Palmaris profundus muscle

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Palmaris profundus
Palmaris profundus 2015.jpg
Palmaris profundus muscle originates from the lateral edge of radius and inserts to palmar aponeurosis.
Details
Origin Lateral edge of radius, ulna, flexor digitorum superficialis or medial epicondyle of humerus
Insertion Palmar aponeurosis
Artery Ulnar artery
Nerve Median nerve, anterior interosseous nerve or ulnar nerve
Actions Wrist flexor
Identifiers
Latin Musculus palmaris profundus
Anatomical terms of muscle

Palmaris profundus (also known as musculus comitans nervi mediani [1] or palmaris bitendinous [2] ) is a rare anatomical variant in the anterior compartment of forearm. It was first described in 1908. [3] It is usually found incidentally in cadaveric dissection or surgery.

Contents

Structure

Pirola et al. [4] classified the muscle into subtypes depending on its origin: (1) from the radius, (2) from the flexor digitorum superficialis fascia, and (3) from the ulna. Though, other origins of the muscle were reported including the medial epicondyle of humerus, [1] the palmaris longus [2] and the flexor pollicis longus. [5] It runs deep to the pronator teres and lateral to the flexor digitorum superficialis. Its tendon passes beneath the flexor retinaculum through the carpal tunnel before broadening out to insert to the deep part of palmar aponeurosis.

In many cases, the muscle is contained within the same fascial sheath as the median nerve. To indicate this association, the term musculus comitans nervi mediani is often used. [1] It can also be referred to as the palmaris bitendinosus when originating from the palmaris longus. [2] It can be considered a variation of the palmaris longus, however, it may exist in addition to the palmaris longus. If both of them coexist, the aberrant palmaris profundus tends to be the deeper one. [6]

Nerve supply to the palmaris profundus varies. Innervations by the median nerve, anterior interosseous nerve or the ulnar nerve were reported. [7]

Function of the palmaris profundus is similar to the palmaris longus. It is a flexor of the wrist.

Clinical significance

The presence of the palmaris profundus is often associated with median nerve compression and carpal tunnel syndrome as available space for the median nerve decreases due to the presence of an additional tendon. [4] It may also complicate the surgical release of the carpal tunnel.

It may compress the anterior interosseous nerve, a motor branch of the median nerve, causing a condition called anterior interosseous nerve syndrome. [8]

See also

Related Research Articles

Median nerve Nerve of the upper limb

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.

Wrist part of the arm between the lower arm and the hand

In human anatomy, the wrist is variously defined as 1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand; (2) the wrist joint or radiocarpal joint, the joint between the radius and the carpus and (3) the anatomical region surrounding the carpus including the distal parts of the bones of the forearm and the proximal parts of the metacarpus or five metacarpal bones and the series of joints between these bones, thus referred to as wrist joints. This region also includes the carpal tunnel, the anatomical snuff box, bracelet lines, the flexor retinaculum, and the extensor retinaculum.

The flexor digitorum profundus is a muscle in the forearm of humans that flexes the fingers. It is considered an extrinsic hand muscle because it acts on the hand while its muscle belly is located in the forearm.

Flexor digitorum superficialis muscle muscle of the upper limb

Flexor digitorum superficialis is an extrinsic flexor muscle of the fingers at the proximal interphalangeal joints.

Ulnar nerve nerve which runs near the ulna bone

In human anatomy, the ulnar nerve is a nerve that runs near the ulna bone. The ulnar collateral ligament of elbow joint is in relation with the ulnar nerve. The nerve is the largest in the human body unprotected by muscle or bone, so injury is common. This nerve is directly connected to the little finger, and the adjacent half of the ring finger, innervating the palmar aspect of these fingers, including both front and back of the tips, perhaps as far back as the fingernail beds.

Upper limb arm (hand + forearm + upper arm + shoulder)

The upper limb or upper extremity is the region in a vertebrate animal extending from the deltoid region up to and including the hand, including the arm, axilla and shoulder.

Ulnar artery Artery of the forearm

The ulnar artery is the main blood vessel, with oxygenated blood, of the medial aspect of the forearm. It arises from the brachial artery and terminates in the superficial palmar arch, which joins with the superficial branch of the radial artery. It is palpable on the anterior and medial aspect of the wrist.

The flexor pollicis longus is a muscle in the forearm and hand that flexes the thumb. It lies in the same plane as the flexor digitorum profundus.

Anterior interosseous artery

The anterior interosseous artery is an artery in the forearm. It is a branch of the common interosseous artery.

Vincula tendina

Within each osseo-aponeurotic canal, the tendons of the flexor digitorum superficialis and flexor digitorum profundus are connected to each other, and to the phalanges, by slender, tendinous bands, called vincula tendina.

Anterior interosseous nerve branch of the median nerve

The anterior interosseous nerve is a branch of the median nerve that supplies the deep muscles on the anterior of the forearm, except the ulnar (medial) half of the flexor digitorum profundus. Its nerve roots come from C8 and T1.

The posterior compartment of the forearm contains twelve muscles which are chiefly responsible for extension of the wrist and digits, and supination of the forearm. It is separated from the anterior compartment by the interosseous membrane between the radius and ulna.

Carpal tunnel passageway on the palmar side of the wrist that connects the forearm to the hand

In the human body, the carpal tunnel or carpal canal is the passageway on the palmar side of the wrist that connects the forearm to the hand.

Cervical spinal nerve 8

The cervical spinal nerve 8 (C8) is a spinal nerve of the cervical segment.

Anterior interosseous syndrome is a medical condition in which damage to the anterior interosseous nerve (AIN), a distal motor and sensory branch of the median nerve, classically with severe weakness of the pincer movement of the thumb and index finger, and can cause transient pain in the wrist.

Pronator teres syndrome compression neuropathy of the median nerve at the elbow

Pronator teres syndrome is a compression neuropathy of the median nerve at the elbow. It is rare compared to compression at the wrist or isolated injury of the anterior interosseous branch of the median nerve.

Median nerve palsy

Injuries to the arm, forearm or wrist area can lead to various nerve disorders. One such disorder is median nerve palsy. The median nerve controls the majority of the muscles in the forearm. It controls abduction of the thumb, flexion of hand at wrist, flexion of digital phalanx of the fingers, is the sensory nerve for the first three fingers, etc. Because of this major role of the median nerve, it is also called the eye of the hand. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers. Tendon transfers have been very successful in restoring motor function and improving functional outcomes in patients with median nerve palsy.

Muscles of the thumb

The muscles of the thumb are nine skeletal muscles located in the hand and forearm. The muscles allow for flexion, extension, adduction, abduction and opposition of the thumb. The muscles acting on the thumb can be divided into two groups: The extrinsic hand muscles, with their muscle bellies located in the forearm, and the intrinsic hand muscles, with their muscles bellies located in the hand proper.

Linburg–Comstock variation is an occasional tendinous connection between the flexor pollicis longus and the flexor digitorum profundus of the index, the middle finger or both. It is found in around 21% of the population. It is an anatomical variation in human, which may be viewed as a pathology if causes symptoms. It was recognised as early as the 1800s, but was first described by Linburg and Comstock in 1979.

References

  1. 1 2 3 Sahinoglu, K.; Cassell, M. D.; Miyauchi, R.; Bergman, R. A. (1994-06-01). "Musculus comitans nervi mediani (M. palmaris profundus)". Annals of Anatomy - Anatomischer Anzeiger. 176 (3): 229–232. doi:10.1016/s0940-9602(11)80483-8. ISSN   0940-9602. PMID   8059966.
  2. 1 2 3 Sánchez Lorenzo, J.; Cañada, M.; Díaz, L.; Sarasúa, G. (1996-09-01). "Compression of the median nerve by an anomalous palmaris longus tendon: a case report". The Journal of Hand Surgery. 21 (5): 858–860. doi:10.1016/s0363-5023(96)80204-8. ISSN   0363-5023. PMID   8891985.
  3. Reimann, Arthur F.; Daseler, Edward H.; Anson, Barry J.; Beaton, Lindsay E. (1944-08-01). "The palmaris longus muscle and tendon. A study of 1600 extremities". The Anatomical Record. 89 (4): 495–505. doi:10.1002/ar.1090890408. ISSN   1097-0185.
  4. 1 2 Pirola, Elena; Hébert-Blouin, Marie-Noëlle; Amador, Nelly; Amrami, Kimberly K.; Spinner, Robert J. (2009-09-01). "Palmaris profundus: one name, several subtypes, and a shared potential for nerve compression". Clinical Anatomy. 22 (6): 643–648. doi:10.1002/ca.20848. ISSN   1098-2353. PMID   19644968.
  5. Yoshida, Y.; Yasutaka, S.; Seki, Y. (1983-04-01). "[Flexor radialis profundus and palmaris profundus muscles in man]". Kaibogaku Zasshi. 58 (2): 59–67. ISSN   0022-7722. PMID   6637383.
  6. Park, Min Jung; Namdari, Surena; Yao, Jeffrey (2010-02-01). "Anatomic variations of the palmaris longus muscle". American Journal of Orthopedics (Belle Mead, N.J.). 39 (2): 89–94. ISSN   1934-3418. PMID   20396682.
  7. Browne, K. M.; Fauzi, Z.; O’Shaughnessy, M. (2014-10-15). "The palmaris profundus, a rare sight during carpal tunnel release". HAND. 10 (3): 559–561. doi:10.1007/s11552-014-9691-1. ISSN   1558-9447. PMC   4551639 . PMID   26330796.
  8. "Anatomy Atlases: Illustrated Encyclopedia of Human Anatomic Variation: Opus I: Muscular System: Alphabetical Listing of Muscles: P: Palmaris Longus". www.anatomyatlases.org. Retrieved 2016-01-06.