Carpal Tunnel The median nerve and the finger flexion tendons lie within the carpal tunnel. This is a common site of compression neuropathy.
Guyon’s Canal (Ulnar Tunnel) The ulnar nerve and artery lie within Guyon’s tunnel. This is also a common site of compression neuropathy.
Guyon’s Canal (Ulnar Tunnel)
Posterior Aspect The ulnar styloid process is at the posterior aspect of the wrist proximal to the fifth digit. The radial tubercle is at the posterior aspect of the wrist proximal to the thumb. Pain the the tubercle may indicate Colle’s fracture. Pain at the ulnar styloid process may indicate a distal ulnar fracture.
Ulnar Styloid Process and Radial Tubercle
Posterior Aspect There are six fibro-osseous tunnels at the posterior aspect of the wrist. The extensor tendons to the hand pass through these tunnels. They are bound by an extensor retinaculum superficially.
Carpal Tunnel Syndrome Carpal tunnel syndrome is a compression neuropathy of the median nerve. Compression occurs under the flexor retinaculum at the wrist.
Carpal Tunnel Syndrome
Clinical Signs and Symptoms Loss of sensation of the tips of the first three fingers Hand and wrist pain Weakness of grip
Tinel’s Wrist Sign Procedure: Patient’s hand supinated. Stabilize the wrist with one hand. With your opposite hand, tap the palmar surface of the wrist with a neurological reflex hammer. Rationale: Tingling along the distribution of the medial nerve indicates carpal tunnel syndrome. The cause could be any of the following: inflammation of the flexor retinaculum, anterior dislocation of the lunate bone, arthritic changes, or tenosynovitis of the flexor digitorum tendons.
Tinel’s Wrist Sign
Phalen’s Test Procedure: Flex both wrist and approximate them towards each other. Hold for 60 seconds. Rationale: When both wrists are flexed, the flexor retinaculum provides increased compression of the medial nerve in the carpal tunnel. Tingling in the distribution of the median nerve (thumb, index finger, middle finger, and medial half of ring finger) indicates carpal tunnel syndrome.
Reverse Phalen’s Test Procedure: Instruct the patient to extend the affected wrist and have him grip your hand. With your opposite thumb, press on the carpal tunnel. Rationale: Extending the hand and providing pressure over the carpal tunnel further constricts the tunnel. Tingling may indicate compression of the medial nerve.
Reverse Phalen’s Test
Ulnar Tunnel Syndrome The ulnar nerve travels through the tunnel of Guyon and innervates the muscles of the little and ring fingers. Ulnar nerve syndrome is a compression neuropathy of the ulnar nerve.
Guyon’s Canal (Ulnar Tunnel)
Ulnar Tunnel Syndrome Clinical Signs and Symptoms Pain over the little and ring finger Weakness of grip Difficulty with finger spreading Claw hand
Ulnar Tunnel Triad Procedure: Inspect and palpate the patient’s wrist, looking for tenderness over the ulnar tunnel, clawing of the ring finger, and hypothenar wasting. Rationale: All of these signs are indicative of ulnar nerve compression possibly in the tunnel of Guyon.
Ulnar Tunnel Triad
Stenosing Tenosynovitis Stenosing tenosynovitis in the wrist affects the tendon and sheath of the abductor pollicis longus and extensor pollicis brevis. It is also termed de Quervain’s or Hoffman’s disease. Swelling of the tendons and thickening of the sheaths that they pass through is due to an overuse condition of the wrist and thumb.
Stenosing Tenosynovitis Clinical Signs and Symptoms Painful wrist and thumb during movement Swelling over the radial styloid Tendons and sheath tender to palpation
Finkelstein’s Test Procedure: Instruct the patient to make a fist with the thumb across the palmar surface of the hand and to stress the wrist medially. Rationale: Making a fist and stressing it medially will stress the abductor pollicis longus and extensor pollicis brevis tendons. Pain in the distal styloid process of the radius indicates stenosing tenosynovitis of the tendons (de Quervain’s disease).