Palmaris Longus Trigger Points

Introduction

The palmaris longus is a forearm muscle responsible for wrist flexion and tensioning the palm. When trigger points develop in this muscle, they can cause wrist pain, hand weakness, and forearm discomfort, often mimicking carpal tunnel syndrome, wrist tendinitis, or nerve compression.

Name and Area

  • Name: Palmaris Longus

  • Area: Located in the anterior forearm, running from the medial epicondyle of the humerus to the palmar aponeurosis.

Indications

Palmaris longus trigger points may contribute to:

  • Pain in the Wrist and Palm (Mistaken for Carpal Tunnel Syndrome or Wrist Tendinitis)

  • Pain That Radiates to the Forearm (Can Mimic Median Nerve Compression or Overuse Injuries)

  • Weakness in Wrist Flexion (Difficulty Holding Objects, Writing, or Typing)

  • Pain When Gripping, Squeezing, or Using Hand Tools

  • Tightness in the Palm or Forearm That Worsens with Repetitive Use

  • Pain That Worsens with Activities Requiring Wrist Flexion (Typing, Playing an Instrument, Using a Computer Mouse)

Pain from this muscle is often mistaken for carpal tunnel syndrome, wrist arthritis, or repetitive strain injuries.

Muscle Action

  • Flexes the Wrist: Moves the hand toward the palm.

  • Tenses the Palmar Aponeurosis: Supports grip strength and palm stabilization.

The palmaris longus is essential for wrist function, fine motor skills, and hand coordination.

Signs and Symptoms

Individuals with palmaris longus trigger points often report:

  • Pain or Discomfort Along the Wrist and Palm (Worsens with Fine Motor Tasks)

  • Weakness in Wrist Flexion and Grip Strength (Difficulty Holding a Pen, using a Phone, or Carrying Objects)

  • Pain That Extends to the Forearm or Inner Elbow (Can Mimic Golfer’s Elbow or Median Nerve Compression)

  • Pain or Tightness in the Palm That Feels Like a "Pulling" Sensation

  • Cramping or Fatigue in the Forearm with Repetitive Use (E.g., Writing, Typing, Knitting, Playing an Instrument)

Pain worsens with repetitive gripping, wrist flexion, or prolonged forearm use.

Perpetuating Factors

Common causes of palmaris longus trigger points include:

  • Repetitive Wrist Flexion Movements (Typing, Gaming, Playing Instruments, Writing, Knitting, Weightlifting)

  • Frequent Use of a Computer Mouse or Touchscreen Devices (Sustained Wrist Flexion Without Support)

  • Prolonged Hand Grip or Holding Objects for Extended Periods (Driving, Holding a Phone, Steering Wheel Grip, Cooking)

  • Overuse in Racquet Sports (Tennis, Badminton, Squash, or Rock Climbing)

  • Poor Ergonomics (Awkward Wrist Position While Using a Keyboard, Phone, or Mouse)

Trigger Point Referral Pattern

Trigger points in the palmaris longus refer pain to:

  • The wrist and palm (Mistaken for Carpal Tunnel Syndrome or Wrist Tendinitis)

  • The forearm and inner elbow (Can Resemble Golfer’s Elbow or Median Nerve Compression)

  • The base of the thumb (Mistaken for De Quervain’s Tenosynovitis or Thumb Arthritis)

Pain from this muscle is often confused with carpal tunnel syndrome, wrist tendinitis, or nerve compression injuries.

Differential Diagnosis

Palmaris longus trigger points may be mistaken for:

  • Carpal Tunnel Syndrome (Pain, Numbness, and Tingling in the Hand and Fingers, Particularly at Night)

  • Golfer’s Elbow (Medial Epicondylitis – Inner Elbow Pain That Affects the Wrist and Hand)

  • Wrist Flexor Tendinitis (Pain and Stiffness in the Wrist and Forearm After Repetitive Use)

  • Median Nerve Compression (Pain, Weakness, or Numbness in the Thumb and Inner Wrist)

  • De Quervain’s Tenosynovitis (Pain at the Base of the Thumb, Worsens With Gripping or Lifting Movements)

A thorough hand, wrist, and forearm examination is necessary to rule out these conditions.

Associated Trigger Points

Palmaris longus trigger points often co-exist with:

  • Flexor Carpi Radialis (Wrist and Palm Pain, Weakness in Wrist Flexion and Grip Strength)

  • Flexor Digitorum Superficialis (Pain in the Palm and Fingers, Affects Finger Mobility and Dexterity)

  • Pronator Teres (Forearm and Wrist Pain, Can Mimic Nerve Compression or Tendinitis)

  • Extensor Carpi Ulnaris (Outer Wrist and Hand Pain, Affects Grip Strength and Dexterity)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Palmaris Longus Medial epicondyle of humerus Palmar aponeurosis, flexor retinaculum Median nerve (C7–C8)

The palmaris longus is innervated by the median nerve, which also controls wrist flexion, grip strength, and fine motor coordination.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the forearm, wrist, and palm.

  • Resisted Wrist Flexion Testing: Assess pain and weakness when bending the wrist forward against resistance.

  • Grip Strength Testing: Determine if pain affects endurance when holding objects for long periods.

  • Median Nerve Compression Testing: Rule out nerve-related causes of wrist and hand pain.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the palmaris longus, reducing muscle tightness and improving wrist function.

Manual Therapy

  • Trigger Point Release: Apply direct pressure to tight spots in the forearm and palm.

  • Massage Therapy: Helps improve circulation and reduce wrist and forearm tension.

Stretching

  • Wrist Flexor Stretch: Extend the arm with the palm facing upward, gently pull the fingers toward the body.

  • Forearm Rotation Stretch: Rotate the wrist gently to release tension in the wrist flexors.

Strengthening Exercises

  • Wrist Flexion with Resistance Bands: Strengthens the palmaris longus and surrounding hand muscles.

  • Grip Strength Drills: Improves hand endurance and function.

  • Finger Squeeze Exercises: Enhances precision grip and dexterity.

Postural and Ergonomic Adjustments

  • Modify Keyboard and Mouse Positioning (Reduce Wrist and Hand Strain)

  • Use an Ergonomic Mouse or Grip Support (Prevents Overuse Injuries)

  • Take Frequent Breaks During Repetitive Tasks (Allows Hand and Forearm Muscles to Recover)

Conclusion

The palmaris longus plays a crucial role in wrist flexion, grip strength, and palm tension, but trigger points in this muscle can cause significant wrist pain, hand discomfort, and grip weakness. By incorporating dry needling, manual therapy, stretching, and strengthening exercises, individuals can reduce pain, improve mobility, and prevent repetitive strain injuries.

➡️ Learn more about Trigger Points

➡️ Explore our Trigger Point Index

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.