The palmaris longus is a

muscle Skeletal muscles (commonly referred to as muscles) are Organ (biology), organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other ...

visible as a small

tendon A tendon or sinew is a tough, high-tensile-strength band of dense fibrous connective tissue that connects muscle to bone. It is able to transmit the mechanical forces of muscle contraction to the skeletal system without sacrificing its ability ...

located between the flexor carpi radialis and the

flexor carpi ulnaris The flexor carpi ulnaris (FCU) is a muscle of the forearm that flexes and adducts at the wrist joint. Structure Origin The flexor carpi ulnaris has two heads; a humeral head and ulnar head. The humeral head originates from the medial epicondyle o ...

, although it is not always present. It is absent in about 14 percent of the population; this number can vary in African, Asian, and Native American populations, however. Absence of the palmaris longus does not have an effect on grip strength. The lack of palmaris longus muscle does result in decreased pinch strength in fourth and fifth fingers. The absence of palmaris longus muscle is more prevalent in females than males. The palmaris longus muscle can be seen by touching the pads of the fourth finger and thumb and flexing the wrist. The tendon, if present, will be visible in the midline of the anterior wrist.

Structure

Palmaris longus is a slender, elongated, spindle shaped muscle, lying on the medial side of the flexor carpi radialis. It is widest in the middle, and narrowest at the proximal and distal attachments.'' Gray's Anatomy'' (1918), see infobox It arises mainly from the

medial epicondyle of the humerus The medial epicondyle of the humerus is an epicondyle of the humerus bone of the upper arm in humans. It is larger and more prominent than the lateral epicondyle and is directed slightly more posteriorly in the anatomical position. In birds, whe ...

via the common flexor tendon. It also takes origin from the adjacent intermuscular septa and from the antebrachial fascia. It ends in a slender, flattened tendon, which passes over the upper part of the flexor retinaculum and inserts onto the central part of the flexor retinaculum and lower part of the palmar aponeurosis. Frequently, it sends a tendinous slip to the short muscles of the

thumb The thumb is the first digit of the hand, next to the index finger. When a person is standing in the medical anatomical position (where the palm is facing to the front), the thumb is the outermost digit. The Medical Latin English noun for thu ...

Nerve supply

The palmaris longus is innervated by the

median nerve The median nerve is a nerve in humans and other animals in the upper limb. It is one of the five main nerves originating from the brachial plexus. The median nerve originates from the lateral and medial cords of the brachial plexus, and has contr ...

Variation

The palmaris longus muscle is a variable muscle. The most common variation is its absence. Several ''in vivo'' and ''in vitro'' studies have documented the prevalence or absence of the PL tendon in different ethnic groups. Between 5.5 and 24% of Caucasian populations (European and North American) and 4.6 to 26.6% of Asian populations (Chinese, Japanese, Indian, Turkish, Malaysian) have been reported to lack the PL tendon. There are also variations related to its form. It may be tendinous above and muscular below; or it may be muscular in the center with a tendon above and below; or it may present two muscular bundles with a central tendon; or finally it may consist solely of a tendinous band. The muscle may be double, or missing entirely. Slips of origin from the

coronoid process The Coronoid process (from Greek , "like a crown") can refer to: * The coronoid process of the mandible, part of the ramus mandibulae of the mandible * The coronoid process of the ulna The coronoid process of the ulna is a triangular process proj ...

or from the radius have been seen. Partial or complete insertion into the fascia of the forearm, into the tendon of the

and pisiform bone, into the

scaphoid The scaphoid bone is one of the carpal bones of the wrist. It is situated between the hand and forearm on the thumb side of the wrist (also called the lateral or radial side). It forms the radial border of the carpal tunnel. The scaphoid bone ...

, and into the muscles of the

little finger The little finger, or pinkie, also known as the baby finger, fifth digit, or pinky finger, is the most ulnar and smallest digit of the human hand, and next to the ring finger. Etymology The word "pinkie" is derived from the Dutch word ''pi ...

have been observed.

Clinical significance

Use in tendon grafts

The palmaris longus muscle is the most popular for use in tendon grafts for the wrist due to the length and diameter of the palmaris longus tendon, and the fact that it can be used without producing any functional deformities. When a tendon becomes ruptured in the wrist, the palmaris longus tendon may be removed from the flexor retinaculum and grafted to take the place of the ruptured tendon. The tendons most commonly replaced or supplemented by the palmaris longus tendon when ruptured are the long flexors of the fingers and the

flexor pollicis longus The flexor pollicis longus (; FPL, Latin ''flexor'', bender; ''pollicis'', of the thumb; ''longus'', long) is a muscle in the forearm and hand that flexes the thumb. It lies in the same plane as the flexor digitorum profundus. This muscle is uniq ...

tendon. The palmaris longus muscle itself is a weak flexor, and provides no substantial flexing force that would inhibit movement in the wrist if its tendon were cut and moved elsewhere. The palmaris longus may contribute and assist in thumb abduction movements; an action necessary to open the hand. If the palmaris longus muscle is not available for harvesting in an individual, the anatomically homologous plantaris muscle in the leg may be taken instead. Using the patient’s own tendon is advantageous, as it does not introduce foreign material into the body.

Carpal tunnel syndrome and palmaris longus variants

Of the known anatomical variants of the palmaris longus, the reverse belly of the palmaris longus may be localized within the carpal tunnel producing symptoms of

carpal tunnel syndrome Carpal tunnel syndrome (CTS) is the collection of symptoms and signs associated with median neuropathy at the carpal tunnel. Most CTS is related to idiopathic compression of the median nerve as it travels through the wrist at the carpal tu ...

. Knowledge of this variation is important to prevent unnecessary carpal tunnel release surgery, in which the median nerve compression may remain unresolved due to the presence of this palmaris longus variant.

Other animals

Evolution

The evolutionary interpretation of the muscle's absence is that

human Humans (''Homo sapiens'') are the most abundant and widespread species of primate, characterized by bipedalism and exceptional cognitive skills due to a large and complex brain. This has enabled the development of advanced tools, culture, ...

s inherited the muscle through common descent, and numerous animals that humans share a common ancestor with (such as the

orangutan Orangutans are great apes native to the rainforests of Indonesia and Malaysia. They are now found only in parts of Borneo and Sumatra, but during the Pleistocene they ranged throughout Southeast Asia and South China. Classified in the gen ...

) still actively employ the muscle. Close primate relatives (such as the chimpanzee and

gorilla Gorillas are herbivorous, predominantly ground-dwelling great apes that inhabit the tropical forests of equatorial Africa. The genus ''Gorilla'' is divided into two species: the eastern gorilla and the western gorilla, and either four ...

) also do not actively employ the muscle, and hence they also demonstrate the same variability. The common descent principle suggests that at some stage our ancestors employed the muscle actively. The thumb apparatus (and particularly the

thenar muscle The thenar eminence is the mound formed at the base of the thumb on the palm of the hand by the intrinsic group of muscles of the thumb. The skin overlying this region is the area stimulated when trying to elicit a palmomental reflex. The word ...

group) then started developing in the hominin branch, and consequently the ''Palmaris longus'' became

vestigial Vestigiality is the retention, during the process of evolution, of genetically determined structures or attributes that have lost some or all of the ancestral function in a given species. Assessment of the vestigiality must generally rely on co ...

. As there is no apparent

evolutionary pressure Any cause that reduces or increases reproductive success in a portion of a population potentially exerts evolutionary pressure, selective pressure or selection pressure, driving natural selection. It is a quantitative description of the amount of ...

(positive or negative) concerning the muscle, it has remained largely unaffected by evolutionary processes.Maughan ''et al'': ''The Roles of Mutation Accumulation and Selection in Loss of Sporulation in Experimental Populations of Bacillus subtilis'' Genetics. 2007 Oct;177(2):937-48
/ref>

References

External links

PTCentral
{{Authority control Muscles of the upper limb