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

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

Capitate

Capitatetate bone is the largest of the carpal bones, and occupies  the distal row in the center of the wrist.

It has

• A rounded portion or head, which is received into the concavity formed by the scaphoid and lunate bones
• A constricted portion or neck
• The body. The bone is also found in many other mammals, and is homologous with the “third distal carpal” of reptiles and amphibians.

Capitatus in Latin means having a head.

Surfaces & Articulations

The superior surface is round, smooth, and articulates with the lunate bone.

The inferior surface is divided by two ridges into three facets, for articulation with the second, third, and fourth metacarpal bones, that for the third being the largest.

The dorsal surface is broad and rough.

The volar surface is narrow, rounded, and rough, for the attachment of ligaments and a part of the Adductor pollicis muscle.

The lateral surface articulates with the trapezoid by a small facet at its anterior inferior angle.

The medial surface articulates with the hamate nt.

The capitate articulates with seven bones

• Scaphoid and lunate proximally
• Second, third and fourth metacarpal distally
• Trapezoid on the radial side, and hamate on the ulnar side.

Discectomy

A discectomy is a surgical procedure in which the central portion of an intervertebral disc, the nucleus pulposus is removed.

This surgery is done when disc prolapse occurs and causes pain by stressing the spinal cord or nerves.  In addition to traditional discectomy,  procedures like microdiscectomy, endoscopic discectomy and laser discectomy are now commonly done.

Discectomy may or may not carried with laminectomy depending upon surgeon’s preference.

DiGeorge Syndrome

DiGeorge Syndrome is a genetic disorder caused by the deletion of a small section of chromosome 22. This results in a midline congenital defect including thymic aplasia, or congenital deficiency of a thymus.

Patients may present with a profound immunodeficiency disease, due to the lack of T cells. No other immune cell lineages are affected by the congenital absence of the thymus.

DiGeorge Syndrome is the most common congenital cause of thymic aplasia in humans.

Biofeedback

Biofeedback is a process that involves measuring a subject’s specific and quantifiable bodily functions such as the activity of brain waves, blood pressure, heart rate, skin temperature, sweat gland activity, and muscle tension. This information is conveyed to the patient in real-time.

This raises the patient’s awareness and therefore the possibility of conscious control of those functions. Read more

Anterior Longitudinal Ligament

The anterior longitudinal ligament is a ligament that runs down the anterior surface of the spine. It traverses all of the vertebral bodies and intervertebral discs.

This ligament is thick and slightly more narrow over the vertebral bodies and thinner but slightly wider over the intervertebral discs which is much less pronounced than that seen in the posterior longitudinal ligament.

Its posterior counterpart is called posterior longitudinal ligament.

Dermatome

A dermatome is an area of skin that is mainly supplied by a single spinal nerve.

A similar area innervated by peripheral nerves is called a peripheral nerve field.

Dermatomes are useful in locating  the site of damage to the spine.

Important dermatomes and anatomical landmarks

* C2 – posterior half of the skull cap
* C3 – area correlating to a high turtle neck shirt
* C4 – area correlating to a low-collar shirt
* C6 – (radial nerve) 1st digit (thumb)
* C7 – (median nerve) 2nd and 3rd digit
* C8 – (ulnar nerve) 4th and 5th digit, also the funny bone
* T4 – nipples.
* T5 – Inframammary fold.
* T6/T7 – xiphoid process.
* T10 – umbilicus (important for early appendicitis pain)
* T12 – pubic bone area.
* L1 – inguinal ligament
* L4 – includes the knee caps
* S2/S3 – genitalia

Alar Ligament

The alar ligaments connect the sides of the dens on the axis, or the second cervical vertebra to tubercles on the medial side of the occipital condyle.

They are short, tough, fibrous cords and function to check side-to-side movements of the head when it is turned.

The alar ligament is also known as the check ligament of the odontoid.

The fibers within each alar ligament are arranged in a multiplanar fashion, rostrally originating from the medial surfaces of the occipital condyles and converging in a V-shaped fashion on either side of the tip of the odontoid process. This complex composition allows the alar ligaments to serve a variety of functions.