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Case Reports
. 2015 May;9(5):AD03-5.
doi: 10.7860/JCDR/2015/12182.5954. Epub 2015 May 1.

A Bitendinous Palmaris Longus: Aberrant Insertions and Its Clinical Impact - A Case Report

S Iqbal  1 , Raiz Iqbal  2 , Faiz Iqbal  2
Affiliations
Case Reports

A Bitendinous Palmaris Longus: Aberrant Insertions and Its Clinical Impact - A Case Report

S Iqbal et al. J Clin Diagn Res. 2015 May.

Abstract

Palmaris longus, phylogenetically a retrogressive muscle, exhibits significant anatomical variations compared to other muscles of the upper extremity. It is of great surgical importance because, it is the first option tendon for graft procedures in various cosmetic, plastic and reconstructive surgeries. It has also been widely used in various tendon transfer procedures in treating facial paralysis, ptosis correction, lip augmentation and digital pulley reconstruction. We report a rare variant pattern of Palmaris longus with duplicated tendons and with multiple insertions to thenar and hypothenar muscles, fasciae and the flexor retinaculum along with its normal continuation as palmar aponeurosis. Variations in its insertions not only contribute, but also augment the various pathological processes such as Dupuytren's contracture, Carpal tunnel and Guyon's syndromes. So it is of utmost importance for surgeons, physicians and radiologists, to be aware of these variations, well in advance.

Keywords: Anatomical variations; Anomalous insertions; Dupuytren’s contracture; Forearm flexors; Tendon grafts; Tendon transfer.

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Figures

[Table/Fig-1a]:
[Table/Fig-1a]:
Dissection of right forearm showing the dual tendons of Palmaris Longus PL - Palmaris longus; PLT-1 - Superficial tendon of Palmaris longus; PLT-2 -Deep tendon of Palmaris longus; PA - Palmar aponeurosis; FR - Flexor retinaculum; FDS - Flexor digitorum superficialis; FCR - Flexor carpi radialis; FCU - Flexor carpi ulnaris; RA - Radial artery; TE - Thenar muscles; HT - Hypothenar muscles
[Table/Fig-1b]:
[Table/Fig-1b]:
Dissection of front of right wrist showing three slips of insertion of superficial tendon of Palmaris Longus into palmar aponeurosis, thenar and hypothenar eminences PLT-1 - Superficial tendon of Palmaris longus; MS - Medial slip; CS - Central slip; LS - Lateral slip; PLT-2 - Deep tendon of Palmaris longus; FR - Flexor retinaculum; FDS - Flexor digitorum superficialis; FCR - Flexor carpi radialis; FCU - Flexor carpi ulnaris; RA - Radial artery; TE - Thenar muscles; HT - Hypothenar muscles
[Table/Fig-1c]:
[Table/Fig-1c]:
Dissection of front of right wrist showing insertion of deep tendon of Palmaris Longus into flexor retinaculum PL - Palmaris longus; PL-1 - Superficial tendon of Palmaris longus; PL-2 - Deep tendon of Palmaris longus; PA - Palmar aponeurosis; FR - Flexor retinaculum;FDS - Flexor digitorum superficialis; FCR - Flexor carpi radialis; FCU - Flexor carpi ulnaris; RA - Radial artery; TE - Thenar muscles; HT - Hypothenar muscles
See this image and copyright information in PMC

References

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