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Anatomy

Upper Limb

Question 209 of 239

A 31 year old lady slipped on a wet bathroom floor and fell onto her outstretched hand. She is tender over the anatomical snuffbox and imaging shows a fracture of the scaphoid bone. Which of the following structures is most likely to be damaged in this type of injury:

Answer:

The radial artery passes over the floor of the anatomical snuffbox, just superior to the scaphoid bone and hence it is the most likely to be injured in this type of injury. Once in the hand the radial artery divides into the princeps pollicis artery and the deep palmar arterial arch.

Anatomical Snuffbox

Anatomy / Upper Limb / Posterior Forearm

Last Updated: 10th April 2019

The anatomical snuffbox is the triangular depression formed on the posterolateral side of the dorsal wrist and 1st metacarpal by the extensor tendons passing into the thumb.

Table: Anatomical Boundaries and Contents of the Anatomical Snuffbox

Anatomical Boundaries Structure(s)
Medial border Tendon of extensor pollicis longus
Lateral border Tendons of the abductor pollicis longus and extensor pollicis brevis
Proximal border Radial styloid process
Distal border 1st metacarpal
Floor Scaphoid and trapezium bones
Roof Skin
Contents Radial artery, terminal portion of the superficial branch of the radial nerve, cephalic vein

Boundaries

It is bounded laterally by the tendons of the abductor pollicis longus and the extensor pollicis brevis and medially by the tendon of the extensor pollicis longus.

The floor of the anatomical snuffbox is formed by the scaphoid and trapezium carpal bones. The radial styloid process can be palpated proximally and the 1st metacarpal can be palpated distally.

Contents

The radial artery crosses the floor of the anatomical snuffbox. Subcutaneously terminal parts of the superficial branch of the radial nerve and the origin of the cephalic vein pass over the anatomical snuffbox.

The anatomical snuffbox is important clinically as the scaphoid is palpable within the snuffbox; localised pain and tenderness of the anatomical snuffbox is most likely due to a scaphoid fracture.

anatomical-snuffbox

Anatomical Snuffbox. (Image by Grant, John Charles Boileau (An atlas of anatomy, / by regions 1962) [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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