Introduction: Since PALMARIS LONGUS TENDON is the first choice for grafting, its anatomical variation is important. This study was designed to find the anatomical variations of this TENDON in Iranian population by performing a study on cadaver.Method: In this study, 150 forearms belonged to 75 cadavers were studied. After exploring the proximal end of TENDON, TENDON width was measured at its proximal end by caliper. The presence or absence of TENDON in left and right, width of TENDON in males and females, crown to heel height and the relationship between TENDON width and height were determined. Statistical analysis was done by SPSS, and using exact Fischer test, Student t-test, Pearson's correlation coefficient and chi-square.Results: Unilateral absence was seen in 24% and bilateral absence in 10.7 % of 32 females. The TENDON was absent in 4 cases (12.5 %) in left side, in 6 cases (18.8 %) in right side, and in 3 cases (9.4%) in both sides. Of 43 males, in 3 (7%) the TENDON was absent in left side, in 5 (11.6%) in right side and in 5 (11.6%) in both sides. The mean width of TENDON in males was 4.07±2.05 mm in right and 3.97±2.16 mm in left side and in women it was 3.77±2.07mm in right and 3.41±2.20 mm in left side.Conclusion: The prevalence rate of unilateral and bilateral absence of PL in this study was 24% and 10.7% respectively that differs with the reported rates in studies of Asian countries such as China and Japan. There was not statistical difference between men and women in TENDON width, unilateral and bilateral absence and side of absence. There was also no correlation between TENDON width and individual height.

Background: The prevalence of PALMARIS LONGUS agenesis (PLA) has been variously reported to be from 1.5% to 64% in different ethnic groups. Finding the state of PLA among Iranian people was the aim of this study.Methods: 1008 participants were included in this descriptive study during a 6-month period in a teaching hospital in Tehran-Iran. The Schaeffer test was used to detect the presence or absence of PALMARIS LONGUS. The role of gender and handedness was also assessed in PLA.Results: The prevalence of PLA was estimated at 22.8% - 10.2% agenesis on the right side, 5.9% on left side and 6.7% on both sides. The relationship between PLA and gender didn’t appear to be significant. Right handedness was seen in 90.9% of cases with PLA and 72.5% of those without PLA (p=.000, OR=3.8).Conclusion: The prevalence of PLA in Iranian people studied, were comparable to the average Caucasian values in the literature.

Background: The PALMARIS LONGUS is a degenerating weak flexor muscle in the anterior of the forearm. Many techniques for clinically determining the presence of the PALMARIS LONGUS have been described. Ethnic variations in the prevalence of the absence of the PALMARIS LONGUS are well known.Objectives: This study considered the prevalence of absence of the PALMARIS LONGUS muscle TENDON in the north of Iran.Patients and Methods: The presence of the PALMARIS LONGUS was clinically determined in 562 men and women from the Guilan population, using the standard technique (Schaeffer’s test). In subjects with an absent PALMARIS LONGUS, three other tests (Thompson, Pushpakumar and Mishra tests) were performed to confirm the absence.Results: The overall prevalence of right, left, bilateral and total absence of the PALMARIS LONGUS were 4.1%, 5.2%, 3.9% and 13.2%, respectively. There was no significant difference in its absence with regard to the body side or gender (P>0.05).Conclusions: This study demonstrated that the presence of the PALMARIS LONGUS muscle TENDON in the Guilan population was considerably higher than the absence of the PALMARIS LONGUS TENDON. The overall prevalence of right, left, bilateral and total absence of the PALMARIS LONGUS was not significantly different between men and women. The prevalence of the left-absent PALMARIS LONGUS was more common in the present study.

Introduction: Advanced lip carcinomas can invade adjacent structures. Performing surgery for these cancers will lead to defects in this anatomically and functionally important area and will cause post-op difficulties such as drooling, speech alterations and aesthetic considerations, if not properly managed.Case Report: In this study, we will introduce a radial forearm free flap with PALMARIS LONGUS TENDON to reconstruct a defect of a large lower lip carcinoma. Our patients was a male in the 7th decade of life with an advanced lower lip carcinoma invading the full thickness of the buccal mucosa, left commissure and the left third of the upper lip. Resection was performed with adequate margins; checked by frozen sections and radical modified neck dissection was also performed on the left side. Free radial forearm flap with PALMARIS LONGUS TENDON was harvested and anastomosed in the neck. Four months after surgery commissurroplasty was done and the flap volume reducedConclusion: The radial forearm free flap with PALMARIS LONGUS TENDON provides a good functional lip with a reasonable aesthetics in our patient. The patient was satisfied with the result and there were no functional complaints such as drooling reported by him. We think that this flap could be a flap of choice for reconstruction of the large, full thickness lip defects.

Background & Aims: The Plantaris muscle is located in the superficial posterior compartment of the leg and is absent in some individuals. The present study was undertaken to evaluate the absence variation of Plantaris muscle and its possible relation with PALMARIS LONGUS and fifth superficial flexor digitorum of the hand.Methods: 83 fresh cadavers, referred to legal medicine center, Kerman, Iran from April 2010 to November 2011 were enrolled in the study. Dissection was performed using mini incisions and the results were recorded in a questionnaire including presence or absence, length and width of the Plantaris and PALMARIS LONGUS TENDONs, and the presence or absence of the fifth superficial flexor. The suitability of the PALMARIS and Plantaris TENDONs was assessed using the previously described criteria and according to the criteria that are proposed by us.Results: 8 of the 83 cadavers showed variations. Plantaris TENDON was present in 80 (96.3%) and absent in 3 (3.7%), of which was absent bilaterally in two (2.3%) and unilaterally in one (1.2%).6 cadavers (7.2%) were deficient in PALMARIS LONGUS TENDON, 4 bilateral (4.8%) and 2 (2.3%) unilateral. Bilateral absence of fifth flexor digitorum superficialis was observed in 2 cadavers (2.3%) and one showed unilateral absence (1.2%).There was no statistically significant relationship (p<0.05) among the presence of PALMARIS LONGUS, plantaris and fifth superficial flexor. The plantaris TENDON by far showed better characteristics for graft than the PALMARIS TENDON.Conclusion: According to the results of the present study, considering the Plantaris TENDON for graft harvest seems logic, noting its high percentage of presence and better characteristics.

Background: The anatomical variations of the TENDONs of hand are well known but their prevalence is not the same among different races. In most textbooks, PALMARIS LONGUS (PL) absence is reported to be 15%, with a lower rate for Asians compare to Europeans. The 5th finger flexor digitorum sublimes (FDS) TENDON is also absent in nearly 20% of humans. There is no report of the anatomical variations of the TENDONs of hand in Iran, and we would like to report our findings in this matter.Method: Between October 2002 and October 2004, 417 medical students were examined. The presence of PL and 5th finger FDS TENDONs and the relationship between these two were recorded.Results: The PL TENDON in 21% and the 5th FDS in 8.4% were absent. There was no statistically significant difference between the genders and hand dominancy.Conclusions: The rate of absence of PL is the same as Europeans. Due to presence of 5th FDS TENDON in a high number of people, it may be a useful TENDON to be used for transfer.

Background & Aims: Etiologically the causing factor of carpal tunnel syndrome is not clear and multiple contributing factors such as the presence or absence of PALMARIS LONGUS TENDON have been cited. The aim of the present study was to compare patients with carpal tunnel syndrome and healthy individuals in regard to the absence and presence of PALMARIS LONGUS and fifth flexor digitarum superficialis TENDONs. Methods: This prospective study was performed on 60 diseased and 180 normal hands. Presence or absence of each TENDON was determined carefully by the same examiner in both groups. Data were compared by Chi-square test. Results: The relationship between carpal tunnel syndrome and the absence of PALMARIS LONGUS TENDON and fifth flexor digitorum superficialis was significant (P=0.041 & P=0.05 respectively). Carpal tunnel syndrome group compared to the control group had higher rate of the absence of both TENDONs in one hand (P=0.017) and lower rate of the presence of both TENDONs in one hand (P=0.005). By considering only the hands with PALMARIS LONGUS TENDON, there were more cases of absence of fifth flexor digitorum superficialis in carpal tunnel syndrome group (P=0.048), but by considering only the hands with fifth flexor superficialis, there was no significant difference between the two groups in regard to the presence of PALMARIS LONGUS  TENDONe. Conclusion: It seems that the absence of PALMARIS LONGUS TENDON and fifth superficial flexor each alone and in combination is a risk factor for development of carpal tunnel syndrome. Probably the absence of superficial flexor is a greater risk factor than the absence of PALMARIS LONGUS.

Background: The pathophysiology of carpal tunnel syndrome is associated with increased intracarpal canal pressure. Recently, PALMARIS LONGUS has been introduced as an independent risk factor for the development of carpal tunnel syndrome. The purpose of this study was to assess the association of carpal tunnel syndrome with the presence of PALMARIS LONGUS TENDON and functional superficial flexor of the fifth finger.Methods: Fifty-four patients with severe and bilateral carpal tunnel syndromes that had indications for carpal tunnel release, and underwent surgery, were enrolled prospectively in this study. Seventy patients as control group were selected on a basis of age, gender, occupation, diabetes mellitus, thyroid disease, and rheumatoid arthritis. The presence or absence of the PALMARIS LONGUS TENDON and functional superficial flexor TENDON to the little finger were assessed in both groups clinically.Results: The prevalence of PALMARIS LONGUS agenesis was significantly lower in the carpal tunnel group but there was no association between carpal tunnel syndrome and presence of functional superficial flexor to the little finger.Conclusion: The presence of the PALMARIS LONGUS TENDON is associated with the development of carpal tunnel syndrome.

Background: Carpal tunnel syndrome (CTS) describes a set of symptoms caused by compression of the median nerve in the wrist, which is the most common site of nerve compression in the upper limb. This syndrome is a primary source of pain and reduced function in these patients, and the cause is compression of the median nerve where it passes beneath the flexor retinaculum in the wrist.Objectives: The aim of the present cross sectional study is to assess the absence of PALMARIS LONGUS and fifth superficial flexor digitorum TENDON as normal anatomic variations on the sonographic measurement of median nerve surface area in healthy individuals’ wrists.Patients and Methods: Ninety-three healthy volunteers underwent clinical evaluation for determining the presence of TENDONs in both wrists and sonographic measurement of median nerve surface area.Results: In 41 of 186 (22%) hands, the PALMARIS LONGUS TENDON was absent and absence of the fifth flexor digitorum TENDON was noted in eight (4.30 %). The median surface area in the hands without PALMARIS LONGUS was meaningfully lower than the hands with it (P=0.025), while the difference in the median surface area was not statistically significant with regard to presence of the fifth flexor digitorum TENDON (P=0.324).Conclusions: Based upon the findings of the present study, it seems that the median surface area as a sonographic finding is probably related to presence or absence of the PALMARIS LONGUS TENDON, so that hands with the TENDON present have larger surface areas. In addition, it seems that this sonographic finding does not depend on the function of the fifth superficial flexor digitorum TENDON. Therefore, no correlation between CTS and the presence of PALMARIS LONGUS TENDON should be observed.

BACKGROUND: The prevalence of the PALMARIS LONGUS agenesis (PLA) has been variously reported to be from 1.5% to 64% in different ethnic groups. Lack of reliable information about the state of the PLA in Iran made us to design a study on the agenesis of the PALMARIS LONGUS (PL) among Iranian population during 2009.MATERIALS AND METHODS: One thousand participants were included in this descriptive study. Subjects were patients and personnel of a sample of a major orthopedic surgery center in Iran. The Schaeffer test was used to detect the presence or absence of the PL. An orthopedic resident conducted the test (observer reliability 98%). The prevalence of agenesis was determined in the sample and its actual prevalence was estimated for the whole population. The role of gender and handedness was also considered in the presence or absence of the PLA.RESULTS: The prevalence of the PLA was estimated to be 22.8%; 10.2% agenesis on the right side, 5.9% on the left side, and 6.7% bilateral PLA. The relationship between PLA and gender didn’t appear to be significant. Among people with PLA 43% and among people without PLA 17% were left handed (P<0.05, odds ratio [OR]: 3.7).CONCLUSION: The prevalence of the PLA in Iranians seems to be comparable with the average Caucasian values which is estimated to be 22.4%. Furthermore, significant relationship exists between the PLA and left hand dominance.