Ligaments attach bone to bone. An aponeurosis is a strong, flat connective tissue that attaches to muscle. Fascia is tissue that connects muscle to muscle or muscle to skin. The palmaris longus muscle starts up near the elbow and runs across the middle of the forearm, where it inserts on the palmar aponeurosis.
The palmaris longus muscle is absent in approximately 14 percent of the population, but has no affect on tightening and clenching ability. When present, the palmaris longus muscle is visible at the palm side of the wrist when flexed. The supraspinatus muscle is a rotator cuff muscle located in the shoulder, specifically in the supraspinatus fossa, a concave depression in the rear….
The quadratus plantae is a muscle in the foot that extends from the anterior front of the calcaneus heel bone to the tendons of the digitorum…. The depressor labii inferioris muscle is a four-sided facial muscle located in the jaw area that draws the lower lip down and to the side. The muscles of the face give it general form and contour, help you outwardly express your feelings, and enable you to chew your food.
The quadriceps femoris is a group of muscles located in the front of the thigh. The Latin translation of 'quadriceps' is 'four headed,' as the group…. On this page:. General Anatomy and Musculoskeletal System.
Read it at Google Books - Find it at Amazon 2. The variation in the absence of the palmaris longus in a multiethnic population of the United States: an epidemiological study.
Plast Surg Int. Plast Surg Int full text - doi Standring, Susan, and Henry Gray. Gray's anatomy: the anatomical basis of clinical practice. Related articles: Anatomy: Upper limb.
Promoted articles advertising. Figure 1: palmar aponeurosis Gray's illustration Figure 1: palmar aponeurosis Gray's illustration. Loading more images Close Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. In our opinion, the new classification will be of great value in planning the transplantation of this tendon. A dissection of the forearm and hand area was performed by traditional techniques [ 7 , 8 , 19 , 20 ]. Upon dissection, the morphology of the palmaris longus was assessed, together with the location and type of its insertion to the palmar aponeurosis.
The next stage comprised a set of morphometric and anthropometric measurements of the belly and tendon of the palmaris longus muscle. The distance from the midpoint of the interstyloid line a line drawn between the styloid processes of the radius and the ulna and the crossing point the median nerve and the PL muscle tendon were assessed.
An electronic digital calliper was used for all measurements Mitutoyo Corporation, Kawasaki-shi, Kanagawa, Japan. Each measurement was carried out twice with an accuracy of up to 0.
All morphometric measurements were subjected to statistical analysis. The tendon-to-muscle ratio, defined as the relationship between the length of the tendon and the length of the muscle belly, was calculated.
A p -value below 0. The results are presented as a mean and standard deviation unless otherwise stated. The normality of the continuous data distribution was checked with the Shapiro-Wilk test. As the data was not normally distributed, the Mann-Whitney test was used to compare the anthropometric measurements between two types of the palmaris longus muscle.
All types originated on the medial epicondyle of the humerus. Type I was characterised by the origin of the muscular part of the medial epicondyle of the humerus, with the muscle belly turned into the tendon and the insertion located on the palmar aponeurosis. This type was observed in 63 upper limbs Palmaris longus muscle. Right forearm. Left forearm. PL palmaris longus muscle, PA palmar aponeurosis, FCU flexor carpi radialis muscle, md medial division of the tendon of palmaris longus muscle, ld lateral division of the tendon of palmaris longus muscle.
Insertion of the tendon of palmaris longus muscle. Type II demonstrated a proximal attachment with the same morphology as Type I. However, the tendon was bifurcated: the lateral division of the tendon always predominated and was inserted in the palmar aponeurosis, the mean length of the tendon being The mean distance from the interstyloid line, between the styloid processes, and the tendon bifurcation point was This type was found in 10 upper limbs Namely, in one limb, the palmaris longus muscle was observed to be fused with the flexor carpi ulnaris muscle.
In the distal part of the tendon, the insertion is visible in the palmar aponeurosis and in the pisiform bone. This type was found in only 1. The Type I tendon predominated throughout the whole group 63 cases, Type II was found in 10 cases The coefficient lengths of the palmaris tendon and the belly ranged from 0.
The distribution of the types and subtypes of the palmaris longus tendon is presented in Table 2. In the Type I group, low bipennation of the muscle was found in five cases 6.
In all cases, the muscle belly was located deep to the antebrachial fascia at the site where the bicipital aponeurosis blends in the antebrachial fascia.
Muscle with low pinnate. The white arrowheads indicate the pennation. PM palmaris longus muscle, tPL tendon palmaris longus muscle. The dimensions of the palmaris longus tendon and the median nerve at the point of their crossing are presented in Table 3. The nerve was significantly thicker and wider than the tendon. The mean distance from the midpoint of the interstyloid line to the point where the median nerve crosses the palmaris longus tendon was The typical relationship between the course of the palmaris longus muscle and the median nerve is presented in Fig.
However, in Type II, the tendon split in the region where it crossed the median nerve. The mean distance from the interstyloid line to the crossing and to the split were Relationship between median nerve MN and the tendon of the palmaris longus muscle tPL. The comparison of morphometric measurements between two types of the palmaris longus muscle tendon shows that only the width of the muscle tendon in its distal portion was significantly lower in Type II than Type I Table 4.
The palmaris longus muscle was found to be absent in six limbs: two left and four right ones 7. The palmaris longus is one of the most variable muscles in the human body [ 3 , 4 ], and one which demonstrates morphological variability in both the muscle belly and its tendon. The descriptions found in the literature are mainly focused on the morphology of the muscle [ 3 , 4 , 9 , 10 , 12 , 13 , 14 , 15 , 16 , 17 , 21 , 22 ].
Although a classification of muscle structure types based on the ratio between the length of the belly and that of the tendon may certainly be useful in procedures based on palmaris tendon grafts, no such classification currently exists.
Possibly the first description of the anatomical variations of the PL muscle was given by Anson et al. Their study on limbs found the PL to be absent in The incidence of anomalies of all types, eclusive of agnesis, was 46 in consecutive arms. One half of these anomalies 23 in 46 comprised variations in position and form, while the remainder comprised accessory slips and substitute structures 15 examples , duplication of the PL four times and aberrancies of attachment three times [ 19 ].
In a study performed on 48 upper limbs, Mathew et al. The corresponding type in the present study Type I was found in 63 limbs Among other varieties of palmaris longus, Mathew et al. They also report the occurrence of an accessory PL in one limb 2. They also note a fourth or fusifom type of palmaris longus, characterised by a belly occupying the central one-third, which is originated and inserted by means of thin tendons in the upper and lower thirds, respectively.
This type deprives the subject of a source of a lengthy tendon 1 case — 2. None of the above types were found in the present study. This type was identified in 10 limbs in the present study as Type II Some variants of the palmaris longus muscle have also been described as case reports. Bernardes et al. Marpalli et al. Igbal et al. Kumar et al. In our opinion, the case reports given above, including those described by Mathew et al. Every other morphological type described as a case report or differing from Types I and II might also be included in this group.
The PL was found to be absent in six limbs examined in the present study 7. Similarly, Mathew [ 3 ] report the absence of a PL in four limbs 8. Numerous other papers refer to the frequency of occurrence of this muscle in specific populations. Namely, Ceyhan et al. In contrast, the muscle was found to be absent in only 1. Sebastin et al. Attention should be drawn to the specific fascial relationships between the PL and the antebrachial fascia as well as the palmar aponeurosis.
Typically, the muscle is situated deep inside the antebrachial fascia. Its tendon, however, moves to a suprafascial plane in the lower third of the forearm and is in continuity with the longitudinal fibers of the palmar aponeurosis [ 18 ].
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