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A variation of palmaris longus muscle: clinical significance for hand surgery

L. Malinova, A. Iliev, G. Georgiev, I. Dimitrova, B. Landzhov


The palmaris longus muscle (PL) is one of the most variable muscles in the human body. The PL may be agenetic, double, split, tendinous, digastric and may have various insertions. It may be inserted on the flexor retinaculum, the fascia of the forearm, the fascia and the muscles of the hypothenar, the short abductor of the thumb, near the metacarpophalangeal joints, the tendon of the flexor carpi ulnaris muscle, the pisiform bone or the scaphoid bone.A digastric PL was observed in one left forearm from a 69-year-old formol-carbol fixed Caucasian male cadaver. It originated in a usual way through a short, flat tendon from the medial epicondyle of the humerus which then prolonged into a fusiform muscle belly. Approximately halfway through the forearm, this muscle belly sharply transformed into a wide tendon, situated superficially along the midline of the forearm. In the distal fourth of the forearm, this tendon gradually prolonged into a second muscle belly with a thinner proximal end and wider distal portion, which resembled a teardrop. This muscle belly arched over the flexor retinaculum and inserted into the palmar aponeurosis. The innervation of the two muscle bellies was provided by multiple branches extending from the median nerve.In conclusion, the possible presence of PL variations must be considered by clinicians during clinical examination of the forearm, during surgical interventions in that region, or while searching for an entrapment site of the median and/or ulnar nerve. Due to its limited action in carpal flexion and the fact that there is no functional loss in the forearm and hand after its removal, it is an ideal donor for plastic and reconstructive surgery. However, this muscle can also be responsible for median and/or ulnar nerve compression syndromes. It may also simulate a tumor in the region of the antebrachium.

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About The Authors

L. Malinova

A. Iliev

G. Georgiev

I. Dimitrova

B. Landzhov

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