البروفيسور فريح ابوحسان – استشاري جراحة العظام في الاردن

1. Absence of the Palmaris Longus Tendon in Mid Eastern Population
Frcih Odeh Abu Hassanr FRCS(Eng), FRCS (Tr & Orth) Samir Khaled Jabaitir, FRCS
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Abstract
Objectivet Determine the incidence ofthe absence ofthe palmaris longus tendon in the middle eastern population with
relation to gender, hand dominance.
Setting: Orthopaedic department, Plastia and reconstructive surgery department Jordan University Hospital -Amman
Methods: Between September 2004 and August 2007, we exam ined 1,020 Jordanian subjects, (5 l0 men, 5 10 women)
aged between six and 77 years (Mean 29.35 years) for the absence of Palmaris longus tendon. The examination was
done using the usual method of detection by firm opposition ofthe thumb to little.finger with slight wrist flexion. All
statistical analyses werc canied out using the statistical software programme SPSS (Version l4).
Results: In right-handed subjects bilateral absence was more common than unilateral absence, (p = 0.0002).Bilateral
absence in females and males was more common than unilateral absence, (p = 0.0013, and 0.0029), respectively.Overall
absence in females was more common than for males, (2 = 0.0069).
Conclusions: Ourfigures form another variability as the reported literatufe regarding the unilateral and bilateral absence,
furthermore this put middle eastern population comes second to the Turkish population in term ofthe overall prevalence
ofabsence and higher than the Cauoasian population. There is no statistical significance between the dominant hand and
the absent palmaris longus, (p - 0.632l.
Palmaris longus tendon is an essential tendon graft for different surgical specialities. lt is advisable forclinicians working
in the middle east region to be aware ofthese findings.
Key words: Palmaris longus tendon, Tendon graft, Middle East, Caucasian
i Dcpanment of Orlhopcdics and Plastic Surgery, Jordan University Hospital. Anman - Jordan.
Ernail: frcih(O iu.edu.io
70 JBMS Joumal ofthe Bahrain Medical Society,April 2008 Vol20,No.2

2. Absence oflhe Palmaris Lon8us Tendon ir Mid Eastern Populntion
lntroduction
The palmaris longus tendon is one of the accessory
tendons in the body and having a limired function, its
absence produces no disability r':.
It is well-known that unilateral or bilateral absence is
commonrr, and subjectto racial variations and anomaliest
6. There is peNistent conflict in the literature with regard
to the incidence in relation to gender and body side r'',
ln this study, we have tied to find a significalt difference
between palmaris longus tendon absence, g€nder and
hand dominance in a sample group of middle eastern
population .We lhen reviewed the literature regarding the
surgical uses ofthe palmaris longus tendon.
Patients and Methods
Anound, 1,020 Jordanian subjects (510 males, 510
females) aged between six and 77 yearc were studied
prospectively by the authors oyer a three-year period.
Individuals with a history of old trauma or abnormality
of the upper limbs were excluded. The standard method
ofexamination for palmaris longus was used and entailed
inspection of both volar aspects of distal forearms and
wrists at rest, looking for the palmaris longus tendon jusl
ulnar to the flexor carpi radialis tendon, then the subject
was asked to do firm opposition of the thumb to the little
finger, followed by gradual flexion of the wrist joints to
about twenty degrees. Ifthe tendon was not visualized or
palpable, it was considered absent.Patient gender, age, the
presence or absence ofthe tendon for both sides and hand
dominance was recorded on the check list
Statistical analysis
All statistical alalysesw€re carriedout using the statistical
software programme SPSS (Version l4).We analysed the
relationship between tendon absence, gender and hand
dominance.The Pearson chi-square test a I value < 0.05
was considered significant. The z-test for differences of
proponions was used (c = 0.05)
Results
Out of the total subjects, palmaris longus tendon was
present bilaterally in 61.37 /', absent bilaterally in
23.13%, and unilaterally in 15.49 % with an overall total
absence of38.62 % in one and both hands.
l- Right-handed subjects (Table-l )
ln males it is present in 66.5 o/. bilaterally, absent
unilaterally in l3o/. (6.13 % on the right side, 6.3 % on
the left side) and 20.42 o/. bilaterclly absent with overall
absence 33.47 %o.While in females it is present in 57.05
% bilaterally, absent unilaterally in 17.6E% ( 9.68 % on
the right side, 8yo on the left side) and 25.26 o/o bilaterally
absent with overall absence 42.94 o/o. ln right-handed
subjects bilateral absence more common tlran unilateml
absence. (p = 0.0002).
Thble-l; The incidence of palmajis tendon absence in relation to gender and dominant hand
Dominant hand Gcnder "l,j]j::"t Blateralabsenr
Bilatcral
uYCrAll atrs€nt present
Right M
Left
F
Totat
M
F
Total
Totol
62
(t3.Osqa
84
(I'7 .68Ea
t46
(ts.36c/o)
8
(22.9sa)
(t | .4Eo)
12
(ti .r4Eo)
158
(r5.49c/o)
9-1
(20.a2so)
120
(2s.26ca)
217
(22.84Co)
9
(25.1Eo
l0
(28.6Eo
l9
(27 .t+a/o)
236
(23.r3o/o)
t59
(33.4'7 ak)
204
(42.94Vo)
363
G8.2ta/.
l'l
(a8.6/o
T4
(4O.Oca)
31
(44.28c/a)
394
(38.62q")
3 L6
(66.s2o/o)
2't 1
(5'7 .05sc)
58?
6t.tah
18
(51.4o/o)
2l
60.0Ea
39
(s5;7 ta/o)
626
(61.31o/o)
4'15
(tooo/a)
4',75
(1ooEc)
950
(to0a/a)
t)
(IooEc)
J)
(to0Ea)
'70
(t00Ea
1020
( 1007o)
Right + Lefl
JBMS Joumal ofthc Bahrain Medical Society,April 2008 Vol 20,No.2 7I

3. Freih Odeh Abu Hassrn, Samir Khaled Jabaili
2- Left-handed subjects (Table- l)
In males it is present in 51.4 %o bilaterally, absent
unilaterally in 22.97o (8.6 % on the right side. 14.3 7o on
the left side) and 25.7 0/6 bilaterdly absent, while overall
absence in 48,6'/o. ln females it is present bilaterally in
60%, absent unilaterally in ll.4'/o ( 5.7 % on the right
side, 5.7 % on the left side), and 28.6 % bilaterally absent,
with ovenll absence beir.g 40o/o. Bilateral absence in the
left-handed is more common than unilateral absence,
but statistically not significant, (p:0.1542). The overall
absence in left-handed subjects is nore common than
in the right-handed but this is statistically insignificant.
(p = 0.3139). Bilateral absence in females and males is
more common than unilateral absence, (p = 0.0013, and
0.0029), respectively Bilateral absence in femalcs is
more commorl than in males, but this was not statistically
significant, (p = 0.0747); while an overall absence in
females is more than in males and this is statistically
significant. (.ir = 0.0069).
Discussion
The palmaris longus tendon is a slender, fusiform muscle,
lying on the volar aspect of the forearm medial to the
flexor carpi radialis']. lt is considered a phylogenetically
degenerating muscle with a short belly and long tendon {.
Its superficial location in the forearm, adequate length
and qidth, make it easily harvested without producing
any disability and a suitable choice in various surgical
proceduresr 7. lt is the ideal tendon graft for second-stage
replacement of the flexor terdons of the handl
3, in reconstructive tendon transfer for peripheral nerve
palsies in the upper limb'-rr, as a replacement in €xcision
arthroplastyr? 13, and pulley reconstruction in fingersr{. It
is used in ptosis corectionrs, lip reconstruction, p€rioral
and che€k reconstructionr6. and reconstruction for chronic
ankle joint, and elbow instability'1r3.
One ofthe essential land marks for injection in carpal tunnel
syndromere, and forthe insertion of acupuncture needles:0.
In humans the absence of the palmaris longus tendon
appearc to be hereditary with dominant transmission,
inoomplete penetrance and lateral variabilitya. From the
results of nunerous previous shldies investigating the
incidence of palmaris longus tendon absence there were
wide variations, the bilateral absence occurring in 4.6
o/o to 43.2 o/o of individuals, while the unilateral absence
occurring in 3.3 o/o to 20,7 7or l.Absent Palmaris longus
has been discussed before in many ethnic groups,
however, in the region of middle east this subject has not
been raised before.The highest reported total prevalence
of absence ofthe palmaris longus tendon is seen in the
Turkish population, beirg 640/0 !t
.
Caucasian populations have a 22.4 7o overall prevalence
ofthe abs€nce ofthe palmaris longus tendon which form
the second group'r' 'zr. While Asians have a 4.8 7o overall
prevalence of absence of the palmaris longus tendon
which forms the lowest group j.
Our figures form variability (bilateral absence- 23.13%;
unilateral absence - 15.49 % like most of the previous
studies of palmaris longus tendon absence in various
ethnic individualsr {
'?r. Our middle eastern population has
the 2"d highest prevalence of absence, 38.62%. Previous
studies have conflicted with regards to the absence in
relation to gender and body side3 d )r':r. In our sludy right
handed females have a higher incidence of absence than
males (p - 0.0069). (Figure -l)
Palmaris longu3 in.igh hand€d suti6cts
Unil.l€ralB:hlllal Ovoldll Elhtorrl
rbr.nc€ a!$nc. *r.nc. pr.sent
Po3anc6'Ablcnc. olpalmais longut
Figure.l: Prevalence of palmaris longus absence in relation
to gender in right halded subjects
These figures vary from the published reports where in
males it is more common than in femalesr. Furthermore
although the overall absence in left-handed subjects was
more oomnon than in the righGhanded subjects, but
statistically not significant: (p = 0.3139); (Figure -2).
perc€nlage olowall ,bsenc. in ralation lo hand domlnrnce
d
16.00%
11.00s
42.NX
Abl.ncr !10.00!.
38.00%
30.00$
34.009{
Sighihaided Leff handed
Domlndilh&d
Figure-2: Overall prevalence of palmaris longus
abscnce and hand dominance
Conclusion
Absent Palmaris longus has been discussed before in
many ethnic groups, however, in the region of Middle
East this subject has not been raised before. Affound
17 JBMS Journal ofrhe Bahrain Medical Society,April 2008 vol 20,No.2

4. Absence of the Palmaris Longus lbndon in Mid Eastcm Population
-18.62% of rniddle eastem population had absent palmaris
longus tendon, which put our population second to the
Turkish population in tenn of the oyenll prevalence
of absence of the muscle tendon and higher than the
Caucasian population. As palmaris longus tendon is an
essential tendon graft for different surgical specialities ,
it is advisable for clinicians working in the middle east
region to be aware ofthese findings, which form another
variations that is different from other ethnic groups.
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JBMS Jounal ofthe Bahrain Medical Sociery,April 2008 Vol20,No.2