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Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Prateek Behera, Karthick Rangasamy, Nirmal Raj Gopinathan
The ulnar nerve passes superficially on the medial side of the flexor retinaculum in medial relation to the ulnar vessels and divides into superficial and deep branches. The superficial branch supplies the palmaris brevis muscle and gives branches to the medial one-and-a-half fingers along with the nail bed. A deep branch courses behind and in between the pisiform bone and hook of the hamate bone and lies in the concavity of the deep palmar arch.
The Pericardium (PC)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
The carpal tunnel, existing in two distinct parts, narrows in its distal portion, described as that section between the hamulus, or hook, of the hamate bone and the tubercle of the trapezium. The transverse carpal ligament thickens and tenses in this zone, whereas it thins and slackens at the proximal portion, between the pisiform bone and scaphoid tubercle. This allows contents inhabiting the proximal tunnel to expand. Severe or chronic carpal tunnel syndrome constricts the median nerve to such an extent that it acquires an “hour glass deformity” through the narrow zone.
The Hand
Published in Gene L. Colborn, David B. Lause, Musculoskeletal Anatomy, 2009
Gene L. Colborn, David B. Lause
The flexor retinaculum is a dense fibrous band that arches between the carpal bones. Laterally, it is bound to the trapezium and scaphoid bones. Medially it is attached to the pisiform bone and the hamulus of the hamate bone. The retinaculum and carpal bones form a tunnel through which the long flexor tendons and median nerve pass to reach the palm. Reduction of the size of the tunnel by disease processes results in carpal tunnel syndrome, by compression of the median nerve - with pain, paresthesias (such as burning or “tingling”) or diminution in sensation from the area supplied by the median nerve, and atrophy of the thenar muscles.
A case of a painful coalition between pisiform and hamate
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Atsuyuki Inui, Yutaka Mifune, Hanako Nishimoto, Takahiro Niikura, Ryosuke Kuroda
Fusions of the carpal bones are rare anomalies which occur in 1% of the population [1]. Carpal coalition is usually an asymptomatic entity diagnosed by a hand radiograph by chance. Coalitions may occur anywhere in the carpus, but the most common variant occurs between the lunate and triquetral bones followed by the capitate and hamate [2]. Fusion between the pisiform and hamate bones was first described by Cockshott [3]. To date, about ten cases of pisiform and hamate coalition have been reported in English literature. Here we report a case of a painful coalition between the pisiform and hook of the hamate in a teenaged patient.
Two cases of pyrocarbon capitate resurfacing after comminuted fracture of the capitate bone
Published in Case Reports in Plastic Surgery and Hand Surgery, 2020
Aleid C. J. Ruijs, Joël Rezzouk
The second case (LG) is that of a 20-year-old male right-hand dominant student, who presented after a skiing accident with a traumatic injury of his right wrist. Standard X-rays and a CT scan showed a comminuted fracture of the capitate (Figure 3). During surgery, we noted that the capitate was severely comminuted, and there was extensive cartilage damage between the capitate and hamate, and capitate and trapezoid. The comminuted pieces of the capitate were removed and replaced by a corticocancellous bone graft harvested from the iliac crest. The volume needed was measured before harvesting the bone graft. It was a corticocancellous bone graft in one piece. The bone graft was prepared with a 75 degrees angle on the dorsal side, which corresponds to the 15-degree angle of the distal radius. A central tract was made in the graft with a large K-wire. Then the broach was inserted into the bone graft. The implant was placed into the graft, and the graft with implant was then fixed by several K-wires to the other carpal and metacarpal bones. Cancellous bone was added between the trapezoid bone, the bone graft and the hamate bone. K-wires were added for stability. There was good contact and mobility between the RCPI prosthesis and the scaphoid and lunate bones. A spanning external fixator was applied to provide distraction for protection of the cartilage during bone healing (Figure 4(A)). It was removed at 6 weeks post-operatively. At 29 months’ follow-up, his ROM was 55 degrees of flexion and 45 degrees of extension of the wrist, and a loss of both pronation and supination of 15°. Ulnar and radial deviation was functional at respectively 45 and 10 degrees compared to 50 and 30 degrees of the left wrist. Squeeze strength was 100%, Jamar grip strength was 65% and key pinch strength was 91% compared to the left side. At rest, he had no pain in his wrist, and after activity, his maximum pain level was 4 out of 10 (VAS-scale). The Quick Dash showed a score of 6%, and the PRWE a score of 13.5 out of 100. The RCPI prosthesis was in place and there were no signs of secondary degenerative changes between the prosthesis and the scaphoid or lunate bones (Figure 4(B)). He has had to give up his climbing activities but does still ride his motorcycle.