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Case Reports
. 2022 Feb 17;10(2):e4118.
doi: 10.1097/GOX.0000000000004118. eCollection 2022 Feb.

Median Nerve Traction Caused by Palmaris Profundus Muscle: A Case Report

Tonatiuh Flores  1   2 , Hugo Sabitzer  1   2 , Konstantin D Bergmeister  1   2 , Philipp Schatten  1   2 , Michael Pollhammer  1   2 , Gerald Metzger  1   3 , Klaus F Schrögendorfer  1   2
Affiliations
Case Reports

Median Nerve Traction Caused by Palmaris Profundus Muscle: A Case Report

Tonatiuh Flores et al. Plast Reconstr Surg Glob Open. .

Abstract

The palmaris longus muscle is one of the most variant muscles in the human body. Its variations such as the palmaris profundus can cause nerve compression symptoms. Here, we present a case of severe nerve affection due to a palmaris profundus muscle. The palmaris profundus tendon was partially resected at intervention. Pain symptoms started immediately after wearing off of the local anesthetic, and revision surgery had to be performed. Severe traction on the median nerve by the palmaris profundus tendon could be observed at revision. The resection of the palmaris profundus tendon instantly eased the patient's severe pain. At preoperative examination and planning of surgery, the palmaris profundus was not detected. As there is no test for the detection of anatomic variations of the palmaris longus muscle at physical examination, discovering such anomalies is not possible without imaging tools. Ultrasonographic examinations aid in preoperative planning of carpal tunnel release, especially at revision surgeries.

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Figures

Fig. 1.
Fig. 1.
Ultrasound examination of the median nerve after readmission. Ultrasound of the median nerve of the left hand in longitudinal orientation (A). A sickle-shaped formation on top of the nerve is seen [hyperechogenic signal (arrow), creating a hypoechogenic shadow (B), approximately 1-cm long]. A small hematoma (C) distally from the obstructive structure is observable. Picture by G. Metzger.
Fig. 2.
Fig. 2.
Extended incision for a proper overview of the operating field at revision surgery. The partially resected palmaris profundus tendon shows severe adhesions to the median nerve. Photograph by T. Flores.
Fig. 3.
Fig. 3.
Completely decompressed median nerve after resection of the palmaris profundus tendon. Photograph by T. Flores.
Fig. 4.
Fig. 4.
Follow-up picture after 6 months. The patient is able to make a fist without pain symptoms. Photograph by T. Flores.
See this image and copyright information in PMC

References

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