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Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

Flexor Carpi Ulnaris


- See: Forearm Flexors

- Anatomy:
    - origin: 2 heads from medial epicondyle of humerus & medial border of olecranon;
    - insertion: palmar surface of pisiform, hamate, and bases of 5th metacarpal;
    - action: flexes and adducts the hand at the wrist;
    - synergists: flexor carpi radialis;
    - nerve supply: ulnar - C8 > T1;

- Discussion:
      - Flexor Carpi Ulnaris inserts into the pisiform bone;
      - tendon is covered > 50% by muscle fibers at wrist level & extends to volar capsule ligament, joining this structure to form a roof for ulnar artery and nerve;
      - FCU tendon protects  ulnar nerve & artery at wrist level and provides point of recongnition of these structures when local nerve block is performed;

- FCU Tenosynovitis:
      - assoc w/ chronic repetitive trauma and may be bilateral;
      - characterized by tenderness directly over tendon at wrist & pain worsen by wrist flexion, or ulnar deviation against resistance;
      - painful palpation of pisiform;
      - ulnar flexion against resistance painful;
      - calcification may be painful;
      - in most instances x-rays are normal, but calcific deposits in region of tendon may occasionally be seen;
      - diff dx:
           - pisotriquetrial arthritis
           - ulnar neuritis
      - treatment
           - splinting
           - Nsaids
           - Injection - steroid

- Calcific Tendinitis:
    - common type of calcific tendinitis which occurs at its insertion into pisiform;
    - x-ray:
           - forearm is held in mid-supination to demonstrate calcific deposits just proximal to the pisiform



The use of a flexor carpi ulnaris muscle flap in the treatment of an infected nonunion of the proximal ulna. A case report.

Excursion of prime wrist tendons.

Surgical treatment of medial epicondylitis. Results in 35 elbows.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, December 12, 2011 3:59 pm