Background: The palmaris longus (PL) is a superficial forearm flexor frequently harvested as a donor tendon due to its minimal functional role. Its absence varies across populations, making local prevalence data critical for surgical planning and anatomical education. 

Methods: A descriptive cross-sectional study was conducted among 652 medical and dental students at KIST Medical College. Five validated clinical tests: Schaeffer’s, Thompson’s, Mishra I & II, and Pushpakumar’s sign were used bilaterally. Data were analyzed using SPSS v26 (p<0.05). 

Results: Overall PL absence was 23.3% (152/652). Bilateral absence (16.1%) was more common than unilateral (7.2%). Left unilateral absence (4.9%) was more frequent than right (2.3%). Absence was significantly higher in left-handed/ambidextrous participants (p=0.0269). 

Conclusion: With nearly one-quarter of the population lacking the PL, preoperative clinical or sonographic confirmation is essential before considering it for tendon grafting in the Nepalese population.

Keywords: Ambidexterity; Anatomical variation; Palmaris longus; Prevalence; Tendon grafting