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J Hand Surg Eur Vol. 2018 Nov;43(9):948-953. doi: 10.1177/1753193418778990. Epub 2018 Jun 7.

Ultrasound determination of presence, length and diameter of the palmaris longus tendon.

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Hospital for Special Surgery, New York, NY, USA.


Inadvertent median nerve harvest is a devastating complication of palmaris longus harvest. Accurate assessment of palmaris longus presence and dimensions preoperatively would minimize this risk and assure safe harvest. We hypothesized that ultrasound would accurately predict palmaris longus presence, length and diameter. Seventeen cadaveric forearms were studied using a LOGIQ-E9 ultrasound. Two radiologists assessed palmaris longus presence and dimensions. Each wrist was explored, and the tendon was harvested and measured. Inter-rater reliability and agreement between measurements was assessed. The palmaris longus was present in 13 of 17 forearms. Both radiologists correctly identified the tendon and its absence (sensitivity and specificity, 100%). Ultrasound assessment of palmaris longus dimensions significantly correlated with surgical measurements. Intraclass correlation coefficient between radiologists was 0.97. We conclude that ultrasound can determine palmaris longus presence and dimensions with excellent accuracy and inter-observer reliability. Ultrasound is useful for preoperative evaluation of the palmaris longus and its use will increase patient safety.


Graft; harvest; palmaris longus; tendon; ultrasound


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