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palmaris longus
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06/29/2016 20:52
Stefan_K. 
06/29/2016 20:52
Stefan_K. 

palmaris longus

I searched the forum for palmaris longus and its connection with DD after my physiotherapist (for unrelated foot problems) had mentioned it to me and recommended massage and heat to prevent contracture of the connected fingers. To my surprise, although there are numerous papers published about it, I couldn't find a single discussion here.

Two of the papers I am referring to:

http://dupuytrens.org/DupPDFs/1986_Powell.pdf

Apparently only about 3 out of 4 individuals have this tendon, most of them in both arms, but not all. Quite fascinating, as it means it an actually be removed without functional consequences if it is part of the contracture problem, as the study below suggests, or massaged or otherwise treated to release tension, as my physiotherapist says he has done with success.

http://www.ncbi.nlm.nih.gov/pubmed/3740784

"From the promising results and absence of side effects of resection of the palmaris longus tendon the procedure can be recommended combined with surgical treatment of Dupuytren's contracture."

So I wonder, how come I cannot find this among the treatment options discussed here? Does anyone have experience with it, or an opinion?

Stef

[54 year-old male, DD diagnosis 2006, RH contracture and NA/PNF 2014, RT 2015, wearing night splint glove]

Edited 06/29/16 23:53

06/30/2016 07:00
spanishbuddha 

Administrator

06/30/2016 07:00
spanishbuddha 

Administrator

Re: palmaris longus

We mention it on the BDS website. http://dupuytrens-society.org.uk/informa...py-and-massage/. I think Anna found the same interesting papers as you. It's interesting indeed, and another confounding component by association with DD.

06/30/2016 07:27
Stefan_K. 
06/30/2016 07:27
Stefan_K. 

Re: palmaris longus

spanishbuddha:
We mention it on the BDS website. http://dupuytrens-society.org.uk/informa...py-and-massage/. I think Anna found the same interesting papers as you. It's interesting indeed, and another confounding component by association with DD.
Thanks for the link. Even there, there is not much information, and the question remains, why has there been no discussion on this website when clearly there is a connection with Dupuytren contracture and therefore an opportunity to influence it positively? After having been doubtful of the impact massaging can have on nodules and cords, I now plan to pursue this route at least for the relief of tension, and perhaps beyond.

Stef

[54 year-old male, DD diagnosis 2006, RH contracture and NA/PNF 2014, RT 2015, wearing night splint glove]

06/30/2016 08:06
wach 

Administrator

06/30/2016 08:06
wach 

Administrator

Re: palmaris longus

Hi Stef,

I can only speculate why there has not been any follow-up of this paper, neither in Finland nor elsewhere. Reasons might be

- the connection between having a palmaris longus tendon and getting Dupuytren's is postulated, not proven

- the paper aims to show a benefit of partially resecting the palmaris longus tendon. The palmaris longus tendon extends into the forearm, is considered not really neccessary for the hand function and is therefore often also used as tendon donor. The paper shows Dupuytren's recurrence of 43% if the tendon has not been resected and 33% if it has been resected. But the number of cases is low (42 and 30. respectively) and the obervarion period is relatively short (a few years).

- Dupuytren's is a genetic disease, so removing a tendon will not cure it. Major surgery and related trauma may cause disease extension, maybe compensating a potential benefit of a resected palmaris longus.

There might be a benefit if the tendon is partially resected and thus the pulling on the aponeurosis is reduced. In my view it would need larger studies and longer term observation to convincingly prove a benefit of this tendon resection. The effect of having or not having a palmaris longus might also depend on the use of the hand, which is not discussed in the paper that you are referring to. If the hand is generally not heavily exercised, resecting the palmaris longus might have less effect. It might reduce the risk of developing Dupuytren's for rock climbers but climbers then might have less grip in their hand.

Wolfgang

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