Tendon of Flexor Carpi Radialis in carpal tunnel: a radiologic and cadaveric study

Vatansever, Alper; DEMIRY�REK, MEHMET DENIZ; Ercakmak Gunes, Burcu; Ozsoy, Mehmet Hakan; Ergun, Kadriye mine

doi:10.3906/sag-2012-31

Tendon of Flexor Carpi Radialis in carpal tunnel: a radiologic and cadaveric study

Burcu ERÇAKMAK GÜNEŞ, (Hacettepe Üniversitesi, Tıp Fakültesi, Anatomi Anabilim Dalı, Ankara, Türkiye)

Alper VATANSEVER, (Balıkesir Üniversitesi, Tıp Fakültesi, Anatomi Anabilim Dalı, Balıkesir, Türkiye)

Deniz DEMİRYÜREK, (Hacettepe Üniversitesi, Tıp Fakültesi, Anatomi Anabilim Dalı, Ankara, Türkiye)

Mine ERGUN, (Hacettepe Üniversitesi, Tıp Fakültesi, Anatomi Anabilim Dalı, Ankara, Türkiye)

Hakan ÖZSOY (Memorial Hastanesi Ortopedi ve Travmatoloji Anabilim Dalı, Ankara, Türkiye)

Turkish Journal of Medical Sciences

4 0

Yıl: 2021 Cilt: 51 Sayı: 4 Sayfa Aralığı: 1912 - 1916 Metin Dili: İngilizce DOI: 10.3906/sag-2012-31 İndeks Tarihi: 13-01-2022

Tendon of Flexor Carpi Radialis in carpal tunnel: a radiologic and cadaveric study

Öz:

Background/aim: Carpal tunnel is an important anatomical passage that carries the flexor tendons into the hand. As there is still no consensus about its contents among the anatomy textbooks, the main purpose of this study was to identify the relations of the flexor carpi radialis tendon in the carpal tunnel. Materials and methods: This retrospective study was completed in April 2018 at authors’ university’s hospital. Seventy-four female and 44 male patients’ wrists without any pathology were examined by using magnetic resonance images. The series of axial sections where the pisiform exist were evaluated by using T1 sequence and the structures in the carpal tunnel were identified. Results: Results of this study showed that the tendon of the flexor carpi radialis was found above the flexor retinaculum within its own septal compartment in all patients. Conclusion: According to the results, tendon of flexor carpi radialis crosses the wrist region superficial to the carpal tunnel. Thus, tendon of flexor carpi radialis doesn’t have any effect on the carpal tunnel syndrome. Further cadaveric studies would be useful for identifying the contents of the carpal tunnel and morphological organization of the wrist.Key words: Cadaver, carpal tunnel, flexor carpi radialis, magnetic resonance imaging, wrist anatomy

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Standring S. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 41th ed. London, UK: Elsevier Limited; 2016. pp. 863- 864.
2. Moore KL DA, Agur AMR. Clinically Oriented Anatomy. 7th ed. Philadelphia:, USA: Wolters Kluwer/Lippincott Williams & Wilkins Health; 2014. pp. 688-689.
3. Strohl AB, Zelouf DS. Ulnar tunnel syndrome, radial tunnel syndrome, anterior interosseous nerve syndrome, and pronator syndrome. Journal of American Academy of Orthopedic Surgery 2017; 25 (1): e1-e10. doi:10.5435/JAAOS-D-16-00010
4. Brooks R, Kistler A, Chowdhry S, Swiergosz A, Perlin K et al. Anatomic landmarks to locate the median nerve for safe wrist block or carpal tunnel steroid injection. Eplasty 2019; 19: 139- 146.
5. Marquardt TL, Gabra JN, Li ZM. Morphological and positional changes of the carpal arch and median nerve during wrist compression. Clinical Biomechanics (Bristol, Avon) 2015; 30 (3): 248-253. doi:10.1016/j.clinbiomech.2015.01.007
6. Bijannejad D, Azandeh S, Javadnia F, Gholami MR, Gharravi AM et al. Persistent median artery in the carpal tunnel and anastomosis with superficial palmar arch. Case Reports Plastic Surgery Hand Surgery 2016; 3 (1): 25-27. doi:10.3109/2332088 5.2016.1166964
7. Chammas M, Boretto J, Burmann LM, Ramos RM, Dos Santos Neto FC et al. Carpal tunnel syndrome - part 1 (anatomy, physiology, etiology and diagnosis). Revista Brasileira de Ortopedia (English Edition) 2014; 49 (5): 429-436. doi:10.1016/j.rboe.2014.08.001
8. Sinnatamby CS. Last’s Anatomy: Regional and Applied. 12th ed. Elsevier Health Sciences; 2011. pp. 64-66.
9. Moore KL DA, Agur AMR. Clinically Oriented Anatomy. 7th ed. Philadelphia, USA: Wolters Kluwer/Lippincott Williams & Wilkins Health; 2014. pp. 747-749.
10. Bolles CL, Abdella A, Battaglia PJ. Flexor carpi radialis tenosynovitis mimicking carpal tunnel syndrome diagnosed and monitored with ultrasound: case report. SN Comprehensive Clinical Medicine 2020; 2 (6): 797-801. doi:10.1007/s42399- 020-00320-1
11. Rotman MB, Donovan JP. Practical anatomy of the carpal tunnel. Hand Clinics 2002; 18 (2): 219-230. 10.1016/s0749- 0712(01)00003-8
12. Manley M, Boardman M, Goitz RJ. The carpal insertions of the transverse carpal ligament. Journal of Hand Surgery 2013; 38 (4): 729-732. doi:10.1016/j.jhsa.2013.01.015
13. Pensy RA, Brunton LM, Parks BG, Higgins JP, Chhabra AB. Single-incision extensile volar approach to the distal radius and concurrent carpal tunnel release: cadaveric study. Journal of Hand Surgery 2010; 35 (2): 217-222. doi:10.1016/j. jhsa.2009.11.011
14. Tannan SC, Pappou IP, Gwathmey FW, Freilich AM, Chhabra AB. The extended flexor carpi radialis approach for concurrent carpal tunnel release and volar plate osteosynthesis for distal radius fracture. Journal of Hand Surgery 2015; 40 (10): 2026- 2031. doi:10.1016/j.jhsa.2015.07.001
15. Elsaman AM, Thabit MN, Radwan AR, Ohrndorf S. Idiopathic carpal tunnel syndrome: evaluation of the depth of the carpal tunnel by ultrasonography. Ultrasound in Medicine & Biology 2015; 41 (11): 2827-2835. doi:10.1016/j. ultrasmedbio.2015.06.018
16. Luong DH, Smith J, Bianchi S. Flexor carpi radialis tendon ultrasound pictorial essay. Skeletal Radiology 2014; 43 (6): 745- 760. doi:10.1007/s00256-014-1846-1
17. McCann PA, Amirfeyz R, Wakeley C, Bhatia R. The volar anatomy of the distal radius--an mri study of the fcr approach. Injury 2010; 41 (10): 1012-1014. doi:10.1016/j. injury.2010.02.031
18. Parellada AJ, Morrison WB, Reiter SB, Carrino JA, Kloss LA et al. Flexor carpi radialis tendinopathy: spectrum of imaging findings and association with triscaphe arthritis. Skeletal Radiology 2006; 35 (8): 572-578. doi:10.1007/s00256-006- 0116-2
19. Zamborsky R, Kokavec M, Simko L, Bohac M. Carpal tunnel syndrome: symptoms, causes and treatment options. Literature Review. Journal of Ortopedics, Traumatology and Rehabilitation 2017; 19 (1): 1-8. doi:10.5604/15093492.1232629
20. Koh SH, Kwon BC, Park C, Hwang SY, Lee JW et al. A comparison of the performance of anatomical mri and dti in diagnosing carpal tunnel syndrome. European Journal of Radiology 2014; 83 (11): 2065-2073. doi:10.1016/j. ejrad.2014.08.007
21. Newington L, Harris EC, Walker-Bone K. Carpal tunnel syndrome and work. Best Practice & Research: Clinical Rheumatology 2015; 29 (3): 440-453. doi:10.1016/j. berh.2015.04.026
22. Hosapatna M, Souza AD, Rao M, Hari Ankolekar V. Morphology and innervation of brachioradialis and flexor carpi radialis and their utility in tendon transfer surgeries: a cadaveric study. Morphologie 2020; 104 (345): 91-96. 10.1016/j. morpho.2019.10.046
23. Agur AM, Dalley AF. Grant’s Atlas of Anatomy. 12th ed. Lippincott Williams & Wilkins; 2009. pp. 554-555.
24. Elhan A, Karahan ST. Sobotta İnsan Anatomisi Atlası. 7th ed. Ankara, Turkey: Elsevier; 2011. pp. 176-177.
25. Hansen JT. Netter’s Clinical Anatomy. 3th ed. Saunders/ Elsevier; 2014. p.327.
26. Snell RS. Clinical Anatomy by Regions. 9th ed. Wolters Kluwer, Lippincott Williams & Wilkins. 2012. p. 398.
27. Gabra JN, Kim DH, Li ZM. Elliptical morphology of the carpal tunnel cross section. European Journal of Anatomy 2015; 19 (1): 49-56.
28. Gabra JN, Li ZM. Carpal tunnel cross-sectional area affected by soft tissues abutting the carpal bones. Journal of Wrist Surgery 2013; 2 (102): 73-78. doi:10.1055/s-0032-1329593
29. Won HS, Han SH, Oh CS, Chung IH, Suh JS et al. Morphological study of the proximal boundary of the flexor retinaculum and of its constituent parts. Journal of Hand Surgery (European Volume) 2012; 37 (1): 35-41. doi:10.1177/1753193411414515
30. Brink PR, Franssen BB, Disseldorp DJ. A simple blind tenolysis for flexor carpi radialis tendinopathy. Hand (N Y) 2015; 10 (2): 323-327. doi:10.1007/s11552-014-9631-0
31. Zhou M, Ishizawa A, Akashi H, Suzuki R, Kanatsu Y et al. An anomalous case of the flexor carpi radialis with an excessive muscular bundle. Anatomical Science International 2020; 95 (2): 293-296. doi:10.1007/s12565-019-00519-w

APA	Ercakmak Gunes B, Vatansever A, DEMIRY�REK M, Ergun K, Ozsoy M (2021). Tendon of Flexor Carpi Radialis in carpal tunnel: a radiologic and cadaveric study. , 1912 - 1916. 10.3906/sag-2012-31
Chicago	Ercakmak Gunes Burcu,Vatansever Alper,DEMIRY�REK MEHMET DENIZ,Ergun Kadriye mine,Ozsoy Mehmet Hakan Tendon of Flexor Carpi Radialis in carpal tunnel: a radiologic and cadaveric study. (2021): 1912 - 1916. 10.3906/sag-2012-31
MLA	Ercakmak Gunes Burcu,Vatansever Alper,DEMIRY�REK MEHMET DENIZ,Ergun Kadriye mine,Ozsoy Mehmet Hakan Tendon of Flexor Carpi Radialis in carpal tunnel: a radiologic and cadaveric study. , 2021, ss.1912 - 1916. 10.3906/sag-2012-31
AMA	Ercakmak Gunes B,Vatansever A,DEMIRY�REK M,Ergun K,Ozsoy M Tendon of Flexor Carpi Radialis in carpal tunnel: a radiologic and cadaveric study. . 2021; 1912 - 1916. 10.3906/sag-2012-31
Vancouver	Ercakmak Gunes B,Vatansever A,DEMIRY�REK M,Ergun K,Ozsoy M Tendon of Flexor Carpi Radialis in carpal tunnel: a radiologic and cadaveric study. . 2021; 1912 - 1916. 10.3906/sag-2012-31
IEEE	Ercakmak Gunes B,Vatansever A,DEMIRY�REK M,Ergun K,Ozsoy M "Tendon of Flexor Carpi Radialis in carpal tunnel: a radiologic and cadaveric study." , ss.1912 - 1916, 2021. 10.3906/sag-2012-31
ISNAD	Ercakmak Gunes, Burcu vd. "Tendon of Flexor Carpi Radialis in carpal tunnel: a radiologic and cadaveric study". (2021), 1912-1916. https://doi.org/10.3906/sag-2012-31

APA	Ercakmak Gunes B, Vatansever A, DEMIRY�REK M, Ergun K, Ozsoy M (2021). Tendon of Flexor Carpi Radialis in carpal tunnel: a radiologic and cadaveric study. Turkish Journal of Medical Sciences, 51(4), 1912 - 1916. 10.3906/sag-2012-31
Chicago	Ercakmak Gunes Burcu,Vatansever Alper,DEMIRY�REK MEHMET DENIZ,Ergun Kadriye mine,Ozsoy Mehmet Hakan Tendon of Flexor Carpi Radialis in carpal tunnel: a radiologic and cadaveric study. Turkish Journal of Medical Sciences 51, no.4 (2021): 1912 - 1916. 10.3906/sag-2012-31
MLA	Ercakmak Gunes Burcu,Vatansever Alper,DEMIRY�REK MEHMET DENIZ,Ergun Kadriye mine,Ozsoy Mehmet Hakan Tendon of Flexor Carpi Radialis in carpal tunnel: a radiologic and cadaveric study. Turkish Journal of Medical Sciences, vol.51, no.4, 2021, ss.1912 - 1916. 10.3906/sag-2012-31
AMA	Ercakmak Gunes B,Vatansever A,DEMIRY�REK M,Ergun K,Ozsoy M Tendon of Flexor Carpi Radialis in carpal tunnel: a radiologic and cadaveric study. Turkish Journal of Medical Sciences. 2021; 51(4): 1912 - 1916. 10.3906/sag-2012-31
Vancouver	Ercakmak Gunes B,Vatansever A,DEMIRY�REK M,Ergun K,Ozsoy M Tendon of Flexor Carpi Radialis in carpal tunnel: a radiologic and cadaveric study. Turkish Journal of Medical Sciences. 2021; 51(4): 1912 - 1916. 10.3906/sag-2012-31
IEEE	Ercakmak Gunes B,Vatansever A,DEMIRY�REK M,Ergun K,Ozsoy M "Tendon of Flexor Carpi Radialis in carpal tunnel: a radiologic and cadaveric study." Turkish Journal of Medical Sciences, 51, ss.1912 - 1916, 2021. 10.3906/sag-2012-31
ISNAD	Ercakmak Gunes, Burcu vd. "Tendon of Flexor Carpi Radialis in carpal tunnel: a radiologic and cadaveric study". Turkish Journal of Medical Sciences 51/4 (2021), 1912-1916. https://doi.org/10.3906/sag-2012-31