Type of Article:  Original Research

Volume 11; Issue 1 (March 2023)

Page No.: 8550-8558

DOI: https://dx.doi.org/10.16965/ijar.2022.276

Prevalence of Palmaris Longus Muscle Agenesis Among Students Assessed Using Various Clinical Assessment Tests

Yaseen Ahmed Wafa*1,2, Maher Abumosamah 1, Qais Gasibat 3,4.

*1 Lecturer, Department of Anatomy, MAHSA University, Bandar Saujana Putra, 42610 Jenjarom, Selangor, Malaysia.

*2 Lecturer, Department of Anatomy, Faculty of Medicine, Misurata University, Misurata, Libya

3 Senior Physiotherapist, Department of Sport Studies, University Putra Malaysia UPM, 43400 UPM Serdang Selangor, Malaysia.

4 Senior Physiotherapist, Department of Physiotherapy, College of Medical Technology, Misurata, Libya.

Corresponding Author: YASEEN AHMAD WAFI., MBBS., M.SC,  Lecturer, Department of Anatomy, MAHSA University, Bandar Saujana Putra, 42610 Jenjarom, Selangor, Malaysia.

Email: https://orcid.org/0000-0001-5092-1551

Maher Abumosamah: https://orcid.org/0000-0003-4253-2147

Qais Gasibat: https://orcid.org/0000-0002-1193-965X 


Introduction: Since the lack of Palmaris Longus Muscle (PLM) has no effect on hand and wrist function, it is considered a non-essential muscle. However, its clinical relevance stems from its widespread application in reconstructive and hand surgery. In addition to gender differences, some sources assert that its absence is more prevalent in those genders who lack it in some way, that it is more prevalent when both eyes are missing, and that it is more prevalent when just one eye is present.

Aim: The primary objective of this research was to find out how common PLM agenesis is among students of both genders. The secondary objective was to demonstrate that a classical test (Schaffer’s test) can be reliably compared to other tests such as Thompson’s test, Mishra’s test, AIIM’s test, and the Hiz-Ediz test.

Materials and Methods: The study was a cross-sectional study carried out at the MAHSA University; A total of 224 cases, comprised of 126 (56.3%) females and 98 (43.8%) males. Each participant was requested to perform five clinical tests namely, Schaeffer’s test, Thompson’s test, Mishra’s test, AIIM’s test, and the Hiz-Ediz test.

Results: The frequent agenesis of the palmaris longus in the right forearm of our study with the Schaeffer’s test was (20.5%) and Thompson’s and Hiz-Ediz tests had equal percentages of agenesis (22.3%) while Mishra’s test (22.8%), and AIIMs test (29.5%) of the participants. Moreover, Thompson’s test had the highest percentage of (70.5%) compared to other tests for detecting the presence of PLM in the left forearm. The second nearest test for PLM detection was Schaeffer’s test with a percentage of (67.4%). AIIMs test was able to detect PLM in (64.3%) of the participants and Mishra’s test and Hiz-Ediz tests had close percentages of (59.4%) and (57.6%) respectively for PLM detection.

Conclusion: It can be concluded that Thompson’s test had a higher percentage among the tests to detect the presence of the PLM tendon in females while Schaeffer’s test was more significant in males. Thompson’s test had the best accuracy level and the highest percentage level of agreement with Schaeffer’s test compared to the other tests.

KEY WORDS: Palmaris Longus Muscle; Agenesis; Schaeffer’s Test, Anatomical Variation, Forearm.


[1]. Georgiev GP, Iliev AA, Dimitrova IN, Kotov GN, Malinova LG, Landzhov BV. Palmaris Longus Muscle Variations: Clinical Significance and Proposal of New Classifications. Folia Medica. 2017;59(3):289-97. https://doi.org/10.1515/folmed-2017-0035
[2]. Erić M, Krivokuća D, Savović S, Lekšan I, Vučinić N. Prevalence of the palmaris longus through clinical evaluation. Surgical and radiologic anatomy. 2010 Apr;32(4):357-61. https://doi.org/10.1007/s00276-009-0573-0
[3]. Olewnik Ł, Waśniewska A, Polguj M, Podgórski M, Łabętowicz P, Ruzik K, Topol M. Morphological variability of the palmaris longus muscle in human fetuses. Surgical and Radiologic Anatomy. 2018 Nov;40(11):1283-91. https://doi.org/10.1007/s00276-018-2069-2
[4]. Charlton S, Cyna AM, Middleton P, Griffiths JD. Perioperative transversus abdominis plane (TAP) blocks for analgesia after abdominal surgery. Cochrane Database of Systematic Reviews. 2010(12). https://doi.org/10.1002/14651858.CD007705.pub2
[5]. Zahra T, Sumra SA, Shafi S, Amjad A. Frequency of the Palmaris Longus muscle in the Population of Islamabad, Pakistan. Journal of University College of Medicine and Dentistry. 2022 Jun 25;1(2). https://doi.org/10.51846/jucmd.v1i2.174
[6]. Longhurst G, Stone D, Mahony N. Bilateral reversed palmaris longus muscle: a case report and systematic literature review. Surgical and Radiologic Anatomy. 2020 Mar;42(3):289-95. https://doi.org/10.1007/s00276-019-02363-z
[7]. Bordoni B, Zanier E. Anatomic connections of the diaphragm: influence of respiration on the body system. Journal of multidisciplinary healthcare. 2013;6:281. https://doi.org/10.2147%2FJMDH.S45443
[8]. Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R. The thoracolumbar fascia: anatomy, function and clinical considerations. Journal of anatomy. 2012 Dec;221(6):507-36. https://doi.org/10.1111/j.1469-7580.2012.01511.x
[9]. Trussler AP, Kawamoto HK, Wasson KL, Dickinson BP, Jackson E, Keagle JN, Jarrahy R, Bradley JP. Upper lip augmentation: palmaris longus tendon as an autologous filler. Plastic and reconstructive surgery. 2008 Mar 1;121(3):1024-32. https://doi.org/10.1097/01.prs.0000299383.82723.ec
[10]. Penna V, Stark GB, Voigt M, Mehlhorn A, Iblher N. Classification of the aging lips: a foundation for an integrated approach to perioral rejuvenation. Aesthetic plastic surgery. 2015 Feb;39(1):1-7. https://doi.org/10.1007/s00266-014-0415-2
[11]. Friedhofer H, Nigro MV, Sturtz G, Ferreira MC. Correction of severe ptosis with a silicone implant suspensor: 22 years of experience. Plastic and reconstructive surgery. 2012 Mar 1;129(3):453e-60e. https://doi.org/10.1097/PRS.0b013e3182402deb
[12]. Hayashi K, Katori N, Kasai K, Kamisasanuki T, Kokubo K, Ohno-Matsui K. Comparison of nylon monofilament suture and polytetrafluoroethylene sheet for frontalis suspension surgery in eyes with congenital ptosis. American journal of ophthalmology. 2013 Apr 1;155(4):654-63. https://doi.org/10.1016/j.ajo.2012.10.022
[13]. Lai CS, Chang KP, Lee SS, Hsieh TY, Lai HT, Huang YH, Lai YW. The role of frontalis orbicularis oculi muscle flap for correction of blepharoptosis with poor levator function. Annals of Plastic Surgery. 2013 Dec 1;71:S29-36. https://doi.org/10.1097/SAP.0000000000000043
[14]. Pridgen BC, Woon CY, Kim M, Thorfinn J, Lindsey D, Pham H, Chang J. Flexor tendon tissue engineering: acellularization of human flexor tendons with preservation of biomechanical properties and biocompatibility. Tissue Engineering Part C: Methods. 2011 Aug 1;17(8):819-28. https://doi.org/10.1089/ten.tec.2010.0457
[15]. Sebastin SJ, Lim AY, Bee WH, Wong TC, Methil BV. Does the absence of the palmaris longus affect grip and pinch strength?. Journal of Hand Surgery. 2005 Aug;30(4):406-8. https://doi.org/10.1016/J.JHSB.2005.03.011
[16]. Thompson NW, Mockford BJ, Cran GW. Absence of the palmaris longus muscle: a population study. The Ulster medical journal. 2001 May;70(1):22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2449224/
[17]. Kose O, Adanir O, Cirpar M, Kurklu M, Komurcu M. The prevalence of absence of the palmaris longus: a study in Turkish population. Archives of Orthopaedic and Trauma Surgery. 2009 May;129(5):609-11. https://doi.org/10.1007/s00402-008-0631-9
[18]. Soltani AM, Peric M, Francis CS, Nguyen TT, Chan LS, Ghiassi A, Stevanovic MV, Wong AK. The variation in the absence of the palmaris longus in a multiethnic population of the United States: an epidemiological study. Plastic Surgery International. 2012;2012. https://doi.org/10.1155/2012/282959
[19]. Brandon GJ, Azizi AB, Kalaji SM, Singh HS, Ramaiah Y, Retnabrabagaran SP. Variations in the absence of the palmaris longus muscle in a multiethnic population of Malaysia: An epidemiological study. Journal of Dental and Medical Sciences, 14(10), 117-122. https://doi.org/10.9790/0853-14104117122
[20]. Morais MA, Gomes MS, Helrigle C, Malysz T. Prevalence of agenesis of the palmaris longus muscle in Brazil and its clinics correlation. Journal of Morphological Sciences. 2017 Jan 16;29(4):0. http://www.jms.periodikos.com.br/article/587cb4b77f8c9d0d058b481d
[21]. Oudit D, Crawford L, Juma A, Howcroft A. The “four-finger” sign: to demonstrate the palmaris longus tendon. Plastic and Reconstructive Surgery. 2005 Aug 1;116(2):691-2. https://doi.org/10.1097/01.prs.0000175967.01538.3a
[22]. Gangata H. The clinical surface anatomy anomalies of the palmaris longus muscle in the Black African population of Zimbabwe and a proposed new testing technique. Clinical Anatomy: The Official Journal of the American Association of Clinical Anatomists and the British Association of Clinical Anatomists. 2009 Mar;22(2):230-5. https://doi.org/10.1002/ca.20751
[23]. Roohi SA, Choon-Sian L, Tan GH, Naicker AS, Med Rehab M. A study on the absence of palmaris longus in a multiracial population. Malaysian Orthopaedic Journal. 2007;1(1):26-8. https://pesquisa.bvsalud.org/portal/resource/pt/wpr-627372
[24]. Hiz Ö, Ediz L, Ceylan MF, Gezici E, Gülcü E, Erden M. Prevalence of the absence of palmaris longus muscle assessed by a new examination test (Hiz-Ediz Test) in the population residing in the area of Van, Turkey. Journal of Clinical & Experimental Investigations. 2011 Sep 1;2(3). https://doi.org/10.5799/ahinjs.01.2011.03.0050
[25]. Kyung DS, Lee JH, Choi IJ, Kim DK. Different frequency of the absence of the palmaris longus according to assessment methods in a Korean population. Anatomy & Cell Biology. 2012 Mar 1;45(1):53-6. https://doi.org/10.5115/acb.2012.45.1.53
[26]. Sharma DK, Shukla CK, Sharma V. Clinical assessment of absence of palmaris longus muscle and its association with gender, body sides, handedness and other neighboring anomalies in a population of central India. Journal of Anatomical Society of India. 2012 Jun 1;61(1):13-20. https://doi.org/10.1016/S0003-2778(12)80005-0
[27]. Arquez HF. Morphological study of palmaris longus muscle. International Archives of Medicine. 2017 Jul 2;10. https://doi.org/10.3823/2485
[28]. Lamichhane PS, Sharma K, Lamichhane N. Study on palmaris longus muscle tendon agenesis among first year Filipino medical students. Journal of Gandaki Medical College-Nepal. 2017 Aug 1;10(1):17-20. https://doi.org/10.3126/jgmcn.v10i1.17906
[29]. Karimi-Jashni H, Rahmanian K, Jahromi AS. Agenesis of palmaris longus in southern of Iran: A population based study. OnLine Journal of Biological Sciences. 2014 Jan 1;14(1):8. http://dx.doi.org/10.3844/ojbssp.2014.8.11
[30]. Kigera JW, Mukwaya S. Frequency of agenesis palmaris longus through clinical examination-an East African study. PloS one. 2011 Dec 13;6(12):e28997. https://doi.org/10.1371/journal.pone.0028997
[31]. Alves N, Ramírez D, Deana NF. Study of frequency of the palmaris longus muscle in Chilean subjects. International Journal of Morphology. 2011;29(2):485-9. http://dspace.utalca.cl/handle/1950/8950
[32]. Yong MW, Yusof N, Rampal L, Arumugam M. Prevalence of absence of palmaris longus and its association with gender, hand dominance and absence of FDS tendon to little finger among Malay population. The Journal of Hand Surgery (Asian-Pacific Volume). 2017 Dec;22(04):484-9. https://doi.org/10.1142/S021881041750054X
[33]. Sadeghifar A, Kahani AK, Saied A, Rasayi E. Interobserver and intraobserver reliability of different methods of examination for presence of palmaris longus and examination of fifth superficial flexor function. Anatomy & Cell Biology. 2018 Jun;51(2):79-84. https://doi.org/10.5115/acb.2018.51.2.79
[34]. ALIYU MN, TIRYAKIOGLU M. The palmaris longus muscle: A surface study of the population of North Cyprus. Marmara Medical Journal. 2021 Oct 1;34(3):267-7. https://doi.org/10.5472/marumj.101345

Cite this article: Yaseen Ahmed Wafa, Maher Abumosamah, Qais Gasibat. Prevalence of Palmaris Longus Muscle Agenesis Among Students Assessed Using Various Clinical Assessment Tests. Int J Anat Res 2023;11(1):8550-8558. DOI: 10.16965/ijar.2022.276