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Anatomy

Upper Limb

Question 225 of 239

A 47 year old secretary presents to the ED complaining of pain in the left wrist. After examination you suspect carpal tunnel syndrome. Which of the following structures passes through the carpal tunnel:

Answer:

The tendons of the flexor pollicis longus, flexor digitorum superficialis and flexor digitorum profundus pass through the carpal tunnel. The ulnar nerve and ulnar artery pass into the hand anterior to the flexor retinaculum and carpal tunnel.

Carpal Tunnel

Anatomy / Upper Limb / Wrist and Hand

Last Updated: 10th April 2019

Table: Anatomical Boundaries and Contents of the Carpal Tunnel

Anatomical Boundaries Structure(s)
Roof Flexor retinaculum
Carpal arch Pisiform and hook of the hamate medially, tubercles of the scaphoid and trapezium laterally
Contents Four tendons of flexor digitorum profundus, four tendons of flexor digitorum superficialis, tendon of flexor pollicis longus, median nerve

Anatomical Boundaries

The carpal tunnel is formed by a deep carpal arch and a superficial flexor retinaculum.

The base of the carpal tunnel is formed medially by the pisiform and the hook of the hamate and laterally by the tubercles of the scaphoid and trapezium.

The flexor retinaculum is a thickened band of fibrous connective tissue on the volar aspect of the hand, which bridges the gap between these carpal bones and forms the roof of the carpal tunnel.

Contents

The following structures pass through the carpal tunnel:

  • the four tendons of the flexor digitorum profundus (FDP)
  • the four tendons of the flexor digitorum superficialis (FDS)
  • the tendon of the flexor pollicis longus (FPL)
  • the median nerve.

Free movement of the tendons in the carpal tunnel is facilitated by synovial sheaths, which surround the tendons. All of the tendons of the FDP and FDS are contained within a single synovial sheath with a separate sheath enclosing the tendon of the FPL. The median nerve lies anterior to the tendons in the carpal tunnel.

Modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons

Carpal Tunnel. (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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