Hello all this is Dr Alsup and in this video we will be discussing how to identify the structures
associated with the carpal tunnel. So these are the same images as you might can tell, this one
is obviously zoomed in a bit, and this is these are both anterior views of the wrist region as
well as the hand and a bit of the forearm. And it makes sense that we're looking at an anterior view
because the carpal tunnel is anteriorly placed. This area right here that's kind of opaque looking
is going to be the, it's opaque and white, and it's going to be a ligament. And to be more specific it
is the transverse carpal ligament which is often referred to as the flexor retinaculum.
This is the roof of the carpal tunnel so the top of the carpal tunnel and the contents are
going to run deep to this ligament, let me erase this right here so we can kind of get into some
of those. All right so the roof is going to be a ligament that transverse carpal ligament and then
we need to figure out what is going on inside, so there is a lot going on in a pretty small region.
And the majority of what is going on are tendons so those long tendons from the
anterior compartment of the forearm so you can see them here in the forearm they are traversing
through this relatively small area and these are those muscles that are going to have a
distal attachment to the phalanges. These include the flexor digitorum superficialis,
flexor digitorum profundus, and the flexor pollicis longus so both of these here have four tendons
each and then there's one tendon associated with the flexor pollicis longus. Now there are ways to
tell so all of these in this general region these are tendons here this is a tendon here
there's ways to tell the difference between, this is actually the ulnar nerve so don't get confused
it's going over over the carpal tunnel region, but there are ways to tell the difference between
which tendon is which but for our purposes I just want you to understand which muscle tendons
will traverse the connect or the tunnel and don't worry so much about differentiating them.
Not visible here are tendon sheaths which are elongated bursi that surround the tendons.
They often give the tendons a very glistening appearance but are very very delicate and often
removed during any form of dissection but as you know from the carpal tunnel learning objective
these tendon sheaths are very important in regards to carpal tunnel syndrome they often
become inflamed and that's what often will cause compression of the one last thing we need to
identify, which is the median nerve so I'm going to outline we can see the median nerve right here.
So the median nerve is the nerve that's often compressed during carpal tunnel syndrome.
Now the hard thing about the median nerve it is that it's almost exactly the same size
and not too far off in terms of color of the tendons, those tendons surrounding it.
But it does tend to run superficial to the tendons and more laterally than most of them not so
much in terms of the flexor pollicis longus tendon but it is generally more superficial so usually
it's distinguishable in that way, you can see it right here the same median nerve as this one.
You can also see this small cutaneous branch that is branching off proximal to the carpal
tunnel, so right here we know right here is the carpal tunnel because here's that
roof the transverse carpal ligament and then this particular cutaneous branch branches off
before or proximal. And this is why the skin because this is a cutaneous branch the skin
over the thenar eminence and palm region won't be affected during carpal tunnel
syndrome because this branch came off before the compression site within the carpal tunnel.
All right excellent that is the carpal tunnel. A whole lot of tendons and that large median
nerve as well. Please take time to review and as always please reach out with any questions