CHAPTER 18 : The Joints of the wrist , hand and fingers

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Flexor retinaculum


Carpal bones (lunate, triquetral, scaphoid, trapezoid)


Hook of hamate, pisiform


Tubercle of scaphoid, ridge of trapezium




The median nerve

All long flexor tendons of fingers and thumb

The synovial sheaths

Connective tissue






  • The four tendons of the superficial flexor are separate and lie in two rows, with the middle and ring finger tendons in front of the index and little finger tendons.

  • The tendons of flexor digitorum profundus lie deeply in one plane.

  • All the eight tendons (of superficialis and profundus) share a common flexor sheath.

  • The tendons of flexor policis longus lies in its own synovial sheath.

  • At the lateral end of the tunnel a deep lamina from the flexor retinaculum is attached to the medial lip of the groove on the trapezium.

  • The tendon of flexor carpi radialis, enclosed in its own synovial sheath, runs in the groove in this subcompartment of the carpal tunnel.

  • The median nerve passes deep the flexor retinaculum between the flexor digitorum superficialis tendon to the middle finger and the flexor carpi radialis.

Carpal tunnel syndrome:

Compression of the median nerve in the carpal tunnel due to arthritic changes in the wrist joint, synovial sheath thickening or edema. Symptoms:

  • Impaired sensation over three and half digits on the thumb side
  • Wasting and weakening of thenar muscles