- See:
Forearm Flexors
- Discussion:
- origin: medial epicondyle of humerus;
- anatomy at the wrist:
- when pt flexes wrist & radially deviates his hand, tendon becomes prominent next to the
palmaris longus;
- FCR lies radial to the
palmaris longus at level of the wrist;
- tendon enters a fibro-osseous tunnel just proximal to the trapezium;
- w/ in the tunnel, the tendon is in partial contact w/ the trapezium;
- after crossing the trapezium, it passes dorsal to the FPL;
- insertion:
- small slip to trapezial tuberosity;
- anterior surface of base of 2nd metacarpal;
- small slip to base of third metacarpal;
- innervation:
median nerve,
C7 >
C6;
- action: flexes and abducts the hand at the wrist;
- synergist:
flexor carpi ulnaris;
- Flexor Carpi Radiolis Tendinitis:
-
FCR tendinitis is less common than tendinitis affecting
FCU;
- it is usually associated with chronic repetitive trauma;
- diff dx: anomalous connection between FPL and FDP;
-
etiology:
- tenosynovitis
-
ganglion cyst
-
basal joint arthritis;
-
distal scaphoid fracture;
- distal radius fracture;
-
patho-anatomy:
- separate compartment of transverse carpal ligament;
- overlying scphoid tubercle and trapezial crest;
- multiple adhesions in the tunnel;
- fibrous sheath over distal end of this tendon may become constricted secondary to trauma or arthrosis and cause pain at base of palm;
- close relationship of FCR &
median nerve occassionally accounts for irritation of median nerve secondary to tenosynovitis of the FCR;
-
exam:
- include tenderness & crepitus on palpation over tendon & & pain on wrist
flexion and radial deviation against resistance or on passive extension;
- cause of volar radial wrist pain;
- pain with flexion and extension
- point tenderness over FCR at wrist flexion crease;
- diagnositic injection into the tendon sheath will confirm the diagnosis;
-
surgery:
- w/ failure of non-op Rx, FCR tunnel should be decompressed;
- incision radial to FCR to prevent injury to
palmar cutaneous branch;
- reflect thenar muscles off transverse carpal ligament;
- open the tendon sheath from proximal to distal;
- release the fibro-osseous tunnel along the ulnar border of the trapezium;
- optionally consider resection of scaphoid tubercle and trapezial crest;
- tenolyse and free FCR to insertion;
- start early motion;
- Rupture of FCR tendon;
- should be included in diff dx of scaphoid frx; (see diff Dx ):
- occurs from a fall on the out stretched hand, causing separation of insertion of FCR deep to the thenar muscles;
- chip of bone may separate w/ tendon, or, in pts > 35 yrs of age, tendon may rupture partially or completely;
- pain is detected over scaphoid on palmar surface of wrist or is present proximally along the course of the FCR;
Spontaneous
rupture of the flexor carpi radialis tendon.
Flexor carpi radialis tendinitis. Part II: Results of operative treatment.
Flexor Carpi Radialis Tendinitis. Part I: Operative Anatomy.
Surgical treatment of medial epicondylitis. Results in 35 elbows.
