Anatomy
Upper Limb
A 49 year old patient sustains a crush injury to his left hand. You are assessing muscle tendon function. Regarding the digital attachments of the flexor muscles, which of the following is paired CORRECTLY:
Answer:
The flexor digitorum profundus is attached distally to the palmar surface of the distal phalanges of all four fingers. The flexor pollicis longus is attached distally to the base of the distal phalanx of the thumb. 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.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 n.b. some terminology is outdated, but attachments are correct.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 |
