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Anatomy

Upper Limb

Question 178 of 239

A 28 year old man presents to ED with a stab wound to lateral dorsal wrist. Imaging shows damage to the first dorsal compartment of the wrist of his left hand. Which of the following tendons may be affected in this injury:

Answer:

The extensor tendons at the level of the wrist are divided into six extensor compartments that are numbered from lateral to medial. The first dorsal compartment contains the tendons of the extensor pollicis brevis and abductor pollicis longus muscles.

Extensor Retinaculum

Anatomy / Upper Limb / Posterior Forearm

Last Updated: 10th April 2019

The extensor retinaculum (dorsal carpal ligament) lies obliquely across the extensor surface of the wrist joint, and holds the extensor tendons in place during movement of the wrist.

It is attached laterally to the anterolateral radius above the styloid process and medially to the pisiform and triquetrum bones. It does NOT attach to the ulna.

Contents

The extensor tendons pass through the extensor tunnel, deep to the extensor retinaculum, in six compartments lined by synovial sheaths:

  • The tendons of the extensor carpi ulnaris and extensor digiti minimi have separate sheaths on the medial side of the wrist
  • The tendons of the extensor digitorum and extensor indicis share a synovial sheath on the posterior surface of the wrist
  • The tendons of the abductor pollicis longus and extensor pollicis brevis, the extensor carpi radialis longus and extensor carpi radialis brevis, and the extensor pollicis longus have three separate sheaths on the lateral side of the wrist

By Henry Vandyke Carter [Public domain], via Wikimedia Commons

Extensor Retinaculum. (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

By Anatomyczar (Own work) [CC BY-SA 4.0 , via Wikimedia Commons

Dorsal Compartments of Wrist: 1) Extensor pollicis brevis and abductor pollicis longus tendons 2) Extensor carpi radialis longus and brevis tendons 3) Extensor pollicis longus tendon 4) Extensor digitorum and extensor indicis tendons 5) Extensor digiti minimi tendon 6) Extensor carpi ulnaris tendon. (Image by Anatomyczar [CC BY-SA 4.0 , 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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