AIIMS test: a simple test to look for presence of palmaris longus

Machhindra, Morey Vivek; Garg, Bhavuk; Tiwari, Vivek; Kotwal, Prakash

doi:10.1007/s12306-015-0354-3

Cited by 4 publications

(5 citation statements)

References 10 publications

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“…2 In this study, the AIIMS test showed the maximum number of 113 (82.4%) tendons in the right hand and 108 (78.8%) tendons in the left hand. Likewise, the prevalence of the agenesis of the PL tendon using the AIIMS test was found to be 24 (17.6%) in the right hand and 29 (21.2%) in the left hand and is comparable with the study conducted by Machhindra et al 7 where the overall prevalence of agenesis of the tendon was 20%. In this study, Thompson's test showed the presence of 109 (79.6%) tendons in the right hand and 106 (77.4%) tendons in the left hand.…”

Section: Discussionsupporting

confidence: 87%

Assessing the Accuracy of Common Clinical Tests for Detecting Palmaris Longus: A Prospective Study in a Tertiary Center

Jayachandiran,

Rajendran,

U.S

et al. 2023

Indian J Plast Surg

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Background Palmaris longus (PL) is a short-bellied muscle with a long tendon that merges with the palmar aponeurosis. It is supplied by the median nerve and acts as a tensor of the palmar aponeurosis and flexes the wrist. This tendon is commonly used for tendon transfers and as a donor for tendon graft. There are numerous clinical tests to detect the presence of PL like Schaeffer's test, Thompson's test, Mishra's test I, Mishra's test II, Pushpakumar's “two-finger sign” method, and AIIMS test. The principle of all these tests is to make the tendon prominent by eliciting its flexor action and then its identification by inspection and palpation. Objectives The tests that are consistently easy to perform with good understandability would be easy to explain to the general population (patients). The aim of our study is to find out the accuracy and easy comprehensibility of various tests using compulsive postures for detecting PL tendon clinically. Materials and Methods This is a prospective study on 137 participants. All the patients were subjected to six clinical tests to detect the presence or absence of PL tendon. The results were recorded for both hands by a single observer. Results Of the 137 participants, 75 were males (54.74%) and 62 were females (45.26%). The mean age was 21 years. The AIIMS test showed the maximum number of tendons, that is, 113 (82.4%) in the right hand and 108 (78.8%) in the left hand. In view of the ability to comprehend the tests, 119 (86.9%) subjects understood Schaeffer's test very easily. Conclusion According to this study, the AIIMS test best demonstrates the PL tendon, and Schaeffer's test was the test most easily understood by the subjects.

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Section: Discussionsupporting

confidence: 87%

Assessing the Accuracy of Common Clinical Tests for Detecting Palmaris Longus: A Prospective Study in a Tertiary Center

Jayachandiran,

Rajendran,

U.S

et al. 2023

Indian J Plast Surg

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“…Palmaris longus and little finger superficial flexor varies anatomically in human body, as one may be present or both are absent in the hand and wrist [ 1 ]. These variations may be assessed by several clinical tests and these tests are more superior to the other according to some studies [ 2 3 4 5 6 7 8 ]. A recent study showed that different tests may suggest different results when the presence of Palmaris Longus is assessed by them [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Interobserver and intraobserver reliability of different methods of examination for presence of palmaris longus and examination of fifth superficial flexor function

et al. 2018

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The palmaris longus is harvested as a tendon graft in various surgical procedures. Several tests are used to assess the presence of palmaris longus tendon. In the present study, we attempted to assess the interobserver and intraobserver reliability of five of the most famous methods and also the examination of fifth superficial flexor function. Two observers, who had been trained on the tests and had practiced them, examined 105 volunteers on two separate occasions and in 1-month interval the results were recorded. The reliability of each method was assessed with Kappa measurement. Kappa ranged from 0.541 (moderate reliability) to 0.813 (almost complete agreement) for palmaris. The highest interobserver and intraobserver reliability and also the best agreement with other tests were of Schaeffer. The lowest kappa was for Thompson and the others have good to excellent reliability. Kappa for interobserver and intraobserver reliability for the fifth flexor were 0.415 and 0.500 (moderate reliability), respectively. The tests that were assessed have good reliability except for Thompson that has a moderate one. It seems that the standard test (Schaeffer) is the best method for the assessment of the absence or presence of palmaris longus. The method used for the evaluation of fifth superficial flexor variations assessment has a moderate interobserver and intraobserver reliability.

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“…Previous studies have compared various clinical tests to detect the PL tendon (Kigera and Mukwaya, 2012; Kyung et al., 2012; Machhindra et al., 2015; Ndou et al., 2010; Sadeghifar et al., 2018), and three of these five also found Schaeffer’s standard test to be the most ‘accurate’ in detecting the PL tendon (Kigera and Mukwaya, 2012; Kyung et al., 2012; Sadeghifar et al., 2018). However, none of these studies verified the accuracy of the examination manoeuvres against surgical dissection or advanced imaging.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical examination accuracy may also be influenced by the examiner’s level of expertise. While the examiners in the present study are attending orthopaedic surgeons with over 60 years of combined experience, examiners in previous studies included medical school or physician assistant students (Kigera and Mukwaya, 2012; Sadeghifar et al., 2018) and first year orthopaedic residents (Machhindra et al., 2015). The most common difficulty reported in the examination for the presence of the PL is the misinterpretation of the flexor carpi radialis as the PL, and novice examiners are more susceptible to this mistake than experienced examiners (Sadeghifar et al., 2018; Sebastin and Lim, 2006).…”

Section: Discussionmentioning

confidence: 99%

“…A variety of clinical manoeuvres have been described to assess PL tendon presence, including Schaeffer’s standard test (Schaeffer’s), Thompson’s test (Thompson’s), Mishra’s first test (Mishra-I), and Mishra’s second test (Mishra-II) (Gangata, 2009; Machhindra et al., 2015; Mahajan, 2005; Mishra, 2001; Oudit et al., 2005; Pushpakumar et al., 2004; Schaeffer, 1909; Thompson et al., 1921). Several studies have assessed the utility of these examination manoeuvres (Kigera and Mukwaya, 2012; Kose et al., 2009; Kyung et al., 2012; Nasiri et al., 2016, Ndou et al., 2010; Machhindra et al., 2015; Sadeghifar et al., 2018; Sebastin and Lim, 2006), but none of these studies compared their clinical tests against a reference standard, such as intraoperative findings or advanced imaging, to verify the presence or absence of the PL tendon.…”

Section: Introductionmentioning

confidence: 99%

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Clinical tests for assessing the presence and quality of the palmaris longus tendon: diagnostic accuracy of examination compared with ultrasound

Johnson

Zusstone

Miller

et al. 2019

J Hand Surg Eur Vol

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Various clinical tests are used to evaluate the palmaris longus tendon, but their accuracy is unknown. We assessed the accuracy of clinical tests (Schaeffer’s, Thompson’s, Mishra-I, Mishra-II) against ultrasound as the reference standard. We hypothesized that Schaeffer’s was most accurate and that examination can reliably assess the palmaris longus tendon’s length. Ninety-six wrists were examined clinically and evaluated with ultrasound by radiologists who were blinded to examination results. We calculated diagnostic accuracy and agreement between length measurements. Sensitivity values were as follows: Schaeffer’s 94%, Mishra-I 100%, Mishra-II 100%, Thompson’s 72%. Specificity values were as follows: Schaeffer’s 94%, Mishra-I 83%, Mishra-II 89%, Thompson’s 91%. Intraclass correlation coefficient between palmaris longus tendon length measurement on examination and ultrasound was 0.54. Schaeffer’s test accurately detected this tendon with >90% sensitivity and specificity, but clinical examination less reliably measured palmaris longus tendon length. Ultrasound may be a useful adjunct to assess potential graft length preoperatively. Level of evidence: I

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AIIMS test: a simple test to look for presence of palmaris longus

Abstract: Our proposed test to evaluate the presence of palmaris longus tendon is very simple and easy-to-understand manoeuvre with good sensitivity. It would be extremely useful in the preoperative planning in most of the reconstructive surgeries, should the palmaris longus tendon be harvested.

Cited by 4 publications

References 10 publications

Assessing the Accuracy of Common Clinical Tests for Detecting Palmaris Longus: A Prospective Study in a Tertiary Center

Assessing the Accuracy of Common Clinical Tests for Detecting Palmaris Longus: A Prospective Study in a Tertiary Center

Interobserver and intraobserver reliability of different methods of examination for presence of palmaris longus and examination of fifth superficial flexor function

Clinical tests for assessing the presence and quality of the palmaris longus tendon: diagnostic accuracy of examination compared with ultrasound

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