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Anatomy

Upper Limb

Question 163 of 239

A patient presents with weakness of the left forearm and hand. You examine the strength of the muscles in the anterior forearm. The flexor carpi ulnaris tendon is attached distally to which of the following structures:

Answer:

The flexor carpi ulnaris is attached distally to the pisiform, hook of hamate and 5th metacarpal.

Digital Attachments of Long Flexor Tendons

Anatomy / Upper Limb / Digital Attachment of Long Tendons

Last Updated: 29th January 2019

The flexor muscles of the anterior forearm all originate from the medial humeral epicondyle.

Table: Digital Attachments of the Long Flexor Tendons

Flexor Tendon Distal Attachment
Flexor pollicis longus Base of distal phalanx of thumb
Flexor digitorum profundus Distal phalanges of all four digits
Flexor digitorum superficialis Middle phalanges of all four digits
Flexor carpi ulnaris Pisiform, hook of hamate and 5th metacarpal
Flexor carpi radialis Base of 2nd and 3rd metacarpal
Palmaris longus Palmar aponeurosis

A detailed knowledge of the distal attachments of the flexor tendons is important to allow understanding of the clinical effects of division/injury at any given level of the finger.

  • The flexor pollicis longus is attached distally to the base of the distal phalanx of the thumb.
  • The flexor digitorum profundus is attached distally to the palmar surface of the distal phalanges of all four fingers.
  • The flexor digitorum superficialis is attached distally to the palmar surface of the middle phalanges of all four fingers.
  • The flexor carpi ulnaris is attached distally to the pisiform, hook of hamate and 5th metacarpal.
  • The flexor carpi radialis is attached distally to the base of the 2nd and 3rd metacarpal.
  • The palmaris longus distally blends with the fibres of the flexor retinaculum which is continuous with the palmar aponeurosis.

Digital Attachments of Long Flexor Tendons. n.b. some terminology is outdated, but attachments are correct. (Image 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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