Extensor tendon compartments of the wrist

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Extensor tendon compartments of the wrist
Wrist extensor compartments (numbered).PNG
Drawing of the back of the wrist showing the extensor compartments
Anatomical terminology

Extensor tendon compartments of the wrist are anatomical tunnels on the back of the wrist that contain tendons of muscles that extend (as opposed to flex) the wrist and the digits (fingers and thumb).

Contents

The extensor tendons are held in place by the extensor retinaculum. As the tendons travel over the posterior (back) aspect of the wrist they are enclosed within synovial tendon sheaths. These sheaths reduce the friction to the extensor tendons as they traverse the compartments that are formed by the attachments of the extensor retinaculum to the distal (far end) of the radius and ulna.

Structure

The compartments are numbered with each compartment containing specific extensor tendons. [1]

CompartmentComponent(s)Function(s)Associated pathology
1 Abductor pollicis longus tendon

Extensor pollicis brevis tendon

Thumb abduction and extension at metacarpophalangeal joint

Forms radial (thumb side) border of the anatomical snuff box

De Quervain's tenosynovitis
2 Extensor carpi radialis longus tendon

Extensor carpi radialis brevis tendon

Extension of wrist Intersection syndrome
3 Extensor pollicis longus tendon Separated from the third compartment by Lister's tubercle

Forms ulnar (little finger side) border of the anatomical snuff box

Extension of interphalangeal joint of thumb

Drummer's wrist
4 Extensor digitorum tendons

Extensor indicis tendon

Extension of the medial four digits Fourth compartment syndrome
5 Extensor digiti minimi tendon Positioned directly over the distal radioulnar joint

Extensor digiti minimi usually has double tendon [2] in the fifth compartment upon inserting onto the little finger

Vaughn-Jackson syndrome
6 Extensor carpi ulnaris tendon The tendon runs within the groove of ulnar head

Extension and adduction of wrist

Snapping extensor carpi ulnaris

Clinical significance

Any of the dorsal compartments of the wrist can develop tenosynovial inflammation. [3] The first compartment is the most frequently affected site, called De Quervain's disease (syndrome or tenosynovitis). The other two most commonly injured are the sixth (extensor carpi ulnaris) and second (intersection syndrome) compartments.

The first compartment is the site where entrapment tendinitis, better known as De Quervain's disease, occurs. Repetitive trauma is believed to cause thickening of the tendons, which lead to movement restriction of the tendons through the compartment. Any movement of the thumb and wrist causes the patient pain, inflammation and swelling.

The presence of anomalous or variant muscles in the fourth compartment may result in chronic dorsal wrist pain, a condition known as the fourth compartment syndrome. [4]

Intersection syndrome can be caused by direct trauma to the second extensor compartment. It is however commonly brought on by activities that require repetitive wrist flexion and extension. Weightlifters, rowers, and other athletes are particularly prone to this condition. The patient presents with pain over dorsal aspect of the forearm and wrist.

The tendon of 6th compartment (extensor carpi ulnaris) can suffer recurrent dislocation due to a tear of the ulnar side of the compartment. Those that engage in racket sports and golf seem to be at the highest risk for this condition.

Additional images

Related Research Articles

<span class="mw-page-title-main">Carpal bones</span> Eight small bones that make up the wrist (or carpus) that connects the hand to the forearm

The carpal bones are the eight small bones that make up the wrist (carpus) that connects the hand to the forearm. The term "carpus" and "carpal" is derived from the Latin carpus and the Greek καρπός (karpós), meaning "wrist". In human anatomy, the main role of the carpal bones is to articulate with the radial and ulnar heads to form a highly mobile condyloid joint, to provide attachments for thenar and hypothenar muscles, and to form part of the rigid carpal tunnel which allows the median nerve and tendons of the anterior forearm muscles to be transmitted to the hand and fingers.

<span class="mw-page-title-main">Radial nerve</span> Nerve in the human body that supplies the posterior portion of the upper limb

The radial nerve is a nerve in the human body that supplies the posterior portion of the upper limb. It innervates the medial and lateral heads of the triceps brachii muscle of the arm, as well as all 12 muscles in the posterior osteofascial compartment of the forearm and the associated joints and overlying skin.

<span class="mw-page-title-main">Wrist</span> Part of the arm between the lower arm and the hand

In human anatomy, the wrist is variously defined as (1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand; (2) the wrist joint or radiocarpal joint, the joint between the radius and the carpus and; (3) the anatomical region surrounding the carpus including the distal parts of the bones of the forearm and the proximal parts of the metacarpus or five metacarpal bones and the series of joints between these bones, thus referred to as wrist joints. This region also includes the carpal tunnel, the anatomical snuff box, bracelet lines, the flexor retinaculum, and the extensor retinaculum.

<span class="mw-page-title-main">Extensor carpi radialis longus muscle</span>

The extensor carpi radialis longus is one of the five main muscles that control movements at the wrist. This muscle is quite long, starting on the lateral side of the humerus, and attaching to the base of the second metacarpal bone.

In human anatomy, the extensor carpi ulnaris is a skeletal muscle located on the ulnar side of the forearm. The extensor carpi ulnaris acts to extend and adduct at the carpus/wrist from anatomical position.

<span class="mw-page-title-main">Flexor carpi radialis muscle</span> Superficial muscle in the anterior side of the forearm

In anatomy, flexor carpi radialis is a muscle of the human forearm that acts to flex and (radially) abduct the hand. The Latin carpus means wrist; hence flexor carpi is a flexor of the wrist.

<span class="mw-page-title-main">Ulnar nerve</span> Nerve which runs near the ulna bone

In human anatomy, the ulnar nerve is a nerve that runs near the ulna bone. The ulnar collateral ligament of elbow joint is in relation with the ulnar nerve. The nerve is the largest in the human body unprotected by muscle or bone, so injury is common. This nerve is directly connected to the little finger, and the adjacent half of the ring finger, innervating the palmar aspect of these fingers, including both front and back of the tips, perhaps as far back as the fingernail beds.

<span class="mw-page-title-main">De Quervain syndrome</span> Medical condition

De Quervain syndrome occurs when two tendons that control movement of the thumb become constricted by their tendon sheath in the wrist. This results in pain and tenderness on the thumb side of the wrist. Radial abduction of the thumb is painful. On occasion, there is uneven movement or triggering of the thumb with radial abduction. Symptoms can come on gradually or be noted suddenly.

<span class="mw-page-title-main">Tenosynovitis</span> Medical condition

Tenosynovitis is the inflammation of the fluid-filled sheath that surrounds a tendon, typically leading to joint pain, swelling, and stiffness. Tenosynovitis can be either infectious or noninfectious. Common clinical manifestations of noninfectious tenosynovitis include de Quervain tendinopathy and stenosing tenosynovitis

Intersection syndrome is a painful condition that affects the lateral side of the forearm when inflammation occurs at the intersection of the muscle bellies of the abductor pollicis longus and extensor pollicis brevis cross over the extensor carpi radialis longus and the extensor carpi radialis brevis. These 1st and 2nd dorsal muscle compartments intersect at this location, hence the name. The mechanism of injury is usually repetitive resisted extension, as with rowing, weight lifting, or pulling.

<span class="mw-page-title-main">Wrist drop</span> Medical condition

Wrist drop is a medical condition in which the wrist and the fingers cannot extend at the metacarpophalangeal joints. The wrist remains partially flexed due to an opposing action of flexor muscles of the forearm. As a result, the extensor muscles in the posterior compartment remain paralyzed.

<span class="mw-page-title-main">Upper limb</span> Consists of the arm, forearm, and hand

The upper limbs or upper extremities are the forelimbs of an upright-postured tetrapod vertebrate, extending from the scapulae and clavicles down to and including the digits, including all the musculatures and ligaments involved with the shoulder, elbow, wrist and knuckle joints. In humans, each upper limb is divided into the arm, forearm and hand, and is primarily used for climbing, lifting and manipulating objects.

In human anatomy, the extensor pollicis longus muscle (EPL) is a skeletal muscle located dorsally on the forearm. It is much larger than the extensor pollicis brevis, the origin of which it partly covers and acts to stretch the thumb together with this muscle.

<span class="mw-page-title-main">Palmaris longus muscle</span> Muscle of the upper limb

The palmaris longus is a muscle visible as a small tendon located between the flexor carpi radialis and the flexor carpi ulnaris, although it is not always present. It is absent in about 14 percent of the population; this number can vary in African, Asian, and Native American populations, however. Absence of the palmaris longus does not have an effect on grip strength. The lack of palmaris longus muscle does result in decreased pinch strength in fourth and fifth fingers. The absence of palmaris longus muscle is more prevalent in females than males.

<span class="mw-page-title-main">Finkelstein's test</span> Test used to diagnose de Quervains tenosynovitis

Finkelstein's test is a test used to diagnose de Quervain's tenosynovitis in people who have wrist pain.

<span class="mw-page-title-main">Flexor retinaculum of the hand</span> Thickened fascia over the carpal tunnel

The flexor retinaculum is a fibrous band on the palmar side of the hand near the wrist. It arches over the carpal bones of the hands, covering them and forming the carpal tunnel.

<span class="mw-page-title-main">Extensor retinaculum of the hand</span> A thickened fascia holding the tendons of the hand extensor muscles in place

The extensor retinaculum is a thickened portion of the antebrachial fascia that holds the tendons of the extensor muscles in place. It is located on the back of the forearm, just proximal to the hand. It is continuous with the palmar carpal ligament.

The posterior compartment of the forearm contains twelve muscles which primarily extend the wrist and digits. It is separated from the anterior compartment by the interosseous membrane between the radius and ulna.

<span class="mw-page-title-main">Carpal tunnel</span> Structure of human wrist

In the human body, the carpal tunnel or carpal canal is the passageway on the palmar side of the wrist that connects the forearm to the hand.

<span class="mw-page-title-main">Extrinsic extensor muscles of the hand</span>

The extrinsic extensor muscles of the hand are located in the back of the forearm and have long tendons connecting them to bones in the hand, where they exert their action. Extrinsic denotes their location outside the hand. Extensor denotes their action which is to extend, or open flat, joints in the hand. They include the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor digitorum (ED), extensor digiti minimi (EDM), extensor carpi ulnaris (ECU), abductor pollicis longus (APL), extensor pollicis brevis (EPB), extensor pollicis longus (EPL), and extensor indicis (EI).

References

  1. Netter, Frank (2014). Atlas of Human Anatomy (sixth ed.). Philadelphia: Elsevier. ISBN   978-1455704187.
  2. Celik, Servet; Bilge, Okan; Pinar, Yelda; Govsa, Figen (2008). "The anatomical variations of the extensor tendons to the dorsum of the hand". Clinical Anatomy. 21 (7): 652–659. doi: 10.1002/ca.20710 . ISSN   1098-2353. PMID   18792963. S2CID   28193078.
  3. Clavero, JA, Golana P, Frainas O, Alomar X, Monill JM, E (2003). "Extensor Mechanism of the Fingers: MR Imaging-Anatomic Correlation". Radiographics. 23 (3): 593–611. doi:10.1148/rg.233025079. PMID   12740463.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  4. Hayashi, H.; Kojima, T.; Fukumoto, K. (1999). "The fourth-compartment syndrome: its anatomical basis and clinical cases". Handchirurgie, Mikrochirurgie, Plastische Chirurgie. 31 (1): 61–65. doi:10.1055/s-1999-13495. ISSN   0722-1819. PMID   10080065.