Prevalence of the palmaris longus through clinical evaluation

Purpose  

Most standard textbooks of hand surgery report on the rate of palmaris longus muscle absence of 15%. The aim of the study was to determine the absence of palmaris longus and to correlate it with age, sex and body side.     

Clinical relevance of palmaris longus agenesis: common anatomical aberration

Palmaris longus muscle, although of little functional use to the human upper limb, assumes great importance when used as a donor tendon for transfer or transplant. The variability in the prevalence of palmaris longus agenesis among various ethnic groups has been established, and the surgeon's awareness of the prevalence in a population or ethnic group is desirable. The prevalence of palmaris longus agenesis has, to the best of the authors' knowledge, not been reported in Indian patients. Five hundred Indian patients were examined for the presence or absence of palmaris longus tendon, using the conventional test for presence of palmaris longus. The prevalence and pattern of palmaris longus agenesis was analyzed statistically and any difference in prevalence or pattern of palmaris longus agenesis with regard to body side or sex was looked for. All statistical analysis was done using SPSS (version 12). chi2 test was used to analyze the association of agenesis with limb laterality and sex. The prevalence of palmaris longus agenesis was found to be 17.2% (8% bilateral and 9.2% unilateral). The prevalence of agenesis was significantly more common on the left side. Male subjects had a greater likelihood of unilateral agenesis, while female subjects were more likely to have bilateral agenesis. That prevalence of palmaris longus agenesis is race dependent is reaffirmed in the present study. Although the prevalence of palmaris longus agenesis in Indian patients was found to be much higher than the reported average prevalence in an Asian population, this tendon can still be counted on by surgeons treating Indian patients for use as a donor tendon, which will be present in a vast majority of Indian patients.     

The prevalence of absence of the palmaris longus muscle in the Bahraini population

Absence of the palmaris longus muscle has been well documented in several populations at a prevalence rate ranging between 2.2 and 63.9% which varies according to race, sex, and side of the body. There is little documentation of the prevalence of absence of this muscle from populations in the Arabian Gulf region. We examined 1,043 subjects, 3-85 years old, from the Kingdom of Bahrain for the presence or absence of the palmaris longus muscle using the conventional test for the presence of this muscle. Statistical analyses investigated the association of muscle absence with sex, hand dominance, and laterality. The palmaris longus muscle was absent in 36.8% of subjects. Bilateral absence (19%) was more common than unilateral absence (17.9%) with preponderance in female subjects. The muscle was absent more often on the left side than the right (P = 0.003). In the right upper limbs the muscle was absent in female subjects more than male subjects (P = 0.031). This study reaffirms that there is population variation in the frequency of absence of the palmaris longus muscle. The tendon of the palmaris longus bifurcated at the wrist in 7.1% of subjects, with male subjects showing this feature more frequently than female subjects in the right hand (P = 0.037) and the left hand (P = 0.030). This has not been reported before. The clinical significance of our findings is discussed.     

A case of an accessory palmaris longus muscle and a duplicate palmaris longus muscle with special reference to their nerve supply--morphologic significance of a common innervation trunk

During a dissection of the forearm and hand, a duplicate palmaris longus muscle with an accessory palmaris longus muscle was observed on the right side of a 73-year-old Japanese male cadaver. Duplications of the palmaris longus muscle have been reported by many authors. Humphry (1872) suggested the presence of radial, intermediate, and ulnar sectors in the superficial layers of the forearm flexor muscular angulus, based on a comparison of fore- and hind limbs and comparative anatomical theory. The palmaris longus muscle usually differentiates from the intermediate sector but differentiation from the other two sectors may also be possible. Some authors have asserted that a common innervation trunk is critical for determining an ontogenetic relation between the muscles (Fuchino, 1960; Honma, 1980; Yamada, 1986). We examined the nerve supply in addition to scrutinize these anomalous palmaris longus muscles. In our case, the ramification of the innervating nerves was specific. The branches to the second palmaris longus muscle and the flexor carpi radialis arose as a common trunk from the median nerve. The branches to the first palmaris longus muscle and the accessory palmaris longus muscle originated as another common trunk from the median nerve. From these observations, we speculated that the second palmaris longus muscle has differentiated from the flexor carpi radialis, while the accessory palmaris longus muscle has differentiated from the first palmaris longus muscle, based on Humphry's suggestion.     

A Case of the Bilateral Duplicate Palmaris Longus Muscles Coupled with the Palmaris Profundus Muscle

The palmaris longus muscle is one of the most variable muscles in human anatomy. During a routine anatomical dissection for medical students at Tottori University, we found duplicate palmaris longus muscles in the bilateral forearms together with the palmaris profundus muscle in the right forearm. The bilateral aberrant palmaris longus muscles were observed at the ulnar side of the palmaris longus muscle and their distal tendons were attached to the flexor retinaculum. The palmaris profundus muscle found in the right forearm was located at the radial side of the flexor digitorum superficialis muscle. The proximal tendon was originated from the anterior surface in the middle of the radius, while the distal tendon coursed radial to the median nerve through the carpal tunnel, finally inserting into the distal part of the flexor retinaculum. Both the palmaris longus and aberrant palmaris longus muscles were innervated by the median nerve. The palmaris profundus muscle was presumably supplied by the median nerve.     

Three-headed reversed palmaris longus muscle and its clinical significance

The palmaris longus muscle originates from the medial epicondyle of the humerus. After a short distance, almost in the middle of the forearm, the muscle belly is toggled into a broad tendon which is inserted into the flexor retinaculum and the palmar aponeurosis. After dissection of the left forearm of a 73-year-old female cadaver we found a reversed palmaris longus muscle. This means that the palmaris longus muscle was tendinous in its upper part and muscular in its lower part. Additionally, the muscle belly was triple, thus our finding was characterized as "three-headed reversed palmaris longus muscle". Rarely is the palmaris longus muscle double, whereas the three-headed reversed palmaris longus muscle is mentioned only once in the literature as a surgical finding, in a patient who suffered from edema and pain in the wrist [Yildiz, M., Sener, M., Aynaci, O., 2000. Three-headed reversed palmaris longus muscle: a case report and review of the literature. Surg. Radiol. Anat. 22, 217-219]. The overuse of the reversed palmaris longus muscle can lead to the muscle's local hypertrophy. According to the literature a reversed palmaris longus muscle may cause a compartment syndrome with pain and edema in the wrist's area, the carpal tunnel syndrome and Guyon's syndrome. The described variation is also useful to the hand surgeon, as the palmaris longus muscle is an anatomical landmark for operations at this area.     

掌长肌内神经血管的解剖学观察及其临床意义

目的：观察掌长肌肌内神经血管解剖分布,探讨该肌肉能否被分割为若干个功能单位,以提供新的功能性骨骼肌游离移植供区.方法：解剖10具10%福尔马林固定的成人尸体共20侧掌长肌,观察其肌外神经血管的分布形式.10具新鲜成人尸体标本共20侧掌长肌,一侧的掌长肌完整剥离后用Sihler＇s染色法行肌内神经的染色,另一侧掌长肌用30%硫酸钡、乳胶混悬液血管灌注并行X线钼靶摄片.而后对照观察神经、血管在肌内分布及其关系.结果：掌长肌血供多为尺侧返动脉和尺动脉肌支,4侧出现肱动脉肌支.其神经支配来自正中神经发出的神经支.该支在进入肌肉前多为1支,有动脉伴行,构成神经血管束.尺侧返动脉肌支和正中神经分支在肌内的分布区域大致吻合.结论：根据掌长肌肌内神经血管在肌内分布的不同情况,可将其分为一个近端和两个远端的3个功能单位,供节段性游离肌肉移植.     

改良带掌长肌腱静脉动脉化皮瓣移植修复指背皮肤肌腱缺损

目的：报道改良带掌长肌腱静脉动脉化皮瓣修复指背肌腱、皮肤复合组织缺损方法和效果。方法：在同侧前臂远端以掌长肌腱为中心寻找到两条并行的静脉，以此设计皮瓣，切断结扎静脉之间交通支，保护腱周血管网。复合组织皮瓣均采用顺行移植。结果：术后6例皮瓣均成活，经4~14个月平均8．5个月的随访，按TAM法疗效评定，5指均达优良。皮瓣柔软，弹性好。结论：改良带掌长肌腱静脉动脉化皮瓣移植，成活稳定，肌腱有血液供应，愈合良好，粘连轻。     

Intramuscular innervations of lower leg skeletal muscles: applications in their clinical use in functional muscular transfer

Purpose

This study aims to investigate nerve distribution patterns of human lower leg skeletal muscles using a modified Sihler’s staining method.

Methods

Sixteen lower leg from eight fresh adult cadavers were used in this study and all the skeletal muscles were dissected. The muscle specimens were classified according to Lim’s classification. The specimens were then stained by further modified Sihler’s staining technique. Data were analyzed according to research results.

Results

After the staining, we found four patterns of nerve distribution in human lower leg muscles: (1) Type 1: single nerve pattern in which the nerve branches into two either running parallel to each other or radiating in a spray pattern (such as the extensor digitorum longus, extensor hallucis longus, fibularis brevis and flexor hallucis longus). (2) Type 2: double nerve pattern, one being proximal and the other being distal (such as the extensor digitorum longus, flexor digitorum longus, flexor hallucis longus). (3) Type 3: multiple branch pattern (such as the tibialis anterior, fibularis longus, gastrocnemius, soleus, tibialis anterior and popliteus).

Conclusion

Our modified Sihler’s staining method is useful for research of large muscles and intramuscular nerves in human. These findings might provide guidance for clinicians for muscle reconstruction surgery.

     

Morphology of flexor digitorum accessorius muscle

Purpose  

Muscle flexor digitorum accessorius is the muscle of the second layer of the sole. It arises by two heads and gets inserted into the tendon of flexor digitorum longus muscle. A variant of this muscle has often been incriminated in causation of tarsal tunnel syndrome. The action and phylogenetic importance of this muscle remains a matter of disagreement among different researchers. The present study was planned to study the morphology of this muscle in human.     

The proximal origins of the flexor–pronator muscles and their role in the dynamic stabilization of the elbow joint: an anatomical study

Purpose

The purpose of this study was to anatomically investigate the proximal origin of flexor–pronator muscles (FPMs) and clarify their contribution to dynamic stabilization of the elbow joint during valgus stress.

Methods

52 elbows from 26 donated formalin-fixed cadavers were examined. The pronator teres muscle (PT), flexor carpi radialis muscle (FCR), palmaris longus muscle (PL), flexor digitorum superficialis muscle (FDS), and flexor carpi ulnaris muscle (FCU) were identified, and their proximal origin and relationship to the anterior bundle of the medial ulna collateral ligament (AOL) were macroscopically and histologically investigated.

Results

The PT, FCR, PL, and FDS converged and formed a common tendon at their proximal origin (the anterior common tendon: ACT). The ACT was attached to the medial epicondyle and the joint capsule, just anterior and parallel to the AOL. The histological morphology of the ACT was quite similar to that of the AOL. The ulnar head of the PT was observed in 48 of 52 elbows (92.3 %), just behind the humeral head of PT. It mainly originated from the anterior edge of the sublime tubercle, while the upper part of ulnar head transitioned directly into the thickened joint capsule just anterior to the AOL.

Conclusion

The proximal attachment of the FPMs had a characteristic morphology. According to our results, the ACT and PT might assist the AOL by sharing static and dynamic traction forces applied to the medial elbow joint.     

Carpal Tunnel Syndrome Caused by Space Occupying Lesions

Purpose

To evaluate the diagnosis and treatment of the carpal tunnel syndrome (CTS) due to space occupying lesions (SOL).

Materials and Methods

Eleven patients and 12 cases that underwent surgery for CTS due to SOL were studied retrospectively. We excluded SOL caused by bony lesions, such as malunion of distal radius fracture, volar lunate dislocation, etc. The average age was 51 years. There were 3 men and 8 women. Follow-up period was 12 to 40 months with an average of 18 months. The diagnosis of CTS was made clinically and electrophysiologically. In patients with swelling or tenderness on the area of wrist flexion creases, magnetic resonance imaging (MRI) and/or computed tomogram (CT) were additionally taken as well as the carpal tunnel view. We performed conventional open transverse carpal ligament release and removal of SOL.

Results

The types of lesion confirmed by pathologic examination were; tuberculosis tenosynovitis in 3 cases, nonspecific tenosynovitis in 2 cases, and gout in one case. Other SOLs were tumorous condition in five cases, and abnormal palmaris longus hypertrophy in 1 case. Tumorous conditions were due to calcifying mass in 4 cases and ganglion in 1 case. Following surgery, all cases showed alleviation of symptom without recurrence or complications.

Conclusion

In cases with swelling or tenderness on the area of wrist flexion creases, it is important to obtain a carpal tunnel view, and MRI and/or CT should be supplemented in order to rule out SOLs around the carpal tunnel, if necessary.     

Prevalence of pollen‐induced allergic rhinitis with high pollen exposure in grasslands of northern China

Background

The aim of this study was to investigate the prevalence of epidemiologic and physician‐diagnosed pollen‐induced AR (PiAR) in the grasslands of northern China and to study the impact of the intensity and time of pollen exposure on PiAR prevalence.

Methods

A multistage, clustered and proportionately stratified random sampling with a field interviewer‐administered survey study was performed together with skin prick tests (SPT) and measurements of the daily pollen count.

Results

A total of 6043 subjects completed the study, with a proportion of 32.4% epidemiologic AR and 18.5% PiAR. The prevalence was higher in males than females (19.6% vs 17.4%, P = .024), but no difference between the two major residential and ethnic groups (Han and Mongolian) was observed. Subjects from urban areas showed higher prevalence of PiAR than rural areas (23.1% vs 14.0%, P < .001). Most PiAR patients were sensitized to two or more pollens (79.4%) with artemisia, chenopodium, and humulus scandens being the most common pollen types, which were similarly found as the top three sensitizing pollen allergens by SPT. There were significant regional differences in the prevalence of epidemiologic AR (from 18.6% to 52.9%) and PiAR (from 10.5% to 31.4%) among the six areas investigated. PiAR symptoms were positively associated with pollen counts, temperature, and precipitation (P < .05), but negatively with wind speed and pressure P < .05).

Conclusion

Pollen‐induced AR (PiAR) prevalence in the investigated region is extremely high due to high seasonal pollen exposure, which was influenced by local environmental and climate conditions.     

Symptomatic palmaris longus muscle variation with MRI and surgical correlation report of a single case

Abstract A young woman presented with a painful soft tissue swelling of the anterior aspect of the distal forearm. MRI revealed a hypertrophied reversed palmaris longus muscle confirmed by surgery, which also showed a second insertion to the flexor carpi radialis tendon. Variants of the palmaris longus muscle are discussed.     

Muscle variations and abnormal branching and course of the ulnar nerve in the forearm and hand

During dissection of the right forearm of a 27-year-old female cadaver, variations in the form and insertion of the palmaris longus muscle were observed. The tendon of the palmaris longus muscle, which demonstrated a centrally placed belly, split into two tendons: one inserted into the palmar aponeurosis and the other into the proximal part of the flexor retinaculum. Additionally, we found an accessory muscle extending between the flexor retinaculum and the tendon of the abductor digiti minimi muscle. This accessory muscle was located deep to the ulnar artery but superficial to the superficial and deep branches of the ulnar nerve at the wrist. Finally, an aberrant branch of the ulnar nerve was identified in the forearm; it traveled distally alongside the ulnar artery and in the palm demonstrated communications with common palmar digital nerves from the ulnar and the median nerves. No variations were observed in the contralateral upper limb.     

Effect of smoking on lung function,respiratory symptoms and respiratory diseases amongst HIV-positive subjects: a cross-sectional study

Background  

Smoking prevalence in human immunodeficiency virus (HIV) positive subjects is about three times of that in the general population. However, whether the extremely high smoking prevalence in HIV-positive subjects affects their lung function is unclear, particularly whether smoking decreases lung function more in HIV-positive subjects, compared to the general population. We conducted this study to determine the association between smoking and lung function, respiratory symptoms and diseases amongst HIV-positive subjects.     

Anatomical study of the morphological continuity between iliotibial tract and the fibularis longus fascia

Purpose

Recent research indicates that the skeletal muscles of the human body do not function as independent actuators. Instead, they seem to be linked by connective tissue forming myofascial chains. While the existence of such meridians has been demonstrated for the ventral and the dorsal side of the body, no data are available for morphological fusion of lateral muscles. This study aimed to provide evidence for the inferior part of the lateral myofascial chain.

Methods

Fourteen legs (7 embalmed cadavers, four ♂, 86 ± 7 years) were dissected to reveal a potential myofascial continuity between the fibularis longus muscle, more detailed, its fascia, and the iliotibial tract (ITT). Three investigators judged the general existence as well as the degree and characteristics of the continuity. If an anatomical continuity was evident, strain was applied to both structures in order to evaluate the tissues’ ability for tensile transmission.

Results

An indirect connection between the iliotibial tract and the fascia of the fibularis longus muscle was found: in all examined legs, the ITT fused strongly with the crural fascia. The latter was hardly separable from the fibularis longus fascia. Application of strain to the ITT caused local movement in the crural fascia and the underlying fascia of the fibularis muscle.

Conclusions

The iliotibial tract fuses firmly with the crural fascia and the degree of continuity suggests that moderate amounts of strain might be transmitted. However, biomechanical studies precisely quantifying this tensile transmission are warranted in order to estimate the relevance of the linkage for the locomotor system.

     

Chronic fatigue syndrome in an ethnically diverse population: the influence of psychosocial adversity and physical inactivity

Background  

Chronic fatigue syndrome (CFS) is a complex multifactorial disorder. This paper reports the prevalence of chronic fatigue (CF) and CFS in an ethnically diverse population sample and tests whether prevalence varies by social adversity, social support, physical inactivity, anxiety and depression.     

Association of the absence of palmaris longus tendon with an anomalous superficial palmar arch in the human hand

The normal arterial supply to the human hand is via the ulnar and radial arteries which unite mid-palm to form a complete arch called the superficial palmar arch (SPA). From the SPA blood vessels pass anteriorly to supply the thumb and digits, and deeply to complete the deep palmar arch. Previous reports have documented anomalies of the SPA formation, and this may change the normal blood distribution to the thumb and the digits. There have also been reports of the absence of the palmaris longus tendon. A total of 47 embalmed cadaveric hands (some paired, some single) were dissected and the presence of an anomalous SPA was more frequently observed when the palmaris longus tendon was absent. This may be significant when considering the suitability of patients for hand surgery which involves interruption to the vascular supply to the hand, e.g. harvesting upper limb vessels for coronary artery grafting. The current techniques for assessing the vascular supply to the hand (Aliens test and/or Doppler ultrasounding) are unreliable. Demonstration of a palmaris longus tendon in the living arm is easy and the use of this in combination with the other techniques may improve overall reliability.     

Use of complementary and alternative medicine by cancer patients at the University of Nigeria Teaching Hospital,Enugu, Nigeria

Background  

The use of Complementary and Alternative Medicine (CAM) by cancer patients is very common and varies between populations. The referenced English literature has no local study from Africa on this subject. This study was conducted to define the prevalence, pattern of use, and factors influencing the use of CAM by cancer patients at the University of Nigeria Teaching Hospital Enugu (UNTH-E), Nigeria