A Rare Variation of Palmaris Longus Muscle and Flexor Carpi Ulnaris Muscle with Clinical Significance: Case Report

Authors

  • Manol Anastasov Kalniev Department of Anatomy and Physiology, Faculty of Public Health, Healthcare and Sports, South-West University “Neofit Rilski” of Blagoevgrad, Blagoevgrad, Bulgaria
  • Dimo Stoyanov Krastev Department of Anatomy and Physiology, Faculty of Public Health, Healthcare and Sports, South-West University “Neofit Rilski” of Blagoevgrad, Blagoevgrad, Bulgaria
  • Nikolay Stoyanov Krastev Department of Anatomy, Histology and Embryology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
  • Ludmil Marinov Marinov Clinic of General and Abdominal Surgery, Institute Medical De Champel of Geneve, Genève, Switzerland

DOI:

https://doi.org/10.55677/IJCSMR/V4I2-05/2024

Keywords:

Palmaris longus muscle, flexor carpi ulnaris muscle, variations, hand surgery.

Abstract

Not so many variations of the muscles belonging to the flexor muscle group of the forearm are described in comparison to the tendons of extensor muscle group of the forearm. During routine dissection in the section hall of the Department of Anatomy, Histology and Embryology in Medical University of Sofia we came across a very interesting variation of palmaris longus muscle and the tendons of flexor carpi ulnaris muscle. We observed the division of the tendon of palmaris longus into two wide and flat tendon bellies called lateral and medial. These bellies formed a Y-shaped figure.  The lateral tendon belly passed over the upper part of the flexor retinaculum and inserted into the palmar aponeurosis. The medial tendon however ran deeper than the lateral one and the beginning of the palmar aponeurosis and finally reached the flexor retinaculum where it was inserted. We also came across the presence of additional tendon belly belonging to the flexor carpi ulnaris muscle. That additional belly arose from the pisiform like the pisohamate and pisometacarpal ligaments, then ran deeper than usual and finally joined the fourth metacarpal bone.

References

Gray H. In: Stranding S, (ed) Gray’s Anatomy. 41th Edition. Elsevier, London: 2016, p. 850.

Sebastin SJ, Puhaindran ME, Lim AY, Lim IJ, Bee WH. The prevalence of absence of the palmaris longus - a study in a Chinese population and a review of the literature. J Hand Surg Br. 2005; 30(5):525-527.

Troha F, Baibak GJ, Kelleher JC. Frequency of the palmaris longus tendon in North American Caucasians. Ann Plast Surg. 1990; 25(6):477-478.

Cetin A, Genc M, Sevil S, Coban YK. Prevalence of the palmaris longus muscle and its relationship with grip and pinch strength. Hand (New York, N.Y.). 2013; 8(2): 215–220.

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.

Kawashima T, Kikushima S, Yokota E, Ohkubo F, Yamana Y, Sato F, Sasaki H. A case of an accessory palmaris longus muscle and a duplicate palmaris longus muscle with special reference to their nerve supply - morphologic significance of a common innervation trunk. Okajimas Folia Anat Jpn. 2002; 79(2-3):75-81.

Regan PJ, Feldberg L, Bailey BN. Accessory palmaris longus muscle causing ulnar nerve compression at the wrist. J Hand Surg Am. 1991; 16(4):736- 738.

Roberts PH. An anomalous accessory palmaris longus muscle. Hand. 1972; 4(1):40-41.

Meyer FN, Pflaum BC. Median nerve compression at the wrist caused by a reversed palmaris longus muscle. J Hand Surg Am. 1987; 12(3):369-371.

Server F, Miralles RC, Galcera DC. Carpal tunnel syndrome caused by an anomalous palmaris profundus tendon. J Anat. 1995; 187(1):247-248.

Park MJ, Namdari S, Yao J. Anatomic Variations of the Palmaris Longus Muscle. The American Journal of Orthopaedics. 2010; 39(2): 89-94.

Chou HC, Jeng H, Ko TL, Pai MH, Chang CY, Wu CH. Variant palmaris profundus enclosed by an unusual loop of the median nerve. J Anat. 2001; 199(4):499-500.

Fatah MF. Palmaris profundus of Frohse and Frankel in association with carpal tunnel syndrome. J Hand Surg Br. 1984; 9(2):142-144.

Gleda Ang G, Rozen WM, Vally F, Eizenberg N, Grinsell D . Anomalies of the flexor carpi ulnaris: clinical case report and cadaveric study. Clin Anat. 2010; 23 (4):427-430.

Vojtech K, Stulpa M, Feigl G, Kachlik D. Accessory flexor carpi ulnaris muscle with associated anterior interosseous artery variation: case report with the definition of a new type and review of concomitant variants. Surgical and Radiologic Anatomy. 2019; 41 (11): 1315–1318.

Ramana VollalaV, Bhat S, Rodrigues V, Prasad D, Pamidi N. Additional Muscle Slip of Flexor Carpi Ulnaris Associated with Anomalous Ulnar Nerve and Ulnar Artery in the Distal Forearm. Int J Morphol. 2008; 26(2):373-376.

Sakthivel S, Verma S. Accessory Flexor Carpi Ulnaris and Bilaterally Variant Vascular Anatomy of Upper Limb: An Unusual Presentation. Int J Appl Basic Med Res. 2017; 7(2):143-145.

Al-Qattan MM, Duerksen F. A variant of flexor carpi ulnaris causing ulnar nerve compression. J Anat. 1992; 180: 189-190.

Dibbs RP, Ali K, Sarrami SM, Koshy JC. Revision Peripheral Nerve Surgery of the Upper Extremity. Semin Plast Surg. 2021; 35(2):119-129.

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Published

2024-02-08

How to Cite

Manol Anastasov Kalniev, Dimo Stoyanov Krastev, Nikolay Stoyanov Krastev, & Ludmil Marinov Marinov. (2024). A Rare Variation of Palmaris Longus Muscle and Flexor Carpi Ulnaris Muscle with Clinical Significance: Case Report. International Journal of Clinical Science and Medical Research, 4(2), 31–35. https://doi.org/10.55677/IJCSMR/V4I2-05/2024