The treatment of Doyle types II and III mallet finger with the encircling fixation of a transplanted palmaris longus tendon

ObjectiveThis study aimed to investigate the clinical effect of the encircling fixation of a transplanted palmaris longus tendon in the treatment of Doyle types II and III mallet finger.MethodsThere were 115 cases of mallet finger deformity with Zone 1 extensor tendon rupture and defect. After debridement by first intention, the tendon bundles of the palmaris longus tendon were used to pass through the subcutaneous tunnel on the volar side of the base of distal phalanx, forming an encircling binding, crossing on the dorsal side. The tail of the tendon was then overlapped with the proximal extensor tendon and sutured. The finger extension position was fixed with plaster for four weeks. If the skin defect could not be closed directly, depending on the size of the skin defect, either a local turndown flap or a pedicled flap was used to cover the wound.ResultsThe patients were followed up for 3–12 months after the operation. According to Total Active Motion criteria, the clinical effect was excellent in 89 cases, good in 16 cases, acceptable in 7 cases, poor in 2 cases and inferior in 1 case. Conclusion: The treatment of Doyle types II and type III mallet finger with the encircling fixation of a transplanted palmaris longus tendon is simple and effective, with a low recurrence rate, few complications, and satisfactory results.     

Opponensplasty by abductor digiti minimi for hypoplastic thumb

Surgical Principles Improvement of pinching ability and opposition motion in cases of absence or marked hypoplasia of the thenar muscles. Transposition of the abductor digiti minimi muscle to the thumb in an own modification: lengthening by shifting its origin under careful preservation of blood and nerve supply to the palmaris longus tendon to give better appearance and enough to reach the metacarpophalangeal joint of the thumb and the extensor pollicis longus tendon.     

The prevalence of absence of the palmaris longus--a study in a Chinese population and a review of the literature

Most standard textbooks of hand surgery quote the prevalence of absence of palmaris longus at around 15%. However, this figure varies considerably in reports from different ethnic groups. We studied 329 Chinese men and women and found palmaris longus to be absent unilaterally in 3.3%, and bilaterally in 1.2%, with an overall prevalence of absence of 4.6%. There was no significant difference in its absence with regard to the body side or the sex. Our literature review revealed a low prevalence of absence in Asian, Black and Native American populations and a much higher prevalence of absence in Caucasian populations. It is clear that a standard prevalence of absence of the palmaris longus cannot be applied to all populations.     

Developmental anatomy of the palmar aponeurosis and its relationship to the palmaris longus tendon

The palmar aponeurosis and the palmaris longus tendon were examined in 33 hands of gestational age from 5 weeks to term. At 5 weeks both the longitudinal and transverse layers of the palmar aponeurosis and the palmaris longus tendon were present and in continuity. The palmaris longus tendon was absent in five specimens and in these the longitudinal fibers of the palmar aponeurosis blended into the antebrachial fascia. Otherwise the structure of the palmar aponeurosis was similar in the presence or absence of the palmaris longus tendon. The staining characteristics of the palmaris longus tendon were those of tendon whereas the palmar aponeurosis stained like fascia. These observations, as well as the fact that the palmar aponeurosis has never been reported to be absent, support the view of Kaplan that the palmar aponeurosis and the palmaris longus tendon are separate anatomic structures, which develop independently and are associated only by anatomic proximity.     

Functional absence of flexor digitorum superficialis to the little finger and absence of palmaris longus--is there a link?

We examined 150 men and 150 women aged 18-40 years to assess flexor digitorum superficialis function to the little finger and the incidence of palmaris longus absence. All patients had flexor digitorum superficialis function to the little finger assessed by standard and modified tests. The presence or absence of palmaris longus was assessed by clinical inspection. Following modified testing, ten subjects (14 hands) displayed absolute superficialis deficiency to the little finger. Forty-nine subjects had unilateral absence of palmaris longus (16%). This tendon was absent bilaterally in 26 subjects (9%). On combining the clinical findings, one subject had unilateral absence of flexor digitorum superficialis function to the little finger with contralateral absence of palmaris longus, and one subject had bilateral absence of flexor digitorium superficialis function with unilateral absence of palmaris longus. We conclude that there is no link between an absent little finger flexor digitorium superficialis and an absent palmaris longus.     

Resection of the palmaris longus tendon in surgery for Dupuytren's contracture

The present investigation presents preliminary results of the operative method, where resection of the palmaris longus tendon is combined with regional fasciectomy in the treatment of Dupuytren's contracture. This procedure was developed to prevent recurrence which has been the biggest problem in the treatment regardless the surgical methods employed. The investigation included 70 consecutive patients (80 hands) treated for Dupuytren's contracture; the mean follow-up time was 47 months (62 patients). 96% of the recurrences occurred during the first two years. 42 hands were treated with regional fasciectomy and in these 18 recurrences (43%) were observed. Recurrences were found only in 23% (6/26) of the patients in whom the palmaris longus tendon was eliminated. Following resection of the palmaris longus tendon recurrences manifested themselves mainly in the fingers in the nodular cutaneously fixed form. From the promising results and absence of side effects of resection of the palmaris longus tendon the procedure can be recommended combined with surgical treatment of Dupuytren's contracture.     

Does the absence of the palmaris longus affect grip and pinch strength?

The palmaris longus tendon is the most frequently harvested tendon for reconstructive plastic and hand surgical procedures. A question patients often ask is whether loss of the palmaris longus will result in any functional deficit. In order to answer this question, the presence or absence of the palmaris longus muscle was clinically determined in 418 normal Asian subjects. All subjects also had their grip and pinch strengths measured. No statistically significant difference was seen in the grip or pinch strength measurements between subjects who had a palmaris longus tendon and those who did not. This study demonstrates that absence of the palmaris longus is not associated with a decrease of grip or pinch strength.     

Frequency of the palmaris longus tendon in North American Caucasians

The palmaris longus tendon was reported absent in North American Caucasians 24.4% of the time in one or both arms, by Thompson in 1921. Some studies have described its absence as being more frequent in females, and its bilateral absence more frequent than its unilateral absence. This study randomly evaluated 200 Caucasian patients (100 of each sex), seen in an office or hospital setting, for the presence of the palmaris longus tendon. It was absent in one extremity in 3% of the patients. Two and one-half percent of the patients had bilateral absence for a 5.5% total overall absence. This study demonstrated that absence of the palmaris longus tendon in North American Caucasians was considerably lower than reported by Thompson in his report in 1921.     

The relationship between Vesalius and the Borgarucci family

Two of the four brothers Borgarucci were medical doctors and in one way or another, be it distantly, connected with the great master Vesalius. Giulio Borgarucci was a physician, who became a Calvinist and emigrated to England where he treated many noblemen and friends of Queen Elisabeth I. He was present at a conversation between the Italian writer and traveler Pietro Bizzari and the Venetian jeweler who witnessed Vesalius’ death in Zakynthos. Prospero Borgarucci became professor of anatomy and surgery in Padua, some 20 years after Vesalius. He published several treatises on anatomy, pestilential disease, and materia medica. Prospero Borgarucci became physician to Queen Catherine de Medicis in France, and to Archduke Karl II of Habsburg in Graz. His most important work is the so-called Chirurgia Magna of Vesalius. Text and illustrations of this spurious Vesalian work point to the use of passages of the Epitome, surgical college notes and copied Vesalian images in Borgarucci’s Chirurgia Magna.     

Anatomical variations of the palmaris longus muscle including its relation to the median nerve – a proposal for a new classification

Background

The palmaris longus (PL) muscle is characterised by high morphological diversity, and its tendon crosses the median nerve (MN) at different levels. Due to the fact that the palmaris longus tendon is routinely harvested for reconstruction of other tendons, knowledge of its morphological variations is clinically important. Therefore, the purpose of the study was to suggest a new morphological classification of the PL muscle and characterise the relationship of its tendon to the median nerve.

Methods

Standard dissection was performed on 80 randomised and isolated upper limbs (40 left and 40 right) fixed in a 10% formalin solution. Measurements of muscle belly and tendon were obtained. The course and location of tendon insertion, as well as its relationship to the median nerve, were noted.

Results

The palmaris longus muscle was present in 92.5% of specimens. Three types of palmaris longus muscle were identified based on the morphology of its insertion (types I-III) and these were further subdivided into three subgroups (A-C) according to the ratio of the length of the muscle belly and its tendon. The most frequent was type I (78.8%), where the tendon attached to the palmar aponeurosis, and subtype B, where the tendon-to-belly ratio was 1–1.5 (41.1%). The mean distance from the interstyloid line to the crossing between the median nerve and the palmaris longus tendon was 31.6 mm. In addition, two types of palmaris longus were described.

Conclusion

The presented classification of palmaris longus muscle types allows a better characterization of its diversity and may be useful in planning tendon grafting.

     

The clinical significance of the palmaris longus tendon in the pathophysiology of carpal tunnel syndrome

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.     

Results of Long-Term Follow-Up Observations of Blepharoptosis Correction Using the Palmaris Longus Tendon

BACKGROUND: The frontalis sling procedure is a useful approach for correcting severe blepharoptosis. However, blepharoptosis often recurs after corrective surgery using the tensor fascia lata. Good results without recurrence after a modified Fox method were obtained using the palmaris longus tendon. This study examined the safety and validity of the surgical method using the palmaris longus tendon through long-term follow-up observations. METHODS: To reduce the rate of recurrence, the highest point on the pentagon of the Fox method was fixed to the frontalis fascia and frontalis muscle. It was fixed once again to the area 1 cm above the highest point. This approach remarkably reduces the incidence of recurrence by fixing the pentagon of the Fox method not only to the palmaris longus tendon but also to the frontalis fascia and again to the frontalis muscle. A modified Fox method using the palmaris longus tendon was used to treat 16 eyelids of 10 patients. A senior surgeon performed the procedure in all cases under local anesthesia. RESULTS: The mean follow-up period was 51 months (range = 18-86 months). There was no case of blepharoptosis recurrence and a good field of view was secured after surgery. Long-term follow-up revealed that the visual field had been well secured with a mean MRD1 of 3.1 mm. The eyelids were well maintained without any postoperative adverse reaction such as exposure keratitis. CONCLUSION: The palmaris longus tendon as useful donor material does not lead to recurrence of blepharoptosis, which is often encountered when the tensor fascia lata is used. The modified Fox method using the palmaris longus tendon can be an effective and valid surgical approach that produces both immediate and long-term results.     

Is there an association between an absence of palmaris longus tendon and an absence of plantaris tendon?

Summary Tendon grafts are frequently required, particularly in reconstructive hand surgery. Palmaris longus has been the commonest donor tendon but its absence is quoted in the literature to be about 13%. Plantaris is then often sought as a substitute, and although there is less documentation about its incidence of absence, it appears to be not present in about 7% of cadavers. An anatomical study has been undertaken to see if there is a correlation in the absence of one with an absence of the other, as there appears to be no previous literature on the subject. Of 150 cadavers dissected, there was only one case of absence of all four tendons. In another body, one plantaris was absent with both palmaris longus tendons missing. There was a 7.3% incidence of absence of plantaris. Palmaris longus was absent in 16% of cadavers, bilaterally in 7.3% and unilaterally in 8.66% of cases. The conclusion of the study is that if palmaris longus is missing, unilaterally or bilaterally, there is no evidence to show that plantaris will also be absent.     

自体双股掌长肌腱联合人工韧带重建喙锁韧带治疗肩锁关节脱位

目的:探讨应用自体双股掌长肌腱联合人工韧带重建喙锁韧带治疗肩锁关节脱位的手术方法及临床疗效。方法:2006年4月至2009年6月采用自体双股掌长肌腱联合人工韧带重建喙锁韧带治疗肩锁关节脱位31例,男18例,女13例;年龄18～60岁,平均35岁;急性损伤26例,慢性损伤5例。术前患者主要表现为不同程度肩部疼痛、活动受限、肩锁不稳,X线提示肩锁关节脱位。结果:术后切口愈合好,无一例血管及臂丛神经损伤。全部病例获得随访,平均时间23个月,JOA评分术前(38.8±1.5)分,术后1个月(73.2±1.1)分,末次随访(93.5±0.8)分。本组优28例,良2例,一般1例。结论:应用自体双股掌长肌腱联合人工韧带重建喙锁韧带同时行锁骨远端部分切除是治疗肩锁关节脱位的有效方法。     

Free transplantation of autogenous palmaris longus tendon in the repair of cicatricial ectropion of lower eyelid

Abstract

Treatment of cicatricial lower eyelid ectropion is often difficult and requires surgical intervention. Numerous techniques have been developed over the years to treat the cicatricial lower eyelid ectropion. This article describes an effective surgical technique using the free transplantation of autogenous palmaris longus tendon in the repair of cicatricial lower eyelid ectropion. The operation was performed with the patient under local anaesthesia. After the contracture of the lower eyelid skin or conjunctiva had been thoroughly released, a palmaris longus tendon graft was obtained through small transverse incisions along the non-dominant forearm. The graft is suspended between the medial canthal ligament and lateral orbital rim with proper tension. Then a local skin flap was transferred to cover the wound at the lower eyelid. In this study, 15 patients were treated using autogenous palmaris longus tendon between December 2008 and October 2012. At the 9–18 months of follow-up assessment, there were no major complications reported with any of the cases, and all have achieved good function and satisfactory appearance of the lower eyelid. However, five patients (33%) still had lagophthalmos, but it was in remission. In conclusion, free transplantation of autogenous palmaris longus tendon in the repair of cicatricial ectropion of the lower eyelid is an effective procedure for cicatricial ectropion, the functional and cosmetic results were satisfactory, the recurrence rate is low. Especially for the moderate and severe ectropion this method is a good choice.     

Efficacy of interference screw and double-docking methods using palmaris longus and GraftJacket for medial collateral ligament reconstruction of the elbow

Single-strand elbow medial collateral ligament reconstruction strength was evaluated by use of double-docking and interference screw methods with either a palmaris longus tendon or GraftJacket as the reconstruction material. Thirteen upper extremities were mounted in 90 degrees of valgus orientation and subjected to cyclic valgus loading that increased progressively until failure occurred. The double-docking reconstructions outperformed the interference screw reconstructions (P < .05), whereas the palmaris longus and GraftJacket performed comparably (P > .05). The favorable initial strength of the GraftJacket make it a potentially viable alternative to the use of autogenous palmaris longus tendons; however, further studies are required to evaluate graft strength during healing. The clinical use of the double-docking technique of single-strand medial collateral ligament reconstruction should be considered because of its simplicity and initial strength.     

On the form and function of the abductor pollicis brevis muscle.

The abductor pollicis brevis muscle acts in conjunction with the palmaris longus and the abductor pollicis longus to abduct the first metacarpal in the sagittal plane. Segments of the abductor pollicis brevis which arise from the tendons of the palmaris longus and/or the abductor pollicis longus and are inserted into the extensor expansion are the lumbricals of the thumb. The lateral border of the abductor pollicis brevis presents an important muscular (in four cases out of ten neurovascular) hilum. The tendinous slip to the abductor pollicis brevis from the palmaris longus presents near its origin an orifice which the palmar branch of the median nerve traverses to become superficial.     

Prevalence of the palmaris longus muscle and its relationship with grip and pinch strength: a study in a Turkish pediatric population

Clinical studies generally reveal a trend of variation in the reported prevalence of the palmaris longus (PL) muscle absence. The aim of this study was to find an answer to the question of whether the congenital absence of tendon would affect hand functions or not. A total of 585 subjects, comprised of 305 males and 280 females, were included in our study. Mean age was 8.9?±?1.4 standard deviation within a range of 6–11. For both sexes, the groups were divided further into three subgroups including 6–7, 8–9, and 10–11 years of age ranges. The grip strength of each hand and pinch strength of all fingers of each subject were measured separately. The absence of PL tendon in the right hand was 35.4 % in females, 25.9 % in males, and 30.4 % in overall average. The distribution of absence of the palmaris longus muscle between both genders was statistically significant. The p value for the right hand was 0.013. The absence of PL tendon in the left hand was 37.5 % in females, 27.9 % in males, and an overall average of 32.5 %. The p value for the left hand was 0.017. In terms of grip strength, a comparison between females and males did not reveal a significant difference. The pinch strength of the second fingers of both hands did not show any difference in both sexes. Pinch strength of the third finger of the right hand was different only in girls of subgroup 6–7 ages (p?=?0.024). In girls, the pinch strength of the fourth finger of the right hand of subgroups 6–7 and 10–11 ages showed difference (p?=?0.009 and p?=?0.026, respectively). In boys, the fourth finger in subgroup of 8–9 ages showed significant difference in both hands (p?=?0.011). The fifth fingers of both hands were found different in males for only subgroup of 8–9 ages (p?=?0.001). Pinch strength of the fifth finger of the right hand was different in females for only subgroups of 6–7 and 10–11 ages (p?=?0.023 and p?=?0.047, respectively). While grip strength of the hand was not affected in the case of absence of the palmaris longus, in both sexes, pinch strength of the fourth and fifth fingers of both hands decreased.     

The correction of ulnar claw fingers: a follow-up study comparing the extensor-to-flexor with the palmaris longus 4-tailed tendon transfer in patients with leprosy

PURPOSE: The extensor to flexor 4-tailed tendon transfer (EF4T) and the palmaris longus 4-tailed tendon transfer (PL4T) are 2 surgical procedures used to correct intrinsic paralysis of the hand in leprosy. The EF4T traditionally is the more common procedure and requires the transfer of a wrist extensor muscle. The PL4T requires the transfer of the palmaris longus and morbidity is expected to be lower. A follow-up study was performed to determine whether the clinical outcome of the PL4T is superior to the EF4T procedure in leprosy patients with ulnar claw fingers that are considered mobile before surgery. METHODS: Fifty-five patients presented 65 affected hands, of which 40 hands had the PL4T and 25 had the EF4T procedure. Each hand was assessed before surgery and at follow-up evaluation by predetermined angle measurements, standardized photographs, mechanical function, and patient satisfaction. Each hand was given an overall technical grade according to previously published standards. RESULTS: After an average follow-up period of 33 months there was no statistically significant difference in the technical outcome or patient satisfaction between the 2 tendon transfer procedures. CONCLUSIONS: Whenever the palmaris longus is available it may be considered to be the motor tendon of choice to undertake a many-tailed procedure for claw finger reconstruction in mobile hands paralyzed by leprosy. The palmaris longus should be considered as a possible motor tendon when correcting intrinsic muscle paralysis of the hand.     

微型骨锚联合掌长肌腱片移植治疗陈旧性锤状指畸形

目的:探讨采用微型骨锚和掌长肌腱片移植治疗陈旧性锤状指的临床疗效。方法:自2008年1月至2013年6月,采用微型骨锚和掌长肌腱片移植治疗26例陈旧性锤状指患者,其中男18例,女8例;年龄18～52岁,平均(32.0±1.3)岁;机器绞伤8例,摔伤6例,打架扭伤6例,自发性断裂4例,刀伤2例。16例患者伸肌腱止点无肌腱附丽,10例有0.3～0.5 cm残留肌腱附丽。患者均有手指末节屈曲畸形,背伸活动障碍。术中将远侧指间关节予以克氏针固定于伸直10°～20°位,运用微型骨锚重建伸肌腱止点,取掌长肌腱片移植伸肌腱止点缺损区,4周后拆除克氏针,辅以石膏外固定下行功能锻炼。观察术后并发症情况,并采用Dargan功能评定标准对手指功能进行评价。结果:术后所有患者获随访,时间6～14个月,平均(5.0±0.3)个月。术后发生创口浅表感染2例,皮肤压迫性溃疡2例,关节活动障碍1例,均予以对症治疗后好转;发生创伤性关节炎2例,1例治疗后好转,另1例存在长期慢性疼痛;无内固定松动、断裂和肌腱断裂发生。按照Dargan功能评定标准评价手指功能,优17例,良8例,差1例。结论:采用微型骨锚结合掌长肌腱片治疗陈旧性锤状指畸形,具有手术操作简单,固定牢靠,并发症少,临床疗效肯定等优点,值得临床推广。