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Scoping review of the palmaris profundus muscle: anatomy of a rare variant and its role in carpal tunnel syndrome

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Abstract

The palmaris profundus muscle is a rare anatomical variation of the forearm muscles. It has been described in both cadaveric and clinical studies as a possible cause of carpal tunnel syndrome. We observed three cases of this variant in recent years and decided to perform a scoping review of this uncommon anatomical entity. Major databases were searched to identify all relevant clinical and anatomical studies containing anatomical descriptions of the muscle, including its origin, insertion, and concomitant presence of the proper palmaris longus muscle or the bifid median nerve. In clinical cases, we studied the surgical approach. Sixty-four articles met our inclusion criteria and contained 88 cases of palmaris profundus muscle. The most common origin was the ventral aspect of the radius in the area of insertion of the pronator teres muscle observed in 11 cases (12.5 %). We found 65 cases (73.3%) in which the tendon was inserted into the palmar aponeurosis or palmar fascia after entering the carpal canal. The concomitant presence of the proper palmaris longus muscle was described in 47 cases (53.4%). We identified 10 cases (10.8%) of the bifid median nerve. In 49 of 69 clinical cases (71%), the surgical approach was to resect the variant muscle. The importance of this variant should not be underestimated due to its potential to compress the median nerve. We found a significant disparity in the muscle origin sites, but uniformity of muscle insertion. In cases where the muscle is found during carpal canal surgery, it should be partially resected to ensure complete nerve decompression.

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Acknowledgements

The authors thank Miroslava Plecitá for help in obtaining the cited articles.

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Authors and Affiliations

  1. Department of Neurosurgery, Purkinje University, Masaryk Hospital, Usti nad Labem, Czech Republic

    Hynek Zitek & Ivan Humhej

  2. Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic

    Ivan Humhej, Vojtech Kunc & David Kachlik

  3. Department of Trauma Surgery, Purkinje University, Masaryk Hospital, Usti nad Labem, Czech Republic

    Vojtech Kunc

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Hynek Zitek: project development, data collection, manuscript writing, surgeon of the cases

Ivan Humhej: data collection, surgeon of the cases

Vojtech Kunc: project development, data collection, manuscript editing

David Kachlik: project development, data collection, manuscript editing

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Correspondence to Hynek Zitek.

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Zitek, H., Humhej, I., Kunc, V. et al. Scoping review of the palmaris profundus muscle: anatomy of a rare variant and its role in carpal tunnel syndrome. Neurosurg Rev 46, 279 (2023). https://doi.org/10.1007/s10143-023-02185-z

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