That Tendon is the Median Nerve: Perils of a Palmaris Longus Deficient Wrist

The Journal of Hand Surgery Asian-Pacific Volume
Colin Yi-Loong WoonPrasad Gourineni

Abstract

To document the course of the median nerve in the distal forearm in palmaris longus (PL) deficient forearms and elucidate features that help distinguish it from the PL. In the cadaveric study, 56 cadaveric forearms were dissected and the location and course of the median nerve were documented. In the clinical study, 20 healthy subjects with absent PL were examined with provocative tests to elucidate the PL (Schaeffer's test and Thompson's test), and modified Durkan's and Phalen's tests. In the imaging study, one subject with a clearly visible and palpable median nerve was further evaluated with MRI with a superficial fiducial marker. Cadaveric dissection revealed that the median nerve was deep to the antebrachial fascia and superficial to the FDS tendons in the distal forearm. In 9 specimens without a PL, the median nerve was the most superficial structure deep and lay draped over the FDS tendons. In the clinical study, PL absence was bilateral in 4 subjects and unilateral in 16. The nerve was visible and palpable in 4 forearms and palpable but not visible in 20 forearms. In all 24 forearms, the nerve was palpable as a lax, mobile, cord-like structure that could be rolled over the taut FDS tendons. Tinel's and Durkan's signs we...Continue Reading

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Citations

Jun 9, 2018·The Journal of Hand Surgery, European Volume·Christine C JohnsonScott W Wolfe
Jul 25, 2019·The Journal of Hand Surgery, European Volume·Russell E HolzgrefeMichael B Gottschalk
Oct 31, 2020·Surgical and Radiologic Anatomy : SRA·Nurdan FidanCuneyt Yucesoy

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