Structures of wrist and hand

Question 1

Describe contents of carpal tunnel

Answer 1

Just deep to the flexor retinaculum – median nerve recurrent branch first affected (supplies thenar muscles)
Then tendons of Flexor digitorum superificalis – ring and middle finger are more superficial than the other two
Deep to the superificialis is profundus tendons arranged in a row
All eight tendons of the superficial and deep flexors share a common tendon sheath, which does not invest them completely but is reflected from their radial sides, where arteries gain access.

Lateral to that Flexor pollicis longus
The tendon of flexor pollices longus lies in its own synovial sheath as it passes through the fibro-osseous tunnel.

anterior to that and in own compartment is flexor carpi radialis

Ulnar nerve and artery pass superfically to the retinaculum through the canal of guyon

Nil named arteries through the carpal tunnel

Question 2

Describe the flexor retinaculum

Answer 2

Flexor retinaculum stops tendons of flexor of forearm from bow-stringing
In the hand
Attaches from tubercle of the scaphoid proximally and ridge of trapezium distally on radial side
Attaches to pisiform proximally and distally hook of hamate on the ulnar

Inserted into it are palmaris longus and brevis
Superficial to it ulnar nerve and artery, palmar cutaneous branches of ulnar and median nerve

Question 3

Will patients with carpal tunnel syndrome loose sensation over the thenar emminence

Answer 3

No as palmar cutaneous branch of the median nerve branches prior to the carpal tunnel and supplies the area of skin over the thenar eminence

Question 4

Describe the anatomical snuff box

Answer 4

Lies on the lateral side of the hand 
Triangular shaped area 
Borders by tendons 
-Dorsal tendon extensor pollicis longus 
-palmar tendon extensor pollicis brevis and abductor pollicis longus 

Within snuff box can feel trapezium and scaphoid bones

Radial artery passes through the snuff box
Cephalic vein begins just proximal to the snuff box
superficial branch of the radial nerve runs over EPL

Question 5

Describe the structures of the ventral aspect of the wrist from medial to lateral

Answer 5

1) superciail branch of the radial nerve
2) brachioradialis
3) radial artery
4) flexor capri radialis
5) median nerve
6)palmar cutaneous branch
7) palmaris longus
8) flexor digitorum superficialis
9) ulnar artery
10ulnar nerve with its palmar cutaneous branch (11) and dorsal cutaneous nerve (12)
13) flexor carpi ulnaris

Question 6

Describe the extensor retinaculum

Answer 6

Attaches to the lateral side of the radius
Attaches medially to the pisiform and triquetral bone
stops bowstringing

Question 7

Describe the nerve distribution of nerves to the hand

Answer 7

Ulnar branches

• Dorsal cutaneous hand – ventral medial one and half fingers
• Palmar cutaneous branch hypothena emminence
• Once passed flexor retinaculum through canal of guyon branches into deep which supplies muscles and superfical which supplies the digital branches of the ulnar – palmar one and half

Median branches

• Palmar cutaneous branch (superficial to flexor retinaculum)- thenar eminence
• Digital branches arise from the deep median nerve after it has traversed the carpal tunnel -supplies the three and half radial finger on the palmar side and the distal parts of the dorsal sides of the radial three and half fingers

Radial branches
supplies the dorsal surface of the lateral three and a half fingers except for the distal portion of the fingers which are supplied by the median nerve