scholarly journals The Palmaris Longus and Its Association with Carpal Tunnel Syndrome

2020 ◽  
Vol 9 (06) ◽  
pp. 493-497
Author(s):  
Andrew D. Boltuch ◽  
Michael A. Marcotte ◽  
Christopher M. Treat ◽  
Anthony L. Marcotte
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Carpal Tunnel ◽  
Predictive Value ◽  
Carpal Tunnel Release ◽  
Longus Tendon ◽  
Palmaris Longus ◽  
Tunnel Syndrome ◽  
Palmaris Longus Tendon

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.

Palmaris profundus in the carpal tunnel

2021 ◽  
Vol 14 (8) ◽  
pp. e241328
Author(s):  
Theodore Paul Pezas ◽  
Rajive Jose
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Anatomical Variant ◽  
Longus Tendon ◽  
Raising Awareness ◽  
Tunnel Syndrome ◽  
Palmaris Longus Tendon ◽  
Secondary Causes

Carpal tunnel release is a routinely performed operation to relieve pressure caused by compression on the median nerve. In the majority of cases, the causation of the compression will be idiopathic. Among the secondary causes of median nerve compression is the palmaris profundus, a rare anatomical variant separate to the palmaris longus tendon. It has been suggested that it may cause carpal tunnel syndrome as it courses underneath the flexor retinaculum with the contents of the carpal tunnel reducing the space available to the median nerve. Several cases have found it intimately associated with the median nerve within the carpal tunnel. Raising awareness of this anatomical variant is therefore important for those undertaking carpal tunnel decompression in order to avoid unintended damage.

The Clinical Significance of the Palmaris Longus Tendon in the Pathophysiology of Carpal Tunnel Syndrome

2006 ◽  
Vol 31 (6) ◽  
pp. 657-660 ◽  
Author(s):  
G. R. KEESE ◽  
M. D. WONGWORAWAT ◽  
G. FRYKMAN
Keyword(s):  
Risk Factor ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Independent Risk Factor ◽  
Prospective Clinical Study ◽  
Absolute Increase ◽  
Longus Tendon ◽  
Palmaris Longus ◽  
Tunnel Syndrome ◽  
Palmaris Longus Tendon

Carpal tunnel syndrome is associated with increased intracarpal canal pressure. The effect of tendon loading on intracarpal canal pressures is documented in biomechanical studies. Palmaris longus loading in wrist extension induces the greatest absolute increase in intracarpal canal pressure. Despite this fact, the palmaris longus is not yet a proven independent risk factor for the development of carpal tunnel syndrome. The purpose of this prospective clinical study was to assess and quantify the association between the presence of a palmaris longus tendon and carpal tunnel syndrome. Thirty-six carpal tunnel subjects with bilateral disease were compared with 36 controls. Each subject was clinically examined for the presence of the palmaris longus tendon. The prevalence of palmaris longus agenesis was significantly lower in the carpal tunnel group. The palmaris longus tendon is a strong independent risk factor for carpal tunnel syndrome.

The Safest Location for Steroid Injection in the Treatment of Carpal Tunnel Syndrome

2005 ◽  
Vol 30 (4) ◽  
pp. 412-414 ◽  
Author(s):  
O. RACASAN ◽  
TH. DUBERT
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Steroid Injection ◽  
Major Complication ◽  
Longus Tendon ◽  
Palmaris Longus ◽  
Flexor Carpi Ulnaris ◽  
Tunnel Syndrome ◽  
Palmaris Longus Tendon

Steroid injections are routinely performed for carpal tunnel syndrome. Direct needle injury of the median nerve is the major complication of these injections. The safest location of the injection remains controversial. The purpose of this study is to define safe guidelines to avoid nerve injury. The distances between the Median nerve, Palmaris Longus, Flexor Carpi Ulnaris and Flexor Carpi Radialis tendons were measured preoperatively, 1 cm proximal to the distal wrist crease in 93 endoscopic carpal tunnel releases. We found that the median nerve extended ulnarly beyond the Palmaris Longus tendon in 82 hands (88%). It is concluded that the median nerve is at risk if the injection is performed within 1 cm on either the ulnar or radial side of the Palmaris Longus tendon. More ulnarly, there is risk to the ulnar pedicle. The safest location is to inject through the FCR tendon.

scholarly journals Anomalous Palmaris Longus Tendon Causing Carpal Tunnel Syndrome

2019 ◽  
Vol 52 (03) ◽  
pp. 360-361
Author(s):  
Harsh R. Shah ◽  
Amita Hiremath ◽  
Mukund R. Thatte
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Longus Tendon ◽  
Palmaris Longus ◽  
Tunnel Syndrome ◽  
Palmaris Longus Tendon

scholarly journals Role of ultrasound and electro-diagnostic studies in the diagnosis of carpal tunnel syndrome: A comparative study

2021 ◽  
Vol 9 (1) ◽  
pp. 29-39
Author(s):  
Benthungo N. Tungoe ◽  
Rajesh Kumar Chopra ◽  
Yatish Agarwal ◽  
Ashish Jaiman
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Sensitivity And Specificity ◽  
Carpal Tunnel ◽  
Diagnostic Tool ◽  
Predictive Value ◽  
Cross Sectional ◽  
Diagnostic Studies ◽  
Tunnel Syndrome

BACKGROUND: The current gold standard for the diagnosis of Carpal tunnel syndrome (CTS) is a topic of debate. Nerve conduction studies (NCS) traditionally have been used as the confirmatory test; however, ultrasound (USG) has garnered interest as an alternative diagnostic test for CTS. Ultrasound measurement of the cross sectional area of the median nerve at the carpal tunnel has been proposed as an alternative for confirmation of CTS. AIM: The aim of the study was to compare the sensitivity and specificity between Ultrasound and Electro-diagnostic Studies in the diagnosis of Carpal Tunnel Syndrome with reference to a validated clinical diagnostic tool i.e. CTS- 6; that combines findings from the history and physical examination. MATERIALS AND METHODS: 40 (20 Cases and 20 controls) adult patients and adolescents of both sexes with complain of pain and paraesthesia in upper limb were included in this cross sectional study. All patients were evaluated using CTS-6 clinical diagnostic tool. Those patients with CTS score12 were considered as positive diagnosis for Carpal Tunnel Syndrome (cases) (Main group). Those patients with CTS Score12 were taken as Controls. Ultrasound and Electro-diagnostic Studies were performed by individuals blinded to the results of the CTS-6 and ultrasound examination. RESULTS: We found that USG have sensitivity of 90%, specificity of 85%, and positive predictive value of 85.71% and negative predictive value of 89.47%. Whereas NCS have sensitivity of 85%, specificity of 80%, positive predictive value of 80.95% and negative predictive value of 84.21%. CONCLUSION: Using CTS-6 clinical tool as a standard reference, the sensitivity and specificity of USG is more than that of NCS.

Simultaneous modified Camitz opponensplasty using a pulley at the radial side of the flexor retinaculum in severe carpal tunnel syndrome

2013 ◽  
Vol 39 (6) ◽  
pp. 632-636 ◽  
Author(s):  
N. Kato ◽  
T. Yoshizawa ◽  
H. Sakai
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Radial Side ◽  
Palmaris Longus ◽  
Flexor Retinaculum ◽  
Tunnel Syndrome ◽  
Open Carpal Tunnel Release

Camitz opponensplasty using the palmaris longus has been used in patients undergoing open carpal tunnel release. It is considered to have several advantages over other opponensplasty techniques, but it provides weak flexion and pronation, which are prerequisites for opposition. To address this shortcoming, we have used a modified Camitz procedure with a pulley at the radial side of the dissected flexor retinaculum and have assessed the results in comparison with the conventional Camitz procedure. Both procedures provided significant improvements in palmar abduction and Disabilities of the Arm, Shoulder, and Hand and Kapandji scores at 3 months post-operatively, but patients who underwent the modified Camitz procedure showed better improvement in pulp pinch, palmar abduction, and thumb pronation.

scholarly journals Revision of Carpal Tunnel Release due to Palmaris Longus Profundus

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Lyrtzis Christos ◽  
Natsis Konstantinos ◽  
Pantazis Evagelos
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Transverse Carpal Ligament ◽  
Postoperative Course ◽  
Palmaris Longus ◽  
Tunnel Syndrome

Purpose. The palmaris longus profundus has been documented throughout the literature as a cause of carpal tunnel syndrome. We present a case of palmaris profundus tendon removal during the revision of carpal tunnel release.Method. During a carpal tunnel release in a 66-year-old woman, palmaris profundus tendon was found inside the tunnel under the transverse carpal ligament, just above the median nerve, but it was left intact. The patient complained of pain in the hand at night and weakness of her hand one month after surgery. We decided on a revision of the carpal tunnel release. The palmaris profundus tendon was found and was removed.Results. The patient had a normal postoperative course. Two months later she returned to her normal activities and was asymptomatic.Conclusions. When a palmaris profundus muscle is located in carpal tunnel, we recommend its excision during carpal tunnel release. This excision will eliminate the possibility of recurrent compression over the median nerve.

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