Hypertrophied reverse palmaris longus muscle: a rare cause of carpal tunnel syndrome

Authors

  • Narayanamurthy Sundaramurthy Department of Plastic and Reconstructive Surgery, Saveetha Medical College and Hospital, Thandalam, Kanchipuram, Tamil Nadu
  • Surya Rao Rao Venkata Mahipathy Department of Plastic and Reconstructive Surgery, Saveetha Medical College and Hospital, Thandalam, Kanchipuram, Tamil Nadu http://orcid.org/0000-0002-8214-8871
  • Alagar Raja Durairaj Department of Plastic and Reconstructive Surgery, Saveetha Medical College and Hospital, Thandalam, Kanchipuram, Tamil Nadu

DOI:

https://doi.org/10.18203/2349-2902.isj20200319

Keywords:

Carpal tunnel syndrome, Rare, Reverse palmaris longus

Abstract

Carpal tunnel syndrome (CTS) is usually secondary to compression or irritation of the median nerve in the fibro-osseous canal formed by the flexor retinaculum (transverse carpal ligament) and the carpal bones. The prevalence of CTS in the general population is about 7 to 19%. Several causes both local and systemic have been described, but CTS due to aberrant musculature are rare. Here we report a case of a middle-aged female with paresthesia of the hand and a positive Phalen’s test with nerve conduction study of the median nerve showing sensorimotor neuropathy. The patient underwent surgery for open CTS release where we found a hypertrophied reverse palmaris longus muscle attached to the palmar aponeurosis which was excised along with its proximal tendon. On post-operative follow up all the symptoms of CTS were completely resolved. Muscle abnormalities concern three muscles: the palmaris longus, the flexor digitorum superficialis of index, and the lumbricals. These muscles can be hypertrophied, bifid, duplicated, digastric, inverted or have an abnormal insertion, thus creating a mechanical restriction of the carpal tunnel. Surgical resection of abnormal muscle provides excellent functional recovery.

 

Author Biographies

Narayanamurthy Sundaramurthy, Department of Plastic and Reconstructive Surgery, Saveetha Medical College and Hospital, Thandalam, Kanchipuram, Tamil Nadu

Associate Professor,
Dept. of Plastic & Reconstructive Surgery

Surya Rao Rao Venkata Mahipathy, Department of Plastic and Reconstructive Surgery, Saveetha Medical College and Hospital, Thandalam, Kanchipuram, Tamil Nadu

Professor & Head,
Dept. of Plastic & Reconstructive Surgery

Alagar Raja Durairaj, Department of Plastic and Reconstructive Surgery, Saveetha Medical College and Hospital, Thandalam, Kanchipuram, Tamil Nadu

Associate Professor,
Dept. of Plastic & Reconstructive Surgery

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Published

2020-01-27

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Section

Case Reports