FLEXOR AND EXTENSOR RETINACULA OF UPPER LIMB

A SEMINAR BY V.JANARTHANAN I-MBBS

FLEXOR RETINACULUM OF UPPER LIMB
‡ INTRODUCTION:
Thickening of distal antebrachial fascia just proximal to radiocarpal (wrist) joint. Continuous with wrist) joint. extensor retinaculum at margins of forearm. This forearm. structure is distinct from the transverse carpal ligament, ligament, commonly called "the flexor retinaculum," which forms retinaculum," the roof of the carpal tunnel. tunnel. Synonym: flexor retinaculum of forearm, palmar carpal forearm, ligament, ligament, antebrachial flexor retinaculum,

retinaculum musculorum flexorum manus, ligamentum carpi transversum .

LOCATION(SURFACE MARKING):
PROXIMAL MEDIAL BORDER: PISIFORM BONE PROXIMAL LATERAL BORDER: TUBERCLE OF SCAPHOID DISTAL MEDIAL BORDER: HOOK OF HAMATE DISTAL LATERAL BORDER: CREST OF TRAPEZIUM #CONCAVE PROXIMALLY & DISTALLY#

MEASUREMENT:
AVERAGE: 2 X 2 CM. MAY VARY DEPENDING ON THE SIZE OF THE WRIST

1.median nerve 2.tendons of flexor digitorum superficialis 3.tendons of flexor digitorum profundus 4.tendon of flexor pollicis longus 5.tendon of flexor carpi radialis

ATTACHMENT:
SUPEROSUPERO-MEDIAL: PISIFORM BONE SUPEROSUPERO-LATERAL: TUBERCLE OF SCAPHOID INFEROINFERO-MEDIAL: HOOK OF HAMATE INFEROINFERO-LATERAL: EITHER SIDE OF ANTERIOR GROOVE OF TRAPEZIUM* *THIS FORMS A SEPARATE TUNNEL FOR THE TENDON OF FLEXOR CARPI RADIALIS

Flexor retinaculum (FR) 1 scaphoid 2 trapezium 3 pisiform 4 hamate

4 hamate

RELATIONS(SUPERFICIAL):
TENDON OF PALMARIS LONGUS PALMAR CUTANEOUS BRANCH OF MEDIAN NERVE PALMAR CUTANEOUS BRANCH OF ULNAR NERVE ULNAR VESSELS ULNAR NERVE FLEXOR CARPI ULNARIS HAS PARTIAL INSERTION THENAR AND HYPOTHENAR MUSCLES HAVE PARTIAL ORIGIN

MEASUREMENT:

RELATIONS(DEEP):
MEDIAN NERVE TENDONS OF FLEXOR DIGITORUM SUPERFICIALIS TENDONS OF FLEXOR DIGITORUM PROFUNDUS TENDONS OF FLEXOR POLLICIS LONGUS ULNAR BURSA RADIAL BURSA TENDON OF FLEXOR CARPI RADIALIS

PURPOSE:
HOLDS THE FLEXOR TENDONS IN PLACE ACTS AS A PULLEY DUE TO THE PRESENCE OF SYNOVIAL SHEATHS MAINTAINS THE ANTERIOR CONCAVITY OF THE PALM

CLINICAL ANATOMY:
CARPAL TUNNEL SYNDROME Carpal tunnel syndrome is a common disorder that causes pain, and interferes with the use of the hand. It is caused by pressure on the median nerve as the nerve passes through a canal formed by the bones and ligaments in the wrist (the carpal tunnel). A wide variety of conditions can cause the carpal tunnel to narrow and put pressure on the median nerve, including injuries, such as wrist fractures; arthritis nerve, complicated by swelling of the tendons in the carpal tunnel; pregnancy, which may cause the synovium around the tendons to thicken; and glandular abnormalities, such as diabetes and thyroid disorders. Work that involves repetitive wrist motions may also cause carpal tunnel syndrome. Symptoms of carpal tunnel syndrome include pain and numbness in the thumb and in the index, middle, and ring fingers. Many people wake at night with these symptoms. Some sufferers experience weakness of hand muscles and may drop objects. Symptoms often occur when the wrist is flexed during such activities as driving a car or holding a book while reading. Doctors treat carpal tunnel syndrome by attempting to improve the underlying condition. In many cases, doctors apply a splint to the wrist and prescribe antiantiinflammatory medications. In some cases, surgery is performed to relieve symptoms and to prevent permanent damage to the median nerve

REVIEW:
The flexor retinaculum (transverse carpal ligament, or anterior ligament, annular ligament) is a strong, fibrous band, which arches over the ligament) carpus, carpus, converting the deep groove on the front of the carpal bones into a tunnel, the carpal tunnel, through which the Flexor tendons of the digits tunnel, and the median nerve pass. It is attached, medially, to the pisiform and the hamulus of the hamate bone; bone; laterally, to the tubercle of the scaphoid, and to the medial part of scaphoid, trapezium. the volar surface and the ridge of the trapezium. It is continuous, above, with the volar carpal ligament; and below, with the ligament; palmar aponeurosis. It is crossed by the ulnar vessels and nerve, and the aponeurosis. cutaneous branches of the median and ulnar nerves. nerves. At its lateral end is the tendon of the Flexor carpi radialis, which lies in the radialis, groove on the greater multangular between the attachments of the ligament to the bone. On its volar surface the tendons of the Palmaris longus and Flexor carpi ulnaris are partly inserted; below, it gives origin to the short muscles of the thumb and little finger. finger.

EXTENSOR RETINACULUM OF UPPER LIMB
‡ INTRODUCTION: ‡ A strong fibrous band formed as a thickening of the antebrachial deep fascia, stretching obliquely across the back of the wrist, attaching deeply to ridges on the dorsal aspect of the radius, triquetral and pisiform bones, binding down the extensor tendons of the fingers and thumb. ‡ Synonym: retinaculum extensorum, dorsal carpal ligament, ligamentum carpi dorsale, retinaculum musculorum extensorum manus .

LOCATION:
‡ The extensor retinaculum (dorsal carpal ligament) is an anatomical term for the thickened part of the antebrachial fascia that holds the tendons of the extensor muscles in place. It is located on the back of the forearm, just proximal to the hand. It is continuous with the palmar carpal ligament, which is located on the anterior side of the forearm. ‡ It is a strong, fibrous band, extending obliquely downward and medialward across the back of the wrist, and consisting of part of the deep fascia of the back of the forearm, strengthened by the addition of some transverse fibers. ‡ It is attached, medially, to the styloid process of the ulna and to the triangular and pisiform bones; laterally, to the lateral margin of the radius; and, in its passage across the wrist, to the ridges on the dorsal surface of the radius.

MEASUREMENT:
‡ 2-3 CM. THICK ‡ LENGTH VARIES GREATLY DEPENDINGON VARIOUS FACTORS

ATTACHMENTS:
‡ LATERAL : LOWER SALIENT PART OF THE ‡ ANTERIOR BORDER OF RADIUS ‡ INTERMEDIATE: LONGITUDINAL RIDGES ‡ ON THE POSTERIOR ‡ SURFACE OF THE ‡ LOWER END OF RADIUS AND ‡ HEAD OF ULNA ‡ MEDIAL: i) STYLOID PROCESS OF ULNA ‡ ii) MEDIAL SIDE OF CARPUS ‡ (PISIFORM & TRIQUETRAL)

RELATIONS(COMPARTMENTS):
COMPARTMENT I II i) ii) i) ii) i) i) ii) iii) iv) i) i) STRUCTURES ABDUCTOR POLLICIS LONGUS EXTENSOR POLLICIS BREVIS EXTENSOR CARPI RADIALIS LONGUS EXTENSOR CARPI RADIALIS BREVIS EXTENSOR POLLICIS LONGUS EXTENSOR DIGITORUM EXTENSOR INDICES POSTERIOR INTEROSSEOUS NERVE ANTERIOR INTEROSSEOUS ARTERY EXTENSOR DIGITI MINIMI EXTENSOR CARPI ULNARIS

III IV

V VI

PURPOSE:
‡ HOLDS THE EXTENSOR TENDONS IN PLACE ‡ ACTS AS A PULLEY DUE TO THE PRESENCE OF SYNOVIAL SHEATHS

CLINICAL ANATOMY:
‡ Extensor Retinaculum Graft for Chronic Boxer¶s Knuckle

REVIEW:
‡ The extensor retinaculum (dorsal carpal ligament) is an anatomical term for the thickened part of the antebrachial fascia that holds the tendons of the extensor muscles in place. It is located on the back of the forearm, just proximal to the hand. It is continuous with the palmar carpal ligament, which is located on the anterior side of the forearm. ‡ It is a strong, fibrous band, extending obliquely downward and medialward across the back of the wrist, and consisting of part of the deep fascia of the back of the forearm, strengthened by the addition of some transverse fibers. ‡ It is attached, medially, to the styloid process of the ulna and to the triangular and pisiform bones; laterally, to the lateral margin of the radius; and, in its passage across the wrist, to the ridges on the dorsal surface of the radius.

COURTESY: 
                          

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