Reverse Palmaris Longus Case Study

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Twenty four cadavers used for dissection for the first year medical students of Amrita School of Medicine, Amrita Institute of Medical Sciences were studied serially in the years 2011-14. The flexor compartment was dissected using standard procedure based on Cunninghams Dissection Manual Volume I [6]. The presence, absence and morphological variations of palmaris longus, its nerve supply and its relation to flexor retinaculum and neighbouring structures were noted.
Of the forty eight limbs studied, thirty nine showed the classical textbook description (Figure 1) and in four specimens there was complete agenesis. The other morphological types there numbers and percentage are presented in Table 1.
In all cases it was supplied by the median nerve.
Agenesis of palmaris longus (Figure 2) are said to follow Mendialian
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Reverse palmaris longus was first described by Captain John T. Morrison in 1916 as an incidental post amputation finding [11].It may cause compartment syndrome in the Carpal tunnel and Guyons canal. The patient will present with pain and edema in the wrist region. This is an occupational hazard in people whose work involves repetitive wrist movements as it will result in hypertrophy and cause compression of median nerve and or ulnar nerve. This makes the modern day computer professional particularly vulnerable. Symptomatic patients presenting with a palpable volar swelling should be examined for variations in the palmaris longus. In an asymptomatic subject a hypertrophied muscle will obstruct and result in hazy interpretation of radiological assessment of this region. Difficulties in endoscopic procedure and electro myographic studies may also result from such a reversal
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