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J Wrist Surg 2020; 9(06): 493-497
DOI: 10.1055/s-0040-1714251
Scientific Article

The Palmaris Longus and Its Association with Carpal Tunnel Syndrome

Andrew D. Boltuch 
1   Department of Orthopaedic Surgery, Largo Medical Center, Largo, Florida
,
Michael A. Marcotte
2   Stanford University, Stanford, California
,
Christopher M. Treat
1   Department of Orthopaedic Surgery, Largo Medical Center, Largo, Florida
3   Department of Shoulder and Elbow Surgery, Utica Park Clinic, Tulsa, Oklahoma
,
Anthony L. Marcotte
1   Department of Orthopaedic Surgery, Largo Medical Center, Largo, Florida
4   Department of Hand and Upper Extremity Surgery, Florida Orthopaedic Institute, Clearwater, Florida
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Abstract

Background The palmaris tendon inserts into the palmar fascia and is positioned in close association with the transverse carpal ligament. Loading of this tendon has been demonstrated to increase carpal tunnel pressures.

Purpose The purpose of this study was to determine if a relationship exists between the palmaris tendon, carpal tunnel syndrome (CTS), and handedness. The sensitivity, specificity, positive predictive value, and negative predictive value for Schaeffer's test were calculated.

Methods A retrospective review of patient charts undergoing endoscopic carpal tunnel release was performed. Rates of palmaris longus agenesis (PLA) were compared to a population matched data set. Statistical analysis was performed using a one-proportion z-test. Schaeffer's test for the palmaris longus tendon was performed on all patients and compared to intraoperative confirmation.

Results A total of 520 carpal tunnel releases were performed in 389 consecutive patients. The frequency of PLA in this surgical cohort was significantly lower compared to the population matched dataset. No correlation between handedness and laterality of CTS or PLA was found. Schaeffer's test was evaluated to yield sensitivity (93.6%), specificity (100%), positive predictive value (100%), and negative predictive value (50.8%).

Conclusion The palmaris tendon was more prevalent in a population of patients undergoing carpal tunnel release. These findings can be used to provide further insight into the pathophysiology of CTS. While Schaeffer's test was accurate in detecting the palmaris longus tendon, a negative test was frequently incorrect. Further imaging is recommended in patients with a negative Schaeffer's test when the palmaris longus is desired for surgical utilization.

Level of Evidence This is a Level III, prognostic study.

Keywords

carpal tunnel syndrome - congenital absence - endoscopic carpal tunnel release - palmaris longus tendon - median nerve compression

Note

The work was performed at Hand & Upper Extremity Surgery, Orthopaedic Specialties of Tampa Bay 1011 Jeffords Street Building D Clearwater, FL 33756 USA.


Ethical Approval

This study is exempt from further institutional review board (IRB) review under 45 CFR 46.101(b) (Exempt Category 4).




Publication History

Received: 30 December 2019

Accepted: 03 June 2020

Article published online:
30 July 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Keese GR, Wongworawat MD, Frykman G. The clinical significance of the palmaris longus tendon in the pathophysiology of carpal tunnel syndrome. J Hand Surg [Br] 2006; 31 (06) 657-660
    CrossrefPubMedGoogle Scholar
  • 2 Jafari D, Taheri H, Shariatzadeh H. et al. The clinical significance of the palmaris longus tendon and functional superficial flexor of the little finger in the pathophysiology of carpal tunnel syndrome. Med J Islam Repub Iran 2008; 22 (01) 8-11
    PubMedGoogle Scholar
  • 3 Server F, Miralles RC, Galcerá DC. Carpal tunnel syndrome caused by an anomalous palmaris profundus tendon. J Anat 1995; 187 (Pt 1): 247-248
    PubMedGoogle Scholar
  • 4 Reinstein L. Hand dominance in carpal tunnel syndrome. Arch Phys Med Rehabil 1981; 62 (05) 202-203
    PubMedGoogle Scholar
  • 5 Mondelli M, Aprile I, Ballerini M. et al. Sex differences in carpal tunnel syndrome: comparison of surgical and non-surgical populations. Eur J Neurol 2005; 12 (12) 976-983
    CrossrefPubMedGoogle Scholar
  • 6 Nathan PA, Meadows KD, Istvan JA. Predictors of carpal tunnel syndrome: an 11-year study of industrial workers. J Hand Surg Am 2002; 27 (04) 644-651
    CrossrefPubMedGoogle Scholar
  • 7 Cranford CS, Ho JY, Kalainov DM, Hartigan BJ. Carpal tunnel syndrome. J Am Acad Orthop Surg 2007; 15 (09) 537-548
    CrossrefPubMedGoogle Scholar
  • 8 Roquelaure Y, Ha C, Pelier-Cady MC. et al. Work increases the incidence of carpal tunnel syndrome in the general population. Muscle Nerve 2008; 37 (04) 477-482
    CrossrefPubMedGoogle Scholar
  • 9 Spahn G, Wollny J, Hartmann B, Schiele R, Hofmann GO. [Metaanalysis for the evaluation of risk factors for carpal tunnel syndrome (CTS) Part II. Occupational risk factors] (in German). Z Orthop Unfall 2012; 150 (05) 516-524
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Kozak A, Schedlbauer G, Wirth T, Euler U, Westermann C, Nienhaus A. Association between work-related biomechanical risk factors and the occurrence of carpal tunnel syndrome: an overview of systematic reviews and a meta-analysis of current research. BMC Musculoskelet Disord 2015; 16 (16) 231
    CrossrefPubMedGoogle Scholar
  • 11 Roquelaure Y, Ha C, Nicolas G. et al. Attributable risk of carpal tunnel syndrome according to industry and occupation in a general population. Arthritis Rheum 2008; 59 (09) 1341-1348
    CrossrefPubMedGoogle Scholar
  • 12 Geoghegan JM, Clark DI, Bainbridge LC, Smith C, Hubbard R. Risk factors in carpal tunnel syndrome. J Hand Surg [Br] 2004; 29 (04) 315-320
    CrossrefPubMedGoogle Scholar
  • 13 Gelberman RH, Hergenroeder PT, Hargens AR, Lundborg GN, Akeson WH. The carpal tunnel syndrome. A study of carpal canal pressures. J Bone Joint Surg Am 1981; 63 (03) 380-383
    CrossrefPubMedGoogle Scholar
  • 14 Rydevik B, Lundborg G, Bagge U. Effects of graded compression on intraneural blood blow. An in vivo study on rabbit tibial nerve. J Hand Surg Am 1981; 6 (01) 3-12
    CrossrefPubMedGoogle Scholar
  • 15 Hargens AR, Romine JS, Sipe JC, Evans KL, Mubarak SJ, Akeson WH. Peripheral nerve-conduction block by high muscle-compartment pressure. J Bone Joint Surg Am 1979; 61 (02) 192-200
    CrossrefPubMedGoogle Scholar
  • 16 Keir PJ, Wells RP, Ranney DA, Lavery W. The effects of tendon load and posture on carpal tunnel pressure. J Hand Surg Am 1997; 22 (04) 628-634
    CrossrefPubMedGoogle Scholar
  • 17 Pękala PA, Henry BM, Pękala JR. et al. Congenital absence of the palmaris longus muscle: A meta-analysis comparing cadaveric and functional studies. J Plast Reconstr Aesthet Surg 2017; 70 (12) 1715-1724
    CrossrefPubMedGoogle Scholar
  • 18 Yammine K. Clinical prevalence of palmaris longus agenesis: a systematic review and meta-analysis. Clin Anat 2013; 26 (06) 709-718
    CrossrefPubMedGoogle Scholar
  • 19 Erić M, Koprivčić I, Vučinić N. et al. Prevalence of the palmaris longus in relation to the hand dominance. Surg Radiol Anat 2011; 33 (06) 481-484
    CrossrefPubMedGoogle Scholar
  • 20 Soltani AM, Peric M, Francis CS. et al. The variation in the absence of the palmaris longus in a multiethnic population of the United States: an epidemiological study. Plast Surg Int 2012; 2012: 282959
    Google Scholar
  • 21 Thompson NW, Mockford BJ, Cran GW. Absence of the palmaris longus muscle: a population study. Ulster Med J 2001; 70 (01) 22-24
    PubMedGoogle Scholar
  • 22 Roghani RS, Holisaz MT, Norouzi AAS. et al. Sensitivity of high-resolution ultrasonography in clinically diagnosed carpal tunnel syndrome patients with hand pain and normal nerve conduction studies. J Pain Res 2018; 11: 1319-1325
    CrossrefPubMedGoogle Scholar
  • 23 McDonagh C, Alexander M, Kane D. The role of ultrasound in the diagnosis and management of carpal tunnel syndrome: a new paradigm. Rheumatology (Oxford) 2015; 54 (01) 9-19
    CrossrefPubMedGoogle Scholar
  • 24 Beekman R, Visser LH. Sonography in the diagnosis of carpal tunnel syndrome: a critical review of the literature. Muscle Nerve 2003; 27 (01) 26-33
    CrossrefPubMedGoogle Scholar
  • 25 Goeghegan JM, Clark DI, Bainbridge LC, Smith C, Hubbard R. Risk factors in carapal tunnel syndrome. J Hand Surg [Br] 2004; 29B: 315-320
    CrossrefPubMedGoogle Scholar
  • 26 Karpitskaya Y, Novak CB, Mackinnon SE. Prevalence of smoking, obesity, diabetes mellitus, and thyroid disease in patients with carpal tunnel syndrome. Ann Plast Surg 2002; 48 (03) 269-273
    CrossrefPubMedGoogle Scholar
  • 27 Yagev Y, Carel RS, Yagev R. Assessment of work-related risks factors for carpal tunnel syndrome. Isr Med Assoc J 2001; 3 (08) 569-571
    PubMedGoogle Scholar
  • 28 Schaeffer JP. On the variations of the palmaris longus muscle. Anat Rec 1909; 3: 275-278
    Google Scholar
  • 29 Erić M, Krivokuća D, Savović S, Leksan I, Vucinić N. Prevalence of the palmaris longus through clinical evaluation. Surg Radiol Anat 2010; 32 (04) 357-361
    CrossrefPubMedGoogle Scholar
  • 30 Kigera JWM, Mukwaya S. Clinical assessment of the palmaris longus- accuracy of common tests. Ann of African Surgery. 2012; 9 (02) 104-107
    PubMedGoogle Scholar
  • 31 Shiri R, Varonen H, Heliövaara M, Viikari-Juntura E. Hand dominance in upper extremity musculoskeletal disorders. J Rheumatol 2007; 34 (05) 1076-1082
    PubMedGoogle Scholar