The Palmaris longus may be strained with loaded wrist flexion, the associated Palmaris fascia may be injured with the use of hand tool that can inflict trauma, such as when pounding on an ice pick, sculpting fool or kitchen chopper when twisting with pressure while using trowels in gardening or when applying pressure with hand held tools in massage therapy, associated trauma can result in shortening of the connective tissue of the palm, similar to that seen in dupuytrens contracture (Madson, 1947).
Indicators for Treatment of Palmaris Longus
(a.) Diagnosis of dupuytrens contraction
(b.) Pricking sensation to the palm and anterior forearm (from trigger points) and
(c.) Tenderness in the palm, especially when working with hand Held tools.
Dupuytrens contracture: is a hand deformity in which the palm fascia contracts and thickens over time, the characteristics of dupuytrens contracture including:
Stage (1): A nodule of the palmar fascia that docs not include the skin with no change in the fascia.
Stage (2): A nodule in the fascia with involvement of the skin.
Stage (3): Same as stage 2 but with a flexion contracture of one or more fingers.
Stage (4): Same as stage 3 plus tendon arid joint contractures.
Due to slow progression, observation and minimal or no treatment are often indicated initially for dupuytren's contracture a non surgical intervention of injection coupled with forceful finger extension may be indicated surgical excision of the fascia may be necessary and the hand may take up to 25 percent of its grip power as a result. Heredity may be a factor in dupuytrens contracture, however it is important to rule out trigger points as part of the problem.
(4) Trigger points in this muscle may stimulate dupuytens contracture and may even produce flexion contracture of the finger.
A Distinguishing feature is that while dupuytrens- may cause a painful palm only, trigger points in Palmaris longus produce the pricking sensations (Cailiet, 1994) describe a spray and stretch technique that covers the anterior forearm and hand that is often beneficial to this condition. NMT hand and forearm protocols are also effective, the value of contrast, Hydro therapies should not be under estimated especially when followed with stretching not only is this therapy readily available and vary inexpensive, it can easily be self applied especially to the forearm and hand.
Prevention of injury in the forearm. Most key to maintaining healthy hands, particular care should be exercised when using tools that can damage the Palmaris fascia, work alternative tools for jobs that might Place stress on the tissues of the palm (Platzer et al., 2004).
Median Nerve Mistaken for Palmaris Longus Tendon Restoration of Function with Sensory Nerve
Intra operative iatrogenic nerve injuries occur despite vigilance in the operating room, most of those injuries occur as a result of patients positioning traction or pressure injury, Haematoma, technical error, the median nerve is especially, susceptible to injury during carpal tunnel release. A rare but devastating injury of the median nerve is complete transection, the number of devastating injuries is not well known, as few of the injuries are documented or publicized we report a case where the median nerve was harvested instead of the Palmaris longus tendon we present a review of the literature and suggest an alternative treatment to median nerve grafting using sensory nerve transfers to the hand. (Wehbe et al., 2007).
Palmaris Longus Test
The knowledge of the Palmaris longus muscle is a growing interest for its wide role in reconstructive plastic surgeries as a done or tendon for transfer or transplant, the prevalence of the Palmaris longus Agenesis has been well documented by many author in different ethnic groups or population many conventional tests for determining the presence of the Palmaris longus has been described, but lamentably there are many discrepancies in confirming its presence or absence, slight modifications of the prevailing methods can still give authenticate results this prospective study was conducted to determine the incidence of unilateral and bilateral agenesis of Palmaris longus and its association with sex and side of the limb.
A total of 942 subjects of both sexes belonging to 18-23 years were used to access the Palmaris longus using various tendon examination techniques including our modified Schaeffers test.
The data collected were analyzed by personals X2 test using (SPSS) soft ware, overall Agenesis of muscle in both sexes was 264 (28%) out of which 40.2% was seen in females and 14.7% in males with the ratio of 3:1 the unilateral Agenesis in 70.5% and bilateral Agenesis 29.5% subjects the left side Agenesis was seen in 51.6% and right side in 48.4% subjects. (Richard, 2008).
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