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Palmaris Longus

- See: technique of tendon graft harvest:

- origin:    medial epicondyle of humerus;
- insertion: transverse carpal ligament  and palmer aponeurosis;
- action: flexes hand at the wrist;
- synerygists:     flexor carpi radialis,  flexor carpi ulnaris, FDS;
- nerve supply: median, C6, C7;

- Discussion:
  - most commonly used tendon graft for the hand;
  - palmaris longus tendon is extrasynovial and does not have synovial membrane;
  - instead of synovial membrane, the tendon has a paratenon which does not promote gluiding as well as intrasynovial tendons;
  - anatomy:
           - palmaris longus partially covers median nerve and inserts into palmar fascia, and varies in size from a thin slip of tendon to a wide, flat tendon;
           - occassionally the muscle belly extends to the wrist and compresses median nerve;
           - is absent in 25% of the population;
           - muscle testing may cause the flexor superficialis to bulge into subQ area of the wrist and simulate the palmaris longus;

- Harvest Technique:
    - determine whether palmaris longus is present w/ active opposition of thumb against the litter finger;
           - attempt to palpate the tendon, as well as, to determine the thickness of the tendon (if there is indication that the tendon is small, the patient should be consented
                     for possible graft harvest from other areas of the body);
     - make transverse wrist incision;
     - spread away the areolar tissue and identify the tendon;
     - make a second transverse incision, about 8 cm above the first incision, and again identify the tendon;
     - pull on tendon from both wounds to ensure that the same tendon has been isolated in both wounds;
     - a third transverse incision can be made, even more proximally;
     - alternatively, an appropriately sized tendon stripper can be used;

Boundary Lubrication between the Tendon and the Pulley of the Finger.   

Palmaris longus tendon transfer for augmentation of the thenar musculature in low median palsy

Median nerve as free tendon graft.