of wrist and forearm. Ultrasonography with a 7.5 Mhz probe may be an option for identification of the palmaris longus muscle in pre-operative work up of cases where the tendon is clinically not palpable. [6]

Depuydt et al [5] reported two cases of effort related median nerve compression in the dominant forearm caused by a reversed palmaris longus muscle. Rubino et al [6] and Lorenzo et al [7] also reported an accessory slip of the palmaris longus causing median nerve compression.

Our patient however did not have any median nerve compression, he had a posterior interosseous nerve palsy. Since he presented late with no objective evidence of nerve recovery he was considered for a tendon transfer. A slip from the flexor carpi ulnaris had to be used due to the presence of an anomalous reverse palmaris longus muscle. With possible known anomalies it may be worth considering routine ultrasonography or MRI to study palmaris longus in patients where it is clinically not demonstrable.

 
   References Top

1.Koo CC and Roberts AHN. The palmaris longus tendon. Another variation in its anatomy. J Hand Surg [Br] 1997;22 (1): 138-139.  Back to cited text no. 1    
2.Bannister LH, Berry MM, Collins P, Dyson M, Dussek JE, Fergusson MWJ. Gray's Anatomy. 38th ed. Edinburgh: Churchill Livingstone, 1995; P. 846.  Back to cited text no. 2    
3.Reimann AF, Daseler EH, Anson BJ, Beaton LE. The palamaris longus muscle and tendon. A study of 1600 extremities. Anat Rec1944; 89: 495-505.  Back to cited text no. 3    
4.Zeiss J, Guilliam-Haidet L. MR demonstration of anomalous muscle about the volar aspect of the wrist and forearm. Clin Imaging 1996; 20(3): 219-221.  Back to cited text no. 4    
5.Depuydt KH, Schuurman AH, Kon M. Reversed palmaris longus muscle causing effort-related median nerve compression. J Hand Surg [Br] 1998;23(1):117-119.  Back to cited text no. 5    
6.Rubino C, Paolini G, Carlesimo B. Accessory slip of the palmaris longus muscle. Ann Plast Surg 1995; 35: 657-659.  Back to cited text no. 6  [PUBMED]  
7.Lorenzo JS, Canada M, Diaz L, Sarasua G. Compression of the median nerve by an anomalous palmaris longus tendon: A case report. J Hand Surg [Am] 1996; 21 (5): 858-860.   Back to cited text no. 7    

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Correspondence Address:
B John
Department of Orthopedics, Christian Medical College and Hospital, Ludhiana-141008, Punjab
India
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Source of Support: None, Conflict of Interest: None


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    Introduction
    Case Report
    Discussion
    References
    Article Figures
 

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