Palmaris Longus Research Articles

Reconstruction of giant full-thickness lower eyelid defects using a combination of palmaris longus tendon with superiorly based nasolabial skin flap and palatal mucosal graft

Reconstruction of a full-thickness lower eyelid defect is challenging. We aim to use palmaris longus tendon to improve clinical outcomes in eyelid reconstruction. We generated a novel “three-layer structure” tissue by combination of palmaris longus tendon with superiorly-based nasolabial skin flap and palatal mucosal graft and applied in eyelid reconstruction surgery in 34 patients with significant full-thickness lower eyelid defects. The satisfaction scores were assessed in each patient to evaluate their cosmetic and functional outcomes in follow-up visits. The mean follow-up period was 15 months (range, 6-24 months). Satisfactory results were obtained in 100% patients. No patients reported deformities, obvious scars at the donor sites, or abnormalities of hand function on the surgical side. Our results demonstrated that the three-layer structure incorporating palmaris longus tendon for the reconstruction of giant full-thickness defects in lower eyelid is an effective procedure with satisfactory long-term results.

Practical ultrasonographic technique to precisely identify and differentiate tendons and ligaments of the elbow at the level of the humeral epicondyles: anatomical study

ObjectivesTo develop a practical step-by-step technique to precisely identify and differentiate tendons and ligaments attaching to the humeral epicondyles, to confirm through gross anatomical study the accurate structure identification provided by this technique and to determine the frequency at which each structure can be identified in healthy volunteers.Materials and methodsFirst, ten fresh frozen cadavers (6 men, age at death = 58–92 years) were examined by two musculoskeletal radiologists and a step-by-step technique for the identification of tendons and ligaments at the level of humeral epicondyles was developed. Second, the accurate identification of structures was confirmed through gross anatomical study including anatomical sections on five specimens and layer-by-layer dissection technique on five others. Finally, 12 healthy volunteers (6 men, average age = 36, range = 28–52) were scanned by two radiologists following the same technique.ResultsAn ultrasonographic technique based on the recognition of bony landmarks and the use of ultrasonographic signs to differentiate overlapping structures was developed and validated through gross anatomical study. In healthy volunteers, most tendons and ligaments were identified and well-defined in ≥ 80% of cases, except for the extensor carpi radialis brevis and extensor digiti minimi tendons on the lateral epicondyle (having common attachments with the extensor digitorum communis) and the palmaris longus tendon on the medial epicondyle (absent, or common attachment with the flexor carpi radialis).ConclusionA step-by-step approach to the ultrasonographic assessment of tendons and ligaments at the humeral epicondyles allowed accurate identification of and differentiation among these structures, in particular those relevant to pathological conditions.

Proximal row carpectomy combined with primary flexor pollicis longus tenorrhaphy: An effective treatment alternative for a rare case of flexor pollicis longus rupture due to scaphoid nonunion advanced collapse

This study describes a case of flexor pollicis longus rupture resulting from long-term scaphoid nonunion advanced collapse. The tendon rupture mechanism was attrition due to sharp bone protuberances from the scaphoid in the carpal tunnel. Although this extremely rare complication has already been reported in the literature, our study is original in showing that proximal row carpectomy with consequent wrist shortening allowed primary tendon repair without transferring the flexor digitorum superficialis tendon of the ring finger or grafting the palmaris longus tendon, which besides using two-level suturing, interposes a non-vascularized tissue.

Diagnostic Evidence Depicting Palmaris Longus Origin Reversal: Ultrasound and MRI Evaluation

Introduction: The palmaris longus (PL) is very prone to anatomical variance. It may exhibit agenesis, reversal, and duplication. The reversal variant presents with the PL tendinous aspect proximally and the muscle belly distally. It is an important finding, and it is important to consider when making a differential diagnosis. This is the only reported case of a left distal forearm PL muscle variant with ultrasound and magnetic resonance imaging (MRI) in a Caucasian adult male. Case Report: A 28-year-old Caucasian male presented to the clinic with an abnormal ultrasound finding of a left wrist mass. The patient was instructed to get an MRI, which demonstrated and further confirmed the reversed PL muscle. Conclusion: Although rare, anatomic muscle variance may occur in many places of the body leading to symptoms that need attention. These variants should be considered in orthopedic differential diagnosis and ruled out appropriately with proper diagnostic techniques. By making the correct diagnosis, it leads to improved patient outcomes and satisfaction both conservatively and surgically.

Prevalence, variants, and morphometrics of Palmaris Longus tendon: a magnetic resonance imaging study.

The palmaris longus (PL) tendon present a high degree of variations; the commonest is its absence which could reach more than 40% in some populations. The PL tendon is highly relevant in hand reconstructive surgery; however, MRI variations of PL tendon have been exceptionally reported. To this, this study investigated PL tendon variations using MRI in a Lebanese population. This is a retrospective study of distal forearm MRI examinations to evaluate the presence, anatomical variations and morphometric of PL tendon. The outcomes were set as overall frequency, gender-based and side-base frequencies, correlations between prevalence and gender/side, morphological variants, thickness, and width of PL tendon. The sample comprised 335 patients including a total of 339 MRI scans. The PL was present in 221 wrists (65.2%), and bilaterally in only one (25%) out of the 4 bilateral cases. All PL were located using the Axial T1 views. Univariate and multivariate analyses showed no correlation with side, gender, or Tesla power. The only morphological variation was a reversed PL in 2 cases (0.6%). The mean width was 4.24 ± 1.2mm. The mean thickness was 2.75 ± 0.6mm. As far as we know, this is the first study to report the total array of variations of PL tendon using MRI, and its prevalence in a Lebanese population. The mean width of PL tendon calculated with high quality MR imaging was found to be similar to that reported by cadaveric studies.

Percutaneous Reconstruction of the Ulnar Collateral Ligament of the Metacarpophalangeal Joint of the Thumb: Technique and Results

Abstract Objectives The present study aims to describe a new percutaneous technique for the reconstruction of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb with a tendon graft, and to evaluate the functional outcomes and stability six months postoperatively. Material and methods The percutaneous ligamentoplasty technique was performed with a palmaris longus tendon graft and tenodesis screws in 6 patients with ulnar instability of the thumb (> 30° degrees of radial deviation) for more than 6 weeks. Range of motion, grip strength, and pinch strength (lateral/key pinch, tip pinch, and palmar pinch) were assessed in comparison to the contralateral limb, as well as the Quick Disabilities of the Arm, Shoulder and Hand (DASH) score. Results At 6 months, the joint movement was of 100%, the grip strength was of 94.8%, the key pinch was of 95%, the palmar pinch was of 85.7%, and the tip pinch was of 93.5% compared to the contralateral limb. The internal tilt was of 14° compared to 9° at the contralateral limb. The Quick DASH score decreased from 24.2 to 2.6 points. Conclusion We devised this versatile surgical procedure to obtain early mobility with the advantages related to the percutaneous techniques.

Determination of congenital absence of palmaris longus tendon with clinical examination and ultrasonography.

The tendon of the palmaris longus is commonly used as a tendon graft in many reconstructive surgeries. Palmaris longus absence (PLA) was found in 15% among individuals worldwide. In this prospective study, we aimed to conduct an incidence study in which physical examination methods were confirmed by ultrasonography in PLA, and to evaluate the relationship of absence with age, gender, laterality and dominant hand. The study included 490 cases. They were initially tested to evaluated by physical examination using the Schaeffer's and Hiz-Ediz test for the assessment of the palmaris longus tendon. Additional ultrasonography was performed to confirm its absence in 129 wrists of 78 cases whose tendons could not be visualized or palpated. The incidence of tendon absence was 13% by physical examination methods. According to the final results when we added ultrasonography to physical examination methods, the incidence of unilateral, bilateral and overall absence of the palmaris longus were 5%, 9% and 11% respectively. There was no statistically significant difference between individuals with and without PLA in terms of gender, side, age and dominant hand (p = 0.796, p = 0.622, p = 0.397 and p = 0.187, respectively). However, bilateral PLA was statistically significantly higher than unilateral in both genders (p = 0.011). We think that agenesis should be proven accurately by ultrasonographic examination for the final result before any surgical procedure with palmaris longus tendon. Furthermore measuring the diameter of the palmaris longus tendon by preoperative ultrasonography can be useful for surgeons who plan a procedure that requires specific measurements.

Closed Traumatic A2 Through A4 Pulley Rupture and Flexor Digitorum Superficialis Avulsion Treated With Reconstruction

Background: Multiple closed spontaneous pulley ruptures are rare injuries and require surgical reconstruction to prevent functional deficits. Pulley rupture combined with avulsion of the flexor digitorum superficialis (FDS) tendon is an even more uncommon occurrence.Case Report: We describe a closed traumatic annular 2 (A2) through annular 4 (A4) pulley rupture with avulsion of the FDS tendon. This uniquely associated pathology was treated with a complex surgical reconstruction that corrected flexion contracture and tendon bowstringing in the left long finger. The desired outcome was achieved through A2 and A4 pulley reconstruction using an autologous palmaris longus tendon graft with FDS tendon excision and proximal interphalangeal joint capsulotomy.Conclusion: Multiple pulley rupture is not commonly combined with FDS avulsion, and treatment of this injury requires careful surgical planning based on pulley biomechanics to maximize postoperative function.

Stabilization of the radial head with the palmaris longus or the gracilis tendon: an anatomical feasibility study.

The proximal radioulnar joint (PRUJ) and the radiocapitellar joint may be destabilized after trauma. Different techniques for stabilization of PRUJ have been proposed, but none of them can stabilize the radiocapitellar joint at the same time. We propose a ligamentoplasty to stabilize the radial head at these two joints by reconstructing the radial head annular ligament and the lateral collateral ulnar ligament (LCUL) with a single graft (palmaris longus or gracilis tendon of the knee). Fifteen cadaveric upper limbs were used to compare the stabilization obtained by performing our ligamentoplasty with the palmaris longus or the gracilis tendon. For each technique, the stabilization obtained was evaluated by measuring the displacement of the radial head in the anterior, lateral and posterior directions when a force of 1N was applied in maximum supination, neutral rotation and maximum pronation. We also evaluated whether this technique could damage the ulnar nerve or the posterior interosseous nerve by dissecting them and whether it could limit the range of rotation of the forearm. Our ligamentoplasty enables to restore PRUJ stability equivalent to the intact ligament condition. The palmaris longus was inconstant (13/15) and too short to allow concomitant reconstruction of the LCUL (except in one case). No nerve damage was found during the dissection, and the range of rotation of the forearm was not limited by the ligamentoplasty. We also report a clinical case with an excellent result and without complications. This ligamentoplasty we have described makes it possible to stabilize the radial head with respect to the radial notch of the ulna and with respect to the capitellum of the humerus. The gracilis tendon is more suitable than the palmaris longus because of its constant presence and length. A clinical series is now necessary to better evaluate this technique.

Traumatic index extensor tendon attenuation mimicking closed tendon rupture: two case reports

BackgroundWhile some traumatic closed index extensor tendon ruptures at the musclotendinous junction have been previously reported, closed index extensor tendon pseudorupture due to intertendinous attenuation is exceedingly rare with only one case report of a gymnastics-related sports injury in the English literature. Herein, we report two non-sports injury related cases of traumatic index extensor tendon attenuation mimicking closed tendon rupture, including the pathological findings and intraoperative video of the attenuated extensor indicis proprius tendon.Case presentationA 28-year-old man and a 30-year-old man caught their hands in a high-speed drill and lathe, respectively, which caused a sudden forced flexion of their wrists. They could not actively extend the metacarpophalangeal joints of their index fingers. Intraoperatively, although the extensor indicis proprius and index extensor digitorum communes tendons were in continuity without ruptures, both tendons were attenuated and stretched. The attenuated index extensor tendons were reconstructed either with shortening by plication or step-cut when the tendon damage was less severe or, in severely attenuated tendons, with tendon grafting (ipsilateral palmaris longus) or tendon transfer. Six months after the operation, the active extension of the index metacarpophalangeal joints had recovered well.ConclusionsTwo cases of traumatic index extensor tendon attenuation were treated successfully by shortening the attenuated tendon in combination with tendon graft or transfer. We recommend WALANT (wide-awake local anesthesia and no tourniquet) in the reconstruction surgery of index extensor tendon attenuation to determine the appropriate amount of tendon shortening or optimal tension for tendon grafting or transfer. Intraoperative voluntary finger movement is essential, as it is otherwise difficult to judge the stretch length of intratendinous elongation and extent of traumatic intramuscular damage affecting tendon excursion.

Reconstruction of acromioclavicular joint reconstruction with palmaris longus autograft: Surgical technique

Objective: A common cause of shoulder pain in the young athletic male is Acromioclavicular (AC) joint separations, so reconstruction measures may be designated for efficient enhancement. A multitude of surgical reconstruction techniques exist. Material and method: 15 patients of AC joint dislocation with type IV and V injury were treated by a technique using a Palmaris longus autograft in reduction and fixation of the joint. Result: Postoperatively, pain and deformity was vanished, no superior relocation was noted even after three years of primary surgery, no infection and no restricted range of motion was noted. Conclusion: The anatomic reconstruction of the coracoclavicular ligaments with grafts validates promising clinical and biomechanical effects.

An assessment of the effects of variations in the Palmaris longus tendon and the fifth superficial flexor digitorum on pinch and grip strength.

The effect of the absence or presence of the Palmaris longus tendon on pinch and grip strength was investigated in this study. Similarly, the effect of the presence or absence of the fifth superficial flexor digitorum on grip strength in the hand was studied. The aim of the present study was to assess the combined effect of these anatomical variations on pinch and grip strength. In this cross-sectional study, 523 volunteers and their 1046 hands were enrolled. Each hand was assessed for the presence or absence of the Palmaris longus tendon and for variations in the fifth superficial flexor digitorum function. Then the grip and pinch power of the hands were measured with the Jammar Dynamometer. The presence or absence of Palmaris longus had no effect on grip strength in the individuals studied. Likewise, variations in fifth superficial flexor digitorum function had no effect on grip and pinch strengths. But the results of statistical testing showed the effect of the presence of Palmaris longus on pinch strength (25.38 lbs in hands with Palmaris present vs 24.43 lbs in hands without Palmaris). Pinch and grip power was higher in men than in women and in the right hand than in the left. Based on the findings of the present study, it seems that absence of the Palmaris longus tendon is associated with a reduction in pinch strength but has no effect on grip strength, and the variations in the fifth superficial flexor digitorum (flexor digitorum superficialis, or FDS) have no effect on pinch and grip strengths.

Fiber type composition of contiguous palmaris longus and abductor pollicis brevis muscles: Morphological evidence of a functional synergy.

The palmaris longus (PL) tendon is used in surgical opponensplasty to restore functional hand movements in thenar paralysis. Although successful PL autologous tendon transfer has been attributed to an established synergistic relationship between the PL and abductor pollicis brevis (APB) muscles in vivo, this functional relationship may be dependent on the quality of their spatial relationship and properties of their constituent muscle fibers. The purpose was to compare the proportion of type I and type II muscle fibers in the APB based on its contiguous morphological relationship with the PL tendon for indirect insight into their functional synergy, contractile capacity, and digastric arrangement. Twenty-four contiguous PL and APB specimens were harvested from the upper limbs (12 right and 12 left) of twelve formalin-embalmed cadavers (mean age: 74±10years). The fiber type composition of these muscles was determined by labeling serial cross sections with myosin heavy chain (MyHC) type I and type II monoclonal antibodies. The PL consisted of a relatively heterogeneous fiber type composition irrespective of the presence of a discrete (type I: 41±11%; type II: 55±12%; hybrid: 4±3%) or rudimentary (type I: 49±10%; type II: 45±9%; hybrid: 6±4%) tendinous connection with the APB. The APB fascicles arranged contiguously with the PL through a discrete tendon had significantly greater proportions of type II fibers (41±19%) compared to those with rudimentary PL connections (type II: 15±8%). Therefore, the APB fascicles arranged in a digastric relationship with the PL may have the capacity to produce more powerful contractions than those with rudimentary PL tendons based on the known contractile properties of type II muscle fibers. Knowledge of the spatial relationship between the PL and thenar musculature prior to PL autologous tendon transfer may be a useful indicator of the quality of established synergy in vivo.

Wide Awake Local Anesthesia No Tourniquet Forearm Triple Tendon Transfer in Radial Nerve Palsy.

Summary:Tendon transfer for radial nerve palsy is a common procedure done under general anesthesia. We describe a surgical technique of triple tendon transfer with wide awake local anesthesia no tourniquet (WALANT). We transfer flexor carpi radialis to extensor digitorum communis, palmaris longus to extensor pollicis longus, and pronator teres to extensor carpi radialis brevis. This is commonly known as the Brand transfer. Our anesthetic or WALANT solution consists of up to 200 mL of 1:400,000 epinephrine, 0.25% lidocaine buffered with sodium bicarbonate. This technique overcomes the problem of judging the appropriate amount of transfer tension by observing awake patients actively extend their fingers, thumb, and wrist during the surgery and making adjustments before we close the wound. In our experience, there is no need of brain retraining because a patient is able to immediately use the flexor muscles to perform extension movements. WALANT is a safe and viable option for radial nerve tendon transfers.

The Palmaris Longus and Its Association with Carpal Tunnel Syndrome.

Background 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. Purpose 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. Methods 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 z -test. Schaeffer's test for the palmaris longus tendon was performed on all patients and compared to intraoperative confirmation. Results 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%). Conclusion 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. Level of Evidence This is a Level III, prognostic study.

Clinical Significance of a Duplicated Palmaris Longus Muscle with One Reversed Muscle: A Case Report

BACKGROUND: Multiple variations of the palmaris longus (PL) muscle are reported throughout literature and include variations such as double muscle bellies, inversion of muscle belly and tendon, and the absence of the muscle. The muscle functions as a weak flexor of the wrist. It originates from the medial epicondyle of the humerus, projects as a superficial muscle of the anterior compartment of the forearm, lies over the transverse carpal ligament, and inserts into the palmar aponeurosis.
 CASE REPORT: Routine dissection of the right forearm of a 70-year-old Caucasian male revealed a rare duplicated PL muscle with the medial PL muscle being reversed. The left forearm appeared normal, with no such variations. The cadaver showed no significant pathological findings due to this variation. Innervation and vasculature of the variant muscle appeared normal.
 CONCLUSION: The PL muscle is highly variable, and clinicians need to be aware of its many possible presentations due to its involvement in surgery, symptomatic clinical presentations, and as an anatomical landmark.

Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability of the Elbow: A Systematic Review.

Background: Posterolateral rotatory instability (PLRI) is a common form of recurrent elbow instability. The aim of this systematic review is to present the outcomes and complications of lateral ulnar collateral ligament (LUCL) reconstruction surgery for PLRI. Methods: A literature search of LUCL reconstructions was performed, identifying 99 potential papers; 11 of which met inclusion/exclusion criteria, accounting for 148 patients. Papers were included if they reviewed cases of PLRI from 1976 to 2016 with reported outcome measures. Data were pooled and analyzed focusing on patient demographics as well as subjective and objective patient outcomes and complications. Results: The average age of patients was 34 years with a mean follow-up time of 49.8 months. The most common mechanism of injury was a traumatic elbow dislocation (66%), followed by cubitus varus deformity (7%), and unknown mechanisms (7%). Overall, 90% of patients achieved elbow stability and 2.7% experienced a failed reconstruction that necessitated an additional surgery. Furthermore, 93% were satisfied with the outcome of the reconstruction, and 83% reported good to excellent outcomes with 11% reporting moderate to severe persistent pain. Nearly half (45%) of reconstructions were done using a palmaris longus tendon graft, 24% with a triceps tendon graft, and 7% with a synthetic graft. Conclusions: Outcomes following LUCL reconstruction for PLRI are excellent and revision rates are low. LUCL reconstruction is a safe and reliable procedure.Level of Evidence: IV Therapeutic.

Our Experience in Oral Commissure Reconstruction After Surgical Excision of Stage 3 and Stage 4 Oral Cavity Malignancy

The upper and lower lips represent the most important functional and aesthetic anatomical structures of the lower segment of the face. The reconstructive aims are to restore the oral lining, oral competence and function (i.e. articulation, speech and mastication). Functional and aesthetic restoration of lip and oral commissure defects can be achieved using the composite radial free forearm flap (RFFF) with Palmaris longus tendon. To present the technique, we have used our experience with this form of reconstruction in 30 consecutive patients with lip and oral commissure defects who were surgically treated between 2012 and 2018. Reconstruction of the lip defect was done with RFFF with Palmaris longus tendon. The ends of the Palmaris longus tendon were passed intraorally and anchored to the remnant orbicularis oris muscle of the upper lip to provide adequate tension so that oral competency could be achieved and sagging of the commissure could be prevented, and in cases, where adequate orbicularis oris was not present, the tendon was sutured to the zygomatic prominence. The patients were followed for 1 year. In our study of 30 cases of stage 3 and stage 4 oral cavity squamous cell carcinoma, we did RFFF with Palmaris longus and found that the graft uptake was excellent, i.e. 93.33%. Flap failure occurred in only 2 out of the total 30 cases. Re-exploration of the flap was done, and venous congestion was the cause of flap failure. Re-anastomosis of the vessels was done, but still the flap could not be salvaged. Donor site healed satisfactorily without any complications except for scarring. All patients had excellent oral competence during rest, speaking and eating. Good sphincteric function was obtained in early post-operative days. Drooling or air leakage was seen only in 6 out of 30 cases after 1 year of follow-up. The patients’ articulation was near-normal. The aesthetic results were accepted by 24 patients. All patients were able to resume regular diet. No complications were observed such as dehiscence, fistula formation or abscess formation. The mouth opening was also adequate (2–3 finger width) in 24 out of 30 patients of oral commissure reconstruction. The RFFF with Palmaris longus has excellent viability. It is a secure and reliable reconstructive option which produced satisfactory aesthetic and functional results.

Frequency of agenesis of Palmaris Longus muscle in medical students of Faisalabad

Objective: To find out frequency of agenesis of palmaris longus (PL) of medical students of Faisalabad.Methodology: This cross-sectional study was conducted from 1st to 31st October 2019 at the anatomy department of a private medical college of Faisalabad. Two hundred and two medical students of age ranging from 18-22 years were evaluated for agenesis of PL by standard Schaeffer’s test. Findings were confirmed by Thompson’s test, Pushpakumar’s “two-finger sign” method, Mishra’s test I, and Mishra’s II test. Data was analyzed by SPSS version 21. Frequencies and percentages for PL agenesis were obtained and compared by chi square test. p value ? 0.05 was considered to be significant.Results: The PL muscle was present in 155 students (76.3%). The frequency of agenesis was noted in 47 students (23.6%). Bilateral agenesis was seen in 16 students (7.9%) while 31 subjects (15 %) had unilateral agenesis.Twenty-nine (29.5%) male students had agenesis of palmaris longus. Out of which bilateral and unilateral agenesis found in 7 (6.8%) and 22 (21%) male students respectively. In comparison to this 18 (17.3%) female students had agenesis of palmaris longus. Out of which bilateral and unilateral agenesis found in 9(8.6%) and 9(8.6%) female students respectively.Conclusion: Unilateral agenesis of PL is more common than bilateral agenesis. Agenesis of PL is more frequent in males as compared to females.
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Extensor indicis transfer versus palmaris longus transplantation in reconstruction of extensor pollicis longus tendon: a protocol for a systematic review

This review will provide an overview of published data comparing transposition of the extensor indicis pollicis (EIP) tendon and palmaris longus (PL) tendon grafting in thumb extension reconstruction following loss of the extensor pollicis longus (EPL) tendon function. We will consider all studies comparing EIP and PL utilized to reconstruct thumb extension after injury/rupture of the EPL tendon. Only studies published in the English and German literature will be included. A systematic literature research will be performed across relevant health databases including the Cochrane Library, MEDLINE, and Google Scholar using the following keywords: ((extensor pollicis longus) OR EPL) AND ((extensor indicis) OR EIP OR (tendon transposition)) AND ((palmaris longus) OR (free tendon graft) OR (tendon transplantation)). Central tendencies will be reported in terms of means and standard deviations where necessary. If not reported, the standard deviation will be calculated from the standard error of the mean. Risk ratios will be calculated where possible. All calculations will be performed with a 95% confidence interval. Statistical significance will be set at P < 0.05. Adjusted effect estimates will be analyzed in preference to the unadjusted estimates, using inverse-variance weighted average. Pooled estimates will only be presented after consideration of both clinical and methodological heterogeneity of included studies. The review will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.Systematic review registrationThe protocol was registered on PROSPERO CRD42019135735: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=135735