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Atypical Palmaris Profundus with Median Nerve Perforation Presenting Ultrasonically as an Intraneural Mass

Deglmann, Claus J., MD*; Nagi, Michael, MD

Plastic and Reconstructive Surgery – Global Open: November 7, 2018 - Volume Latest Articles - Issue - p
doi: 10.1097/GOX.0000000000001995
Latest Articles: PDF Only

Summary: An accessory palmaris profundus tendon might cause carpal tunnel like symptoms and in addition is a known potential reason for persistent symptoms following carpal tunnel release. In our case, a 34-year-old female patient presented with paresthesia of the third digit. Electromyography was without pathological findings. Diagnostic high-resolution ultrasound showed an intraneural mass within the median nerve in the region of the distal forearm. A tumorous lesion was suspected and a microsurgical resection was planned. Intraoperatively, a palmaris profundus tendon was found, perforating the median nerve and keeping an intraneural course, before leaving the median nerve within the carpal tunnel to migrate into the distal retinaculum fibers. The resection of the intraneural tendon of the palmaris profundus led to a recovery of the digital paresthesia’s. We discuss the intraoperative findings and review the literature.

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From the *Centre for Hand Surgery, Microsurgery and Plastic Surgery, Schoen-Klinik Muenchen Harlaching, Harlachinger Str. 51, 81547 Muenchen, Germany

Neurozentrum Pasing, Muenchen, Germany.

Published online 7 November 2018.

Received for publication August 4, 2018; accepted September 14, 2018.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

Claus J. Deglmann, MD, Centre for Hand Surgery, Microsurgery and Plastic Surgery, Schoen-Klinik Muenchen Harlaching, Harlachinger Strasse 51, 81547 Muenchen /Munich, Germany, E-mail: cldeglmann@schoen-kliniken.de

Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.