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Case report
Submitted: 2023-06-21
Accepted: 2023-07-28
Published online: 2023-11-08
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A very rare case of the accessory palmaris longus muscle and clinical significance

Nicol Zielinska1, Andrzej Borowski2, Marek Drobniewski2, Krystian Maślanka1, Piotr Karauda1, Łukasz Olewnik1
·
Pubmed: 37957935
Affiliations
  1. Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
  2. Orthopaedics and Paediatric Orthopaedics Department, Medical University of Lodz, Poland

open access

Ahead of Print
CASE REPORTS
Submitted: 2023-06-21
Accepted: 2023-07-28
Published online: 2023-11-08

Abstract

The palmaris longus muscle is located in the forearm region. It morphological variability was noted during standard anatomical dissection of the upper limb. The muscle was characterized by a normal course, i.e. originating from the medial humeral epicondyle and inserting to the palmaris aponeurosis, but a small additional tendon attached to the flexor retinaculum was observed in its distal part. An accessory palmaris longus muscle was also observed nearby. Interestingly, this accessory muscle was reversed, and the first part was not muscular, but tendinous, represented  by two tendons originating from the common muscular mass attached to the medial epicondyle of the humerus; these later connected together, creating one muscle belly distally attached to the flexor retinaculum. This additional structure was innervated by a neural branch from the median nerve and the ulnar artery was responsible for blood supply. The course of the median nerve is also clinically important, because before entering the carpal tunnel, it was located directly under the accessory palmaris longus muscle. In turn, the ulnar artery passed through a special hole created by the flexor digiti minimi brevis and flexor retinaculum, before passing under the palmaris brevis muscle.

Abstract

The palmaris longus muscle is located in the forearm region. It morphological variability was noted during standard anatomical dissection of the upper limb. The muscle was characterized by a normal course, i.e. originating from the medial humeral epicondyle and inserting to the palmaris aponeurosis, but a small additional tendon attached to the flexor retinaculum was observed in its distal part. An accessory palmaris longus muscle was also observed nearby. Interestingly, this accessory muscle was reversed, and the first part was not muscular, but tendinous, represented  by two tendons originating from the common muscular mass attached to the medial epicondyle of the humerus; these later connected together, creating one muscle belly distally attached to the flexor retinaculum. This additional structure was innervated by a neural branch from the median nerve and the ulnar artery was responsible for blood supply. The course of the median nerve is also clinically important, because before entering the carpal tunnel, it was located directly under the accessory palmaris longus muscle. In turn, the ulnar artery passed through a special hole created by the flexor digiti minimi brevis and flexor retinaculum, before passing under the palmaris brevis muscle.

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Keywords

accessory palmaris longus, bifurcated palmaris longus, median nerve compression, morphological variations, Palmaris longus, palmaris profundus, reversed palmaris longus

About this article
Title

A very rare case of the accessory palmaris longus muscle and clinical significance

Journal

Folia Morphologica

Issue

Ahead of Print

Article type

Case report

Published online

2023-11-08

Page views

179

Article views/downloads

207

DOI

10.5603/fm.96136

Pubmed

37957935

Keywords

accessory palmaris longus
bifurcated palmaris longus
median nerve compression
morphological variations
Palmaris longus
palmaris profundus
reversed palmaris longus

Authors

Nicol Zielinska
Andrzej Borowski
Marek Drobniewski
Krystian Maślanka
Piotr Karauda
Łukasz Olewnik

References (15)
  1. Adachi B. Beitrage zur anatomie der Japaner. XII. Die statistic der muskelvarietten. Z Morphol Anthr. 1909; 12: 261–312.
  2. Osonuga A, Mahama HM, Brown AA, et al. The Prevalence of Palmaris longus agenesis among the Ghanaian population. Asian Pacific J Trop Dis. 2012; 2(22): S887–S889.
  3. Bergman R, Thompson S, Afifi A. Compendium of human anatomic variation. Urban & Schwarzenberg, Baltimore 2018.
  4. Ceyhan O, Mavt A. Distribution of agenesis of palmaris longus muscle in 12 to 18 years old age groups. Indian J Med Sci. 1997; 51(5): 156–160.
  5. Georgiev GP, Iliev AA, Dimitrova IN, et al. Palmaris longus muscle variations: clinical significance and proposal of new classifications. Folia Med (Plovdiv). 2017; 59(3): 289–297.
  6. Lam DS, Lam TP, Chen IN, et al. Palmaris longus tendon as a new autogenous material for frontalis suspension surgery in adults. Eye (Lond). 1996; 10 ( Pt 1): 38–42.
  7. Mathew AJ, Sukumaran TT, Joseph S. Versatile but temperamental: a morphological study of palmaris longus in the cadaver. J Clin Diagn Res. 2015; 9(2): AC01–AC03.
  8. Moore KL, Dalley AF. Clinical Oriented Anatomy. 4th ed. Lippincott Williams&Wilkins, Philadeplphia 1999.
  9. Olewnik Ł, Waśniewska A, Polguj M, et al. Morphological variability of the palmaris longus muscle in human fetuses. Surg Radiol Anat. 2018; 40(11): 1283–1291.
  10. Olewnik Ł, Wysiadecki G, Polguj M, et al. Anatomical variations of the palmaris longus muscle including its relation to the median nerve — a proposal for a new classification. BMC Musculoskelet Disord. 2017; 18(1): 539.
  11. Raouf HA, Kader GA, Jaradat A, et al. Frequency of palmaris longus absence and its association with other anatomical variations in the Egyptian population. Clin Anat. 2013; 26(5): 572–577.
  12. Reimann AF, Daseler E, Anson B, et al. The palmaris longus muscle and tendon. A study of 1600 extremities. Anat Rec. 2005; 89(4): 495–505.
  13. Sebastin SJ, Lim AYT. Clinical assessment of absence of the palmaris longus and its association with other anatomical anomalies — a Chinese population study. Ann Acad Med Singap. 2006; 35(4): 249–253.
  14. Takanashi Y, Eda M, Kaidoh T, et al. A case of the bilateral duplicate palmaris longus muscles coupled with the palmaris profundus muscle. Yonago Acta Med. 2012; 55(4): 75–80.
  15. Zeybek A, Gürünlüoglu R, Cavdar S, et al. A clinical reminder: a palmaris longus muscle variation. Ann Plast Surg. 1998; 41(2): 224–225.

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