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Introduction
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
The hand skeleton comprises of carpal bones, metacarpal and phalanges. There are eight carpal bones. Four in the proximal and four in the distal row. The scaphoid, lunate, triquetral and pisiform form the proximal row. The scaphoid, lunate and triquetrum form a convex arch and articulate with distal radius and inferior radioulnar joint. The pisiform articulates with triquetrum alone. The trapezium, trapezoid, capitate and hamate form the concave distal carpal row. The distal row and fourth and fifth metacarpal are a less mobile unit (Figure 1.7).
Answers
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
The carpal tunnel is the space between the flexor retinaculum and the underlying carpal bones, and through it run the median nerve and the tendons of the flexor digitorum profundus, flexor digitorum superficialis and flexor pollicis longus. An increase in pressure within this closed space may lead to compression of the median nerve, giving rise to carpal tunnel syndrome. The clinical features include numbness, paraesthesia and pain in the median nerve distribution which are often worse at night, weakness of the ‘LOAF’ muscles supplied by the median nerve and wasting of the thenar eminence. Phalen’s and TinePs tests are performed as part of the physical examination, and if positive increase the suspicion of carpal tunnel syndrome. Neurophysiological studies may show a slowing of conduction of the nerve impulse across the carpal tunnel. The role of imaging to aid diagnosis remains unclear.
A to Z Entries
Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
There are several ligaments that limit movement of the wrist, in addition to the joint capsule. The posterior radiocarpal ligament runs diagonally across the posterior aspect of the wrist from the distal end of the radius to the triquetral and hamate carpal bones on the ulnar side of the wrist. This ligament limits flexion of the wrist. The anterior radiocarpal ligament runs from the anterior aspect of the distal end of the radius to the scaphoid, lunate and capitate bones of the wrist. This ligament limits extension of the wrist. The collateral ligaments of the wrist run along the sides of the joint to limit frontal plane motion. The ulnar collateral ligament, running from the styloid process of the ulna to the triquetral, limits abduction of the wrist. The radial collateral ligament, from the styloid process of the radius to the scaphoid bone, limits adduction of the wrist. Minimal movement occurs between the carpal bones themselves; they are held together by the anterior, posterior and interosseous carpal ligaments. The interlocking structure of the carpal bones also provides support for the wrist, in addition to the support provided by these ligaments.
Cross-sectional changes of the distal carpal tunnel with simulated carpal bone rotation
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
The changes of the carpal tunnel cross-section have been studied with respect to carpal bone motion. In a cadaveric study, wrist forces were applied to cadaveric hand specimens and the carpal tunnel cross-section was digitally imaged and analyzed (Bueno-Gracia, Pérez-Bellmunt, et al. 2018). In an in-vivo study, external forces were manually applied to participant wrists and the resulting changes in carpal tunnel morphology were measured via ultrasound (Bueno-Gracia, Ruiz-de-Escudero-Zapico, et al. 2018). These studies showed that the application of wrist forces causing carpal bone motion can increase the cross-sectional area, increase the anterior-posterior diameter and decrease the transverse diameter. Analogous comparisons to the current study can be made regarding the total CSA, which was observed to decrease for all rotation axes excluding CR. Differences can potentially be explained in the bone mobilization method. The external mobilization method employed by Bueno-Gracia et al. (Bueno-Gracia, Pérez-Bellmunt, et al. 2018; Bueno-Gracia, Ruiz-de-Escudero-Zapico, et al. 2018) may have involved bone translation and rotation, as well as the motion of additional carpal bones, aside from just the hamate and trapezium.
Cross cultural adaptation, reliability and construct validity of the Boston Carpal Tunnel Questionnaire in standard Arabic language
Published in Disability and Rehabilitation, 2021
Hayat H. Hamzeh, Nida A. Alworikat
Diagnosis of CTS is usually done clinically, but physical examination findings have to be supported by nerve conduction study to confirm diagnosis. Clinical tests are considered insensitive compared to nerve conduction and electro-myographic studies which measure the damage of the median nerve [6]. CTS can be treated both surgically and conservatively. Conservative treatments are usually suitable to individuals who have mild to moderate symptoms, they are also performed pre operatively to maintain function and prevent complications. Conservative treatment options include ergonomic modification, exercise, therapeutic ultrasound, oral steroids, carpal bone mobilization, wrist splints and carpal tunnel steroid injection [7]. Carpal tunnel release surgery aims to decrease the internal pressure on the nerve and has a reported high success rate.
A new musculoskeletal AnyBody™ detailed hand model
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Lucas Engelhardt, Maximilian Melzner, Linda Havelkova, Pavel Fiala, Patrik Christen, Sebastian Dendorfer, Ulrich Simon
Although Eschweiler et al. (2016) had already developed a detailed model of the human wrist within the AMS, this model is not implemented in the proposed detailed hand model, mainly because of the reduction of complexity of the model. The eight carpal bones in the presented model are defined as one rigid segment, allowing no movement between the carpal bones. When the research questions do not address the force distribution inside the wrist joint, Schuind et al. (1995) showed that this lack does not have a great influence on the outcome of the muscle activities. This limitation can be addressed in a future version of the model, where splitting of the wrist joint into an ulnar and radial side might be convenient. Further enhancements might be the implementation of helical joint axes in the thumb joints, as proposed by Kerkhof et al. (2016).