Prague Med. Rep. 2024, 125, 356-364

https://doi.org/10.14712/23362936.2024.32

Accessory Flexor Muscle of Forearm – A Rare Variant – Embryological and Clinical Prospect

Kamalesh Saravanan1, Rajesh Kumar2, Dibakar Borthakur1, Harisha Kusuma1, Seema Singh1

1Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
2Department of Anatomy, All India Institute of Medical Sciences, Patna, India

Received July 24, 2024
Accepted October 29, 2024

References

1. al-Qattan, M. M., Duerksen, F. (1992) A variant of flexor carpi ulnaris causing ulnar nerve compression. J. Anat. 180(Pt 1), 189–190.
2. Alvin, M., Alan, N., Leone, J., Fredieu, J. R. (2011) A unilateral accessory flexor carpi ulnaris muscle observed during cadaveric dissection. Clin. Anat. 24(8), 971–973. <https://doi.org/10.1002/ca.21234>
3. Ametewee, K., Harris, A., Samuel, M. (1985) Acute carpal tunnel syndrome produced by anomalous flexor digitorum superficialis indicis muscle. J. Hand Surg. Br. 10(1), 83–84. <https://doi.org/10.1016/S0266-7681(85)80025-5>
4. Ang, G. G., Rozen, W. M., Vally, F., Eizenberg, N., Grinsell, D. (2010) Anomalies of the flexor carpi ulnaris: Clinical case report and cadaveric study. Clin. Anat. 23, 427–430. <https://doi.org/10.1002/ca.20952>
5. Asfour, H. A., Allouh, M. Z., Said, R. S. (2018) Myogenic regulatory factors: The orchestrators of myogenesis after 30 years of discovery. Exp. Biol. Med. (Maywood) 243(2), 118–128. <https://doi.org/10.1177/1535370217749494>
6. Bergman, R. A., Thompson, S. A., Afifi, A. K., Saadeh, F. A. (1988) Compendium of Human Anatomic Variation. Urban and Schwarzenberg, Baltimore.
7. Bernardes, A., Melo, C., Pinheiro, S. (2016) A combined variation of palmaris longus and flexor digitorum superficialis: Case report and review of literature. Morphologie 100(331), 245–249. <https://doi.org/10.1016/j.morpho.2016.03.002>
8. Buckingham, M., Bajard, L., Chang, T., Daubas, P., Hadchouel, J., Meilhac, S., Montarras, D., Rocancourt, D., Relaix, F. (2003) The formation of skeletal muscle: From somite to limb. J. Anat. 202(1), 59–68. <https://doi.org/10.1046/j.1469-7580.2003.00139.x>
9. Ceyhan, O., Mavt, A. (1997) Distribution of agenesis of palmaris longus muscle in 12 to 18 years old age groups. Indian J. Med. Sci. 51(5), 156–160.
10. Čihák, R. (2013) Ontogenesis of the Skeleton and Intrinsic Muscles of the Human Hand and Foot. Springer, Berlin, Heidelberg.
11. Depuydt, K. H., Schuurman, A. H., Kon, M. (1998) Reversed palmaris longus muscle causing effort-related median nerve compression. J. Hand Surg. Br. 23(1), 117–119. <https://doi.org/10.1016/S0266-7681(98)80241-6>
12. Diogo, R., Abdala, V., Aziz, M. A., Lonergan, N., Wood, B. A. (2009) From fish to modern humans – Comparative anatomy, homologies and evolution of the pectoral and forelimb musculature. J. Anat. 214(5), 694–716. <https://doi.org/10.1111/j.1469-7580.2009.01067.x>
13. Dyreby, J. R., Engber, W. D. (1982) Palmaris profundus – Rare anomalous muscle. J. Hand Surg. Am. 7(5), 513–514. <https://doi.org/10.1016/S0363-5023(82)80050-6>
14. Elias, L. S., Schulter-Elias, F. P. (1985) Anomalous flexor superficialis indicis: Two case reports and literature review. J. Hand Surg. Am. 10(2), 296–299. <https://doi.org/10.1016/S0363-5023(85)80128-3>
15. Georgiev, G. P., Jelev, L. (2009) Unusual coexistence of a variant abductor digiti minimi and reversed palmaris longus and their possible relation to median and ulnar nerves entrapment at the wrist. Rom. J. Morphol. Embryol. 50(4), 725–727.
16. Georgiev, G. P., Jelev, L., Surchev, L. (2009) Presence of a palmaris longus related variations in three members of a family. J. Hand Surg. Eur. Vol. 34(2), 277–278. <https://doi.org/10.1177/1753193408099826>
17. Giunta, R., Brunner, U., Wilhelm, K. (1993) Bilateral reversed palmaris longus muscle – A rare cause of peripheral median nerve compression syndrome. Case report. Unfallchirurg 96(10), 538–540. (in German)
18. Jeffery, A. K. (1971) Compression of the deep palmar branch of the ulnar nerve by an anomalous muscle: Case report and review. J. Bone Joint Surg. Br. 53(4), 718–723. <https://doi.org/10.1302/0301-620X.53B4.718>
19. Kachlik, D., Hajek, P., Konarik, M., Krchov, M., Baca, V. (2016) Coincidence of superficial brachiomedian artery and bitendinous palmaris longus: A case report. Surg. Radiol. Anat. 38, 147–151. <https://doi.org/10.1007/s00276-015-1512-x>
20. Kapoor, S. K., Tiwari, A., Kumar, A., Bhatia, R., Tantuway, V., Kapoor, S. (2008) Clinical relevance of palmaris longus agenesis: Common anatomical aberration. Anat. Sci. Int. 83(1), 45–48. <https://doi.org/10.1111/j.1447-073X.2007.00199.x>
21. Kernohan, J., Dakin, P. K., Quain, J. S., Helal, B. (1984) An anomalous flexor digitorum superficialis indicis muscle in association with a fibroma presenting as a stiff painful finger. J. Hand Surg. Br. 9(3), 335–336. <https://doi.org/10.1016/0266-7681(84)90056-1>
22. Kigera, J. W., Mukwaya, S. (2011) Frequency of agenesis palmaris longus through clinical examination – An East African study. PLoS One 6(12), e28997. <https://doi.org/10.1371/journal.pone.0028997>
23. Kostka, K. H., Steen, M. (1990) The abductor digiti minimi longus muscle as a cause of distal ulnar compression syndrome. Handchir. Mikrochir. Plast. Chir. 22(1), 53–54. (in German)
24. Kreulen, M., Smeulders, M. J. (2008) Assessment of flexor carpi ulnaris function for tendon transfer surgery. J. Biomech. 41(10), 2130–2135. <https://doi.org/10.1016/j.jbiomech.2008.04.030>
25. Kuan, S. Y., Smith, B. A., Fearnside, S. M., Black, A. P., Allan, G. S. (2007) Flexor carpi ulnaris tendonopathy in a Weimaraner. Aust. Vet. J. 85(10), 401–404. <https://doi.org/10.1111/j.1751-0813.2007.00187.x>
26. Kunc, V., Stulpa, M., Feigl, G., Kachlik, D. (2019) Accessory flexor carpi ulnaris muscle with associated anterior interosseous artery variation: Case report with the definition of a new type and review of concomitant variants. Surg. Radiol. Anat. 41, 1315–1318. <https://doi.org/10.1007/s00276-019-02261-4>
27. Lahey, M. D., Aulicino, P. L. (1986) Anomalous muscles associated with compression neuropathies. Orthop. Rev. 15(4), 199–208.
28. Le Double, A. F. (1897) Traité des Variations du Système Musculaire de L’homme: Et de Leur Signification au Point de Vue de L’anthropologie Zoologique, Vol. 2. Schleicher frères, Paris.
29. Lemon, M., Belcher, H. J. (2002) An anomalous flexor carpi ulnaris. J. Hand Surg. Br. 27(2), 194–197. <https://doi.org/10.1054/JHSB.2001.0705>
30. Lim, A. Y., Kumar, V. P., Sebastin, S. J., Kapickis, M. (2006) Split flexor carpi ulnaris transfer: A new functioning free muscle transfer with independent dual function. Plast. Reconstr. Surg. 117(6), 1927–1932. <https://doi.org/10.1097/01.prs.0000209996.52222.2e>
31. Longhurst, G., Stone, D., Mahony, N. (2020) Bilateral reversed palmaris longus muscle: A case report and systematic literature review. Surg. Radiol. Anat. 42, 289–295. <https://doi.org/10.1007/s00276-019-02363-z>
32. Macalister, A. (1875) Additional observations on muscular anomalies in human anatomy (third series), with a catalogue of the principal muscular variations hitherto published. Trans. Roy. Irish Acad. Sci. 25, 1–134.
33. Metikala, S., Mohammed, R., Vakamallu, V. R. (2020) Clinical application of anomalous muscles for tendon transfer in the upper limb: A systematic review of the literature. Cureus 12(3), e7222.
34. Meyer, F. N., Pflaum, B. C. (1987) Median nerve compression at the wrist caused by a reversed palmaris longus muscle. J. Hand Surg. Am. 12(3), 369–371. <https://doi.org/10.1016/S0363-5023(87)80006-0>
35. Mori, M. (1964) Statistics on the musculature of the Japanese. Okajimas Folia Anat. Jpn. 40, 252–254. <https://doi.org/10.2535/ofaj1936.40.3_195>
36. Natsis, K., Levva, S., Totlis, T. (2007) Three-headed reversed palmaris longus muscle and its clinical significance. Ann. Anat. 189(1), 97–101. <https://doi.org/10.1016/j.aanat.2006.07.008>
37. Ninković, M., Hefel, L., Öhler, K. (1995) Acute median nerve compression produced by reversed palmaris longus muscle. Eur. J. Plast. Surg. 18, 129–130. <https://doi.org/10.1007/BF00168903>
38. O’Hara, J. J., Stone, J. H. (1988) Ulnar neuropathy at the wrist associated with aberrant flexor carpi ulnaris insertion. J. Hand Surg. Am. 13(3), 370–372. <https://doi.org/10.1016/S0363-5023(88)80011-X>
39. Pires, L. A. S., Machado, G. D. C. R., Fernandes, R. M. P., Manaia, J. H. M., Champs, J. F. S., Babinski, M. A. (2019) Notes on the accessory flexor carpi ulnaris muscle: A rare supernumerary variation. J. Morphol. Sci. 36(02), 138–140.
40. Pribyl, C. R., Moneim, M. S. (1994) Anomalous hand muscle found in the Guyon’s canal at exploration for ulnar artery thrombosis: A case report. Clin. Orthop. Relat. Res. 306, 120–123.
41. Rao, K. G., Bhat, S. M., Venkataramana, V., Rodrigues, V. (2009) Ulnar and humeral heads forming separate bellies: A rare case of digastric flexor carpi ulnaris muscle. Int. J. Morphol. 27(1), 31–34.
42. Reimann, A. F., Daseler, E. H., Anson, B. J., Beaton, L. E. (1944) The palmaris longus muscle and tendon. A study of 1600 extremities. Anat. Rec. 89(4), 495–505. <https://doi.org/10.1002/ar.1090890408>
43. Roberts, P. H. (1972) An anomalous accessory palmaris longus muscle. Hand 4(1), 40–41. <https://doi.org/10.1016/0072-968X(72)90008-3>
44. Schoenwolf, G. C., Bleyl, S. B., Brauer, P. R., Francis-West, P. H. (2014) Larsen’s Human Embryology. Elsevier Health Sciences, Amsterdam.
45. Sebastin, S. J., Puhaindran, M. E., Lim, A. Y., Lim, I. J., Bee, W. H. (2005) The prevalence of absence of the palmaris longus – A study in a Chinese population and a review of the literature. J. Hand Surg. Br. 30(5), 525–527. <https://doi.org/10.1016/j.jhsb.2005.05.003>
46. Sefton, E. M., Kardon, G. (2019) Connecting muscle development, birth defects, and evolution: An essential role for muscle connective tissue. Curr. Top. Dev. Biol. 132, 137–176. <https://doi.org/10.1016/bs.ctdb.2018.12.004>
47. Shen, S., Pang, J., Seneviratne, S., Ashton, M. W., Corlett, R. J., Taylor, G. I. (2008) A comparative anatomical study of brachioradialis and flexor carpi ulnaris muscles: Implications for total tongue reconstruction. Plast. Reconstr. Surg. 121(3), 816–829. <https://doi.org/10.1097/01.prs.0000299920.14548.2a>
48. Still, J. M. Jr., Kleinert, H. E. (1973) Anomalous muscles and nerve entrapment in the wrist and hand. Plast. Reconstr. Surg. 52(4), 394–400. <https://doi.org/10.1097/00006534-197352040-00012>
49. Testut, L., Latarjet, A. (1928) Traite D’anatomie Humaine, 8th Edition. Gaston Douin, Paris.
50. Tonkin, M. A., Lister, G. D. (1985) The palmaris brevis profundus. An anomalous muscle associated with ulnar nerve compression at the wrist. J. Hand Surg. Am. 10(6 Pt 1), 862–864. <https://doi.org/10.1016/S0363-5023(85)80162-3>
51. Troha, F., Baibak, G. J., Kelleher, J. C. (1990) Frequency of the palmaris longus tendon in North American Caucasians. Ann. Plast. Surg. 25(6), 477–478. <https://doi.org/10.1097/00000637-199012000-00008>
52. Vanhoenacker, F. M., Desimpel, J., Mespreuve, M., Tagliafico, A. (2018) Accessory muscles of the extremities. Semin. Musculoskelet. Radiol. 22(3), 275–285.
53. Vichare, N. A. (1970) Anomalous muscle belly of the flexor digitorum superficialis. Report of a case. J. Bone Joint Surg. Br. 52(4), 757–759. <https://doi.org/10.1302/0301-620X.52B4.757>
54. Vollala, V. R., Kumar, P. B. (2007) Additional belly of flexor carpi ulnaris muscle found in a South Indian male cadaver. Internet J. Orthop. Surg. 5(1), 5–8.
55. Wang, C. K., Ng, C. Y. (2021) Accessory flexor carpi ulnaris: A rare cause of distal ulnar nerve compression. J. Hand Surg. Eur. Vol. 46(2), 197–199. <https://doi.org/10.1177/1753193420943050>
56. Williams, P., Bannister, L., Berry, M., Collins, P., Dyson, M., Dussek, J. (1995) Gray’s Anatomy: The Anatomical Basis of Medicine and Surgery, 38th Edition. Churchill Livingstone, Edinburgh.
57. Yammine, K. (2013) Clinical prevalence of palmaris longus agenesis: A systematic review and meta-analysis. Clin. Anat. 26(6), 709–718. <https://doi.org/10.1002/ca.22289>
58. Yuan, J., Dhanaraj, I. D., Ng, H. J. H., Rajaratnam, V. (2019) Accessory palmaris longus: A concise anatomic review with a relevant case study. Ann. Plast. Surg. 83(3), 363–366. <https://doi.org/10.1097/SAP.0000000000001832>
front cover

ISSN 1214-6994 (Print) ISSN 2336-2936 (Online)

Archive