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Three Part Question

In a patient with a [transacted Palmaris longus tendon], should it be [repaired or treated conservatively] [to give the best long term clinical outcome]?

Clinical Scenario

A 35 year old right hand dominant carpenter presented to the emergency department after sustaining an injury with his saw to his right wrist. On examination, there was a transverse incision across the palmar crease with an completely transacted Palmaris longus tendon. He had limited range of motion in his wrist due to the swelling. X-ray revealed no fractures or foreign bodies. You wonder if it should be repaired or treated conservatively to give best clinical outcome.

Search Strategy

Medline interface on the world wide web. 1966 – August 2010
[({Palmaris longus.mp} AND {cut or transect or transaction or divide or divided or lacerated or injured or tear} AND {repair or management or treatment or conservative}]
LIMIT to English

Search Outcome

1 paper was found which addressed the question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Sarangapani K & Brown HG 1977 UK	12 patients with completely transacted Palmaris longus tendon	Prospective case series	Complications present post repair	None present	Small patient number No functional score noted pre/post operatively Follow up period not noted Not compared with non-operative treatment

Comment(s)

Sarangapani et al performed a prospective case series on 12 patients with transacted Palmaris longus tendons. Their main finding was that there were no complications post operatively however there was no comparision made against conservative treatment and functional outcome was not clearly documented. They had no complications and their conclusion was that it should be repaired in the event that if a future tendon graft is required, it is often first choice.

Clinical Bottom Line

There is no evidence to show whether conservative or operative treatment of Palmaris longus gives a better clinical outcome. A randomized study with pre and post operative scoring would be required. There is an argument to repair the tendon as a site for future graft harvesting.

References

1. K. Sarangapani and H. G. Brown CUT PALMARIS LONGUS TENDON--TO REPAIR OR NOT TO REPAIR? The Hand 1977; Vol, 9 No. 1, Page 86