Thread: Palmeris longus

Hi BD,

When I was 17, I cut my hand on a piece of broken glass. I damaged the tendon on my left hand, little finger. I was unable to bend it at all. I saw a doctor at the local hospital who basically told me there was nothing wrong with it. A few weeks later, still unable to bend it, I saw my GP who advised I had damaged the tendon and would need reconstructive surgery to have it fixed.

I ended up having a two stage tendon reconstruction done over about 11 months, using the palmeris longus. Surgeries went very well, I ended up with quite a good range of movement back. Over the years since the surgery, I ended up with a small amount of scar tissue, so I went back for revision surgery in 2006. I have had some problems in recent years with crepitus and I almost ruptured the graft once or twice. Very sensitive to cold weather and the finger would almost turn blue. But that has settled down and I only get the odd pain from time to time.

If a small percentage of the population are born without a palmeris longus, what does it actually do? I seem to have quite a bit of strength difference between the hands, and not just because I am right dominant. If I am bicep curling or doing chest work, the left hand will give out completely, with a lot of fatigue felt around the thickest, meatiest part of the forearm, which is where I seem to also get a lot of day to day pain, I guess from the palmeris longus harvest? Would that be right? I keep my left hand and wrist strapped during exercise as it seems to help (not sure if this is just a mental thing).

Pushups also cause me problems, having to keep the hand flat I lose all strength in that arm and can't even do one pushup. If I use a bench or something that I can push the palm of my hand in to, it gets better.

I guess my question, is the forearm pain I am getting attributed to the removal of the palmeris longus? Anything I can do to help it? If it is related, had I have known about this pain before hand, I probably would have left the finger as it was, even though that in itself caused pain with the damaged tendon pulling and getting snagged all the time.

The palmaris longus (PL) is a remnant and genetic variant, some say related to when we used to swing in the trees. Some people have none, some have two, and some only have one. It does contribute in a very minor way to wrist flexion and tenses the palmar fascia, so really, not a terrible lot.

The area of pain in the common flexor belly (the meaty part of the forearm) is where the muscle belly of PL lives. I'm not sure how much exploring they did to harvest your tendon, but it's likely the muscle belly is still there and atrophied (not that it's very big anyway). I would suggest you add in some grip strengthening exercises and some forearm flexor strengthening, really concentrating on ulnar flexion - which means when you do a wrist curl, you concentrate on pulling your little finger side of the hand to the inside aspect of your elbow, or funny-bone area. Don't just do these curls on a flat bench with your hands over the edge, use a preacher curl pad too, and even cables.

The pain you're still experiencing can occur post-op for up to 12-18 months in some people. I would suggest some regular acupuncture and massage or therapeutic ultrasound to assist any scar tissue and get decent circulation into the area. I think that in time it should settle, but just take things easy, gradually build your forearm strength, but absolutely get some body work done.

Keep us updated.

BD

Originally Posted by BODY DOC

Don't just do these curls on a flat bench with your hands over the edge, use a preacher curl pad too, and even cables.

Thanks BD.

I had actually stopped doing curls with the preacher curl pad as the meaty part of the arm ended up too sore (and then also ended up with tennis/golf elbow type pain). I will take it slow and steady, as perhaps in the past, I rushed in to these exercises too quickly. I'm going to start acupuncture and also get my jaw looked at as well for the TMJ. Might as well while I am there.

Thanks again. :)