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200
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Anatomy

Upper Limb

Question 29 of 239

A 41 year old man presents to ED having sustained an injury to his left anterior wrist. On examination you note the laceration lies anterior to the flexor retinaculum which remains intact. Which of the following structures is most likely damaged in this type of injury:

Answer:

The ulnar artery, ulnar nerve, and tendon of the palmaris longus pass into the hand anterior to the flexor retinaculum. The median nerve and the flexor tendons pass into the hand deep to the flexor retinaculum, within the carpal tunnel.

Flexor Retinaculum

Anatomy / Upper Limb / Wrist and Hand

Last Updated: 10th April 2019

The flexor retinaculum (transverse carpal ligament) is a thickened band of fibrous connective tissue on the volar aspect of the hand which forms the roof of the carpal tunnel. The flexor retinaculum holds the flexor tendons in place at the wrist and prevents them from bowstringing.

It is attached laterally to the scaphoid and trapezium and medially to the pisiform and the hook of the hamate. The thenar and hypothenar muscles arise from the flexor retinaculum.

Relations

  • The ulnar artery, ulnar nerve, and tendon of the palmaris longus pass into the hand anterior to the flexor retinaculum, and therefore do not pass through the carpal tunnel.
  • The flexor carpi radialis tendon passes through the lateral aspect of the flexor retinaculum into the hand.
  • The four tendons of the flexor digitorum profundus, the four tendons of the flexor digitorum superficialis, the tendon of the flexor pollicis longus and the median nerve pass into the hand posterior to the flexor retinaculum, within the carpal tunnel.

Flexor Retinaculum. (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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