Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 12;17(6):e85854.
doi: 10.7759/cureus.85854. eCollection 2025 Jun.

A Comparative Study of the Presence of the Palmaris Longus Tendon Using Physical and Ultrasound Examination

Hasan Al-Ali  1 , Nour Gamgoum  1 , Michael Atalla  2   1 , Andrew Yacoub  1 , Ali Skiredj  1 , Youssef Skiredj  1 , Haider Hilal  3 , Tarek Alambrouk  3 , James Coey  3 , Sadia Javed  3
Affiliations

A Comparative Study of the Presence of the Palmaris Longus Tendon Using Physical and Ultrasound Examination

Hasan Al-Ali et al. Cureus. .

Abstract

Introduction The palmaris longus muscle (PLM), located in the forearm's anterior compartment, plays an essential role in wrist flexion. Its tendon is often used for grafting because of its accessibility and minimal function. However, its anatomy varies, with congenital absence being the most common variation. This study aims to detect the incidence of the palmaris longus tendon (PLT) and compare physical examination methods with standard ultrasonography, as previous studies have only utilized physical examinations. Methods In this study, 61 participants were examined bilaterally (122 wrists) using three different physical examination methods: the Schaeffer, Thompson, and Mishra I tests. The ultrasonography test was conducted by a single observer using a GE LOGIQ e ultrasound system (GE HealthCare Technologies, Inc., Chicago, IL, USA), equipped with a linear transducer with a frequency range of 12-15 Hz, attached transversely to the anterior distal forearm. The tendon was visualized anterior to the median nerve, medial to the flexor carpi radialis, and superficial to the flexor retinaculum. To assess the difference between physical examination and ultrasound, statistical analyses were conducted on subgroups using a t-test. Additionally, PLT incidence was evaluated according to gender, ethnicity, and hand dominance. Results On ultrasound examination, the PLT was detected in 72.13% of wrists bilaterally (n = 88), 5.74% unilaterally (n = 7), and was absent in 22.13% of the 122 wrists examined (n = 27). Physical examination methods detected an average of 56.28% bilaterally (n = 68.66), 6.56% unilaterally (n = 8), and 37.16% as absent (n = 45.33). Total detection by ultrasound was 77.87% (n = 95), while the physical examination average was 62.84% (n = 76.66). Overall, there is a significant difference between the physical examination methods and ultrasonography in detecting PLT, with ultrasonography demonstrating greater accuracy. It should also be noted that the prevalence of PLT is not affected by gender. Conclusion Ultrasonography is crucial in clinical settings to confirm the presence of the PLT, even when a physical examination is inconclusive. Physical and ultrasound approaches can, therefore, be combined to avoid producing incorrect negative results when locating the PLT for tendon grafting.

Keywords: anatomical variability; msk ultrasound; palmaris longus muscles; palmaris longus tendon; tendon graft.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Northumbria University issued approval 2024-7087-7008. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Ultrasound Probe Placement on the Wrist
The linear transducer probe was aligned transversely on the anterior distal portion of the supported forearm, with a perpendicular orientation.
Figure 2
Figure 2. Confirmed Presence of Tendon by Ultrasound
Palmaris longus (PL), as labeled in the figure, is identified in the anterior compartment of the forearm, superficial to the flexor retinaculum (FR). Relevant structures, including the flexor carpi radialis (FCR), visualized laterally, and the median nerve (MN), visualized posteriorly, are also shown.
Figure 3
Figure 3. Confirmed Absence by Ultrasound
Ultrasound did not detect the palmaris longus (PL) in this image. No presence of a fusiform muscle was noted superficial to the flexor retinaculum (FR). Additionally, relevant anatomical structures, such as the median nerve (MN) and flexor carpi radialis (FCR), are labeled in this figure.
Figure 4
Figure 4. Presence of the Palmaris Longus Tendon
Count of wrists where the palmaris longus tendon presence was detected by ultrasound, and the three physical examination methods.
Figure 5
Figure 5. Comparison of Detection Methods With Ultrasonography on the Right Side
This graph depicts the accuracy of each physical examination method when compared with ultrasound. p-values were added on the bars of each method to indicate significance. This data is specific to the right wrist.
Figure 6
Figure 6. Comparison of Detection Methods With Ultrasonography on the Left Side
This graph depicts the accuracy of each physical examination method when compared with ultrasound. p-values were added on the bars of each method to depict significance. This data is specific to the left wrist.
Figure 7
Figure 7. Combined Physical Exam Average Prevalence of the Palmaris Longus
This pie chart shows the palmaris longus detection in participants by the combined physical examination methods. Average count values are rounded to the nearest whole number.
Figure 8
Figure 8. Ultrasonography Prevalence of the Palmaris Longus
This pie chart shows palmaris longus detection in participants by ultrasound.
See this image and copyright information in PMC

References

    1. The prevalence of absence of the palmaris longus--a study in a Chinese population and a review of the literature. Sebastin SJ, Puhaindran ME, Lim AY, Lim IJ, Bee WH. J Hand Surg Br. 2005;30:525–527. - PubMed
    1. Frequency of the palmaris longus tendon in North American Caucasians. Troha F, Baibak GJ, Kelleher JC. https://journals.lww.com/annalsplasticsurgery/abstract/1990/12000/Freque.... Ann Plast Surg. 1990;25:477–478. - PubMed
    1. Adequacy of palmaris longus and plantaris tendons for tendon grafting. Jakubietz MG, Jakubietz DF, Gruenert JG, Zahn R, Meffert RH, Jakubietz RG. J Hand Surg Am. 2011;36:695–698. - PubMed
    1. Distribution of agenesis of palmaris longus muscle in 12 to 18 years old age groups. Ceyhan O, Mavt A. https://europepmc.org/article/med/9355719. Indian J Med Sci. 1997;51:156–160. - PubMed
    1. Alternative tests in demonstrating the presence of palmaris longus. Mishra S. Indian J Plast Surg. 2001;34:12–14.

LinkOut - more resources