Carpal Tunnel

In the human body, the carpal tunnel or carpal canal is the fibro-osseous [That consists of bones on one side of canal and fibrous band on other]  passageway on the palmar side of the wrist that connects the distal forearm to the middle compartment of the palm.

Structure

The carpal bones form an arch which is convex on the dorsal side of the hand and concave on the palmar side. The groove on the palmar side, the sulcus carpi, is covered by the flexor retinaculum. [Read more]

Clinical Photograph of Giant Cell Tumor of Radius In Advanced Stage

This is clinical photograph of a 24 years old male farmer who presented after 8  months of beginning of pain and 5 months of progressively increasing swelling.

The xray suggested a giant cell tumor like picture involving radius along with breach of the cortices. The diagnosis was confirmed by FNAC and a biopsy was planned.

The patient was explained the disease and the treatment after biopsy which was a choice between limb salvage surgery and amputation owing to advanced stage of disease.

Patient wanted some time to think over the issue and discuss with family. He never reported back.

Flexor Digitorum Profundus

Flexor digitorum profundus  is a muscle in the forearm  that flexes the fingers or digits. and along with the flexor pollicis longus, pronator quadratus, and flexor digitorum profundus form the deep layer of ventral forearm muscles.

Flexor digitorum profundus originates upper 3/4 of anterior & medial surfaces of ulna, interosseous membrane and deep fascia of the forearm.Flexor digitorum profundus lies deep to flexor digitorum superficialis, but it attaches more distally. [See for insertion on the second diagram below] [Read more]

Flexor Digitorum Superficialis

Flexor digitorum superficialis (flexor digitorum sublimis) is an extrinsic flexor muscle of the fingers which lies in anterior compartment of forearm and  causes flexion at the proximal interphalangeal joints.

The muscle originates from two heads  the humeroulnar and radial. Between these two heads median nerve and ulnar artery pass.

Near wrist, it divides into four tendons which travel through the carpal tunnel formed by the flexor retinaculum. These tendons, along with those of flexor digitorum profundus, are enclosed by a common flexor sheath. The tendons attach to the anterior margins on the bases of the middle phalanges of the four fingers.

The tendons have a split (Camper’s Chiasm) at the end of them through which the tendons of flexor digitorum profundus pass.
Function

The primary function of flexor digitorum superficialis is flexion of the middle phalanges of the fingers at the proximal interphalangeal joints, however under continued action it also flexes the metacarpophalangeal joints and wrist joint.

What Is Discography?

Lumbar discography is an invasive diagnostic procedure that involves, instillation of iodinated contrast into the nucleus pulposus after inserting a needle under fluoroscopy. This procedure is done with an aim to get information on the morphology and integrity nucleus pulposus, vertebral endplates and anulus fibrosus.

In addition to this, the measured contrast injection allows determination of intradiscal pressures and response of the patient to this stimulation is a measure of pain caused by disc.

Thus discography not only to defines the anatomical architecture of the disc but also tells whether a particular disc is painful.

Basis Of Discography

Changes in the intervertebral disc and  anulus  are  potential sources of low-back pain. Pain  caused by internal disruption of the normal structural and biochemical integrity of the symptomatic disc is  called discogenic pain. Discography is done to establish and confirm discgenic pain. [Read more]

Anterior Compartment of Forearm

The anterior compartment of the forearm is also known as flexor compartment contains the muscles responsible for flexion and pronation.

The ulnar nerve and artery are also contained within this compartment.

The muscles contained are [See figure for arrangement of muscles]

• Flexor carpi radialis
• Palmaris longus
• Flexor carpi ulnaris
• Pronator teres
• Flexor digitorum superficialis
• Flexor digitorum profundus
• Flexor pollicis longus
• Deep pronator quadratus

Flexor Carpi Radialis

In anatomy, flexor carpi radialis is a muscle of the human forearm that acts to flex and abduct the hand [Wrist joint]

This muscle originates on the medial epicondyle of the humerus. It runs just laterally of flexor digitorum superficialis and inserts on the anterior aspect of the base of the second metacarpal, and has small slips to both the third metacarpal and trapezial tuberosity.

On the anterior aspect of a person’s forearm, proximal to the wrist, flexor carpi radialis is the most lateral tendon visible when the wrist is brought into flexion.

What Is Chemonucleolysis?

Chemonucleolysis is the term used to denote chemical destruction of nucleus pulposus [Cehmo+nucleo+lysis]. This involves intradiscal injection of chymopapain which causes hydrolysis of he cementing protein of the nucleus pulposus. This causes decrease in water binding capacity leading to reduction in size and drying the disc.

Chemonucleolysis is one of the methods to treat disc herniation not responding to conservative therapy.

Basis of Treatment

Nucleus Pulposus is soft, gelatinous material in the center of disc and is surrounded by a tough fibrous coating annulus fibrosus. In disc herniation weakened or torn annulus fibrosus allows nucleus pulposus to ooze out

Chemonucleolysis uses chymopapain, an enzyme derived from papyrus, to dissolve the disk material. Chemonucleolysis is appropriate for only some cases of HNP.

Chemonucleolysis is not effective in sequestered discs. In a sequestered disk, a fragment of the nucleus pulposus breaks loose from the disk and is free in the spinal canal. [Read more]

Sesamoid Bone

A sesamoid bone is a bone embedded within a tendon.

Sesamoid bones are found in locations where a tendon passes over a joint, such as the hand, knee, and foot. They act to protect the tendon and to increase its mechanical effect by increasing its moment arm.

Patella is a type of sesamoid bone.

Prolapsed Intervertbral Disc or Spinal Disc Herniation

An intervertebral disc lies between two adjacent vertebrae. Disc herniation is a condition in which a tear in the annulus fibrosus (Outer firmer ring) of an intervertebral disc  allows the soft, central portion (nucleus pulposus) to bulge out. Due to that adjacent neural structures may get compressed and produce symptoms of radiculopathy.

Following diagram would make it easier to comprehend how a disc bulge can affect nerve roots. On left side is a normal disc and on the right side is a herniated disc.

Lumbar followed by cervical spine are most commonly affected by disc herniation with former being more common than latter. L4-L5 and L5-S1 discs most common to herniate in lumbar spine. In cervical spine C5-C6 and C6-C7 discs are most commonly involved.

Thoracic disc herniation is rare. [Read more]

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