Medianopathy caused by reversed palmaris longus: A case report
Author(s): Suzan Pessers, Remco Meijer and Ralf Walbeehm
Abstract: The palmaris longus muscle has one of the most anatomic variations of all muscles in the human body and can variate in both number and form. The reversed palmaris longus can cause pain, wrist swelling and is a rare cause of median nerve compression and less frequently ulnar nerve compression. Therefore it is important to recognize and know of their anatomical variation. We present a case of a 32-year old woman with bilateral wrist pain, right more than left, consisting of pain originating from the flexor retinaculum and then spreading to the volar forearm, tingling in her hand and a cold feeling. X-rays AP and lateral of both wrists shows no abnormalities. Ultrasound of the right wrist reveals a distal muscle belly of the palmaris longus (reversed PL) causing the above-mentioned swelling. Electromyography (EMG) shows normal conduction of the median nerve in the carpal tunnel. MRI studies show a reversed palmaris longus, of which the muscle belly has a close relation to the median nerve. Under suspicion of a dynamic compression of the median nerve we decided to excise the muscle belly of the palmaris longus. At 6 weeks follow-up the complaints were all gone, there was a normal range of motion and the patient could participate in her daily life without complaints.
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