Boltuch Andrew D, Marcotte Michael A, Treat Christopher M, Marcotte Anthony L
Department of Orthopaedic Surgery, Largo Medical Center, Largo, Florida.
Stanford University, Stanford, California.
J Wrist Surg. 2020 Dec;9(6):493-497. doi: 10.1055/s-0040-1714251. Epub 2020 Jul 30.
The palmaris tendon inserts into the palmar fascia and is positioned in close association with the transverse carpal ligament. Loading of this tendon has been demonstrated to increase carpal tunnel pressures. The purpose of this study was to determine if a relationship exists between the palmaris tendon, carpal tunnel syndrome (CTS), and handedness. The sensitivity, specificity, positive predictive value, and negative predictive value for Schaeffer's test were calculated. A retrospective review of patient charts undergoing endoscopic carpal tunnel release was performed. Rates of palmaris longus agenesis (PLA) were compared to a population matched data set. Statistical analysis was performed using a one-proportion -test. Schaeffer's test for the palmaris longus tendon was performed on all patients and compared to intraoperative confirmation. A total of 520 carpal tunnel releases were performed in 389 consecutive patients. The frequency of PLA in this surgical cohort was significantly lower compared to the population matched dataset. No correlation between handedness and laterality of CTS or PLA was found. Schaeffer's test was evaluated to yield sensitivity (93.6%), specificity (100%), positive predictive value (100%), and negative predictive value (50.8%). The palmaris tendon was more prevalent in a population of patients undergoing carpal tunnel release. These findings can be used to provide further insight into the pathophysiology of CTS. While Schaeffer's test was accurate in detecting the palmaris longus tendon, a negative test was frequently incorrect. Further imaging is recommended in patients with a negative Schaeffer's test when the palmaris longus is desired for surgical utilization. This is a Level III, prognostic study.
掌长肌腱插入掌腱膜，并与腕横韧带紧密相邻。已证实该肌腱受力会增加腕管压力。本研究的目的是确定掌长肌腱、腕管综合征（CTS）和利手之间是否存在关联。计算了谢弗试验的敏感性、特异性、阳性预测值和阴性预测值。对接受内镜下腕管松解术的患者病历进行了回顾性分析。将掌长肌缺如（PLA）的发生率与匹配的人群数据集进行比较。采用单比例检验进行统计分析。对所有患者进行掌长肌腱的谢弗试验，并与术中确认结果进行比较。连续389例患者共进行了520次腕管松解术。该手术队列中PLA的发生率显著低于匹配的人群数据集。未发现利手与CTS或PLA的左右侧性之间存在相关性。谢弗试验的敏感性为93.6%，特异性为100%，阳性预测值为100%，阴性预测值为50.8%。在接受腕管松解术的患者群体中，掌长肌腱更为常见。这些发现可用于进一步深入了解CTS的病理生理学。虽然谢弗试验在检测掌长肌腱方面是准确的，但阴性试验结果经常有误。当需要掌长肌用于手术时，对于谢弗试验阴性的患者，建议进一步进行影像学检查。这是一项III级预后研究。
