Extensor retinaculum of hand

Definition

(Also known as dorsal carpal ligament or the p osterior annular ligament ),is a thickened oblique band of deep fascia in the distal end of the forearm behind the hand.
Figure No.1

Attachment

Medially : triquetrum bone and pisiform bone
Laterally : lateral margin of radius bone

Function

Keeping the tendons in their position and hold them together during their movement.

Structures pass deep to the extensor retinaculum

There are structures pass deep to the extensor retinaculum, these structures are divided into six compartments, arranged from lateral to medial : Figure No2

• First compartment contains:

1- Extensor pollicis brevis tendon
2- Abductor pollicis longus tendon

• Second compartment contains:

1- Extensor carpi radialis longus
2- Extensor carpi radialis brevis tendons.

• Third compartment contains:

Extensor pollicis longus tendon

• Fourth compartment contains:

1- Extensor digitorum tendon
2- Extensor indicis tendon

Note :
1-the fourth compartment contains anterior interosseous artery(from ulnar artery) and posterior interosseous nerve(also known as deep branch of radial nerve).

2-Anterior interosseous artery which is accompanied by nerve has the same name (anterior interosseous nerve from median nerve). This artery pierces the membrane in the distal end of the forearm to unite with the posterior interosseous artery ( also from the ulnar artery).

3-Posterior interosseous nerve and anterior interosseous artery pass through the fourth compartment of extensor retinaculum. Figure No2

• Fifth compartment contains:

Extensor digiti minimi tendon.

• Sixth compartment contains:

Extensor carpi ulnaris tendon.

Note:all the tendons are surrounded by synovial sheaths which gives the power and stability to the tendons.

The second and third image It is an explanation of the note

structures pass superficial to the extensor retinaculum

There are some structures pass superficial to the extensor retinaculum: •Dorsal branch of ulnar nerve (gives to the medial one and half fingers)
•Superficial branch of radial nerve (gives sensation to the lateral three and half fingers) Figure No3

•Cephalic vein (laterally)

•Basilic vein (medially).

Some injuries in the extensor retinaculum

•The tendons in the extensor retinaculum may be injured, stretched or being cut . cutting the tendons will lead to:

1- the fall of the wrist and the fingers
2- bending them inability

- Symptoms

1-redness
2-tendon stiffness
3-inability to extend and move

- Treatment

Some cases can be treated with exercise and heal with time Serious cases can be treated surgically.

•Ganglion cysts

it is a pouch containing jelly-like liquid, formed around the joint and
tendons.
It’s oval-shaped and in different sizes.it can be painful and causes numbness if it’s pressure on the nerve have been increased. sometimes it can be healed without treatment, but in some cases it can be very painful and it must be surgically treated by making an incision in the site and taking it out or by emptying it with a needle.
Figure No4

•Gamar thumb (or De Quervain's tenosynovitis)

A pathological condition that affects the tendons which are associated with the thumb ( extensor pollicis brevis and abductor pollicis longus ) due to stress, video games, or continuous tension on the tendon.
-The pain is in the distal side of the wrist along the tendons which are attached to the thumb and some swelling may occur. it( the pain) increases when the thumb or wrist is moved.
- treatment
1- having a rest.
2- put the ice to reduce swelling.
3- not strain the hand.
4- reduce video games.
5- and a bandage can be a way to relieve pain.
Figure No5

•Gymnast's wrist

-It happens to people who practice gymnastics, where there is great pressure on the wrist and tendons, or it may be due to a broken bone, dislocation or sprain.
Figure No6

Symptoms
1- Swelling
2- pain, especially when carrying heavy weight
3- severe pain in the tendons

Treatment
1- having a rest
2- not carrying heavy weights
3- applying ice
4- taking anti -inflammatory drugs

References

References
1. Extensor Retinaculum (Wrist) ; Physiopedia;https://www.physiopedia.com/Extensor_Retinaculum_(Wrist)
2. Robertson BL, Jamadar DA, Jacobson JA, Kalume-Brigido M, Caoili EM, Margaliot Z, De Maeseneer MO;Extensor retinaculum of the wrist: sonographic characterization and pseudotenosynovitis appearance;American Journal of Roentgenology.;2007 Jan
3. Taleisnik J, Gelberman RH, Miller BW, Szabo RM; The extensor retinaculum of the wrist; Journal of Hand Surgery; 1984 Jul
4. Extensor retinaculum (wrist); Radiology Reference Article ; Radiopaedia.org;https://radiopaedia.org/articles/extensorretinaculum-wrist
5. Common Hand Injuries in Gamers ;Hand and Wrist Institute;https://handandwristinstitute.com/common-handinjuries-in-gamers/
6. Ganglion Cyst of the Wrist and Hand ; OrthoInfo ; AAOS;https://orthoinfo.aaos.org/en/diseases-conditions/ganglion-cyst-of-the-wrist-and-hand/
7. Ann & Robert H. Lurie Children's Hospital of Chicago | 225 E. Chicago Ave. Chicago, IL 60611 | 1.800.543.7362

References of figures

interface image:
Athlete with Overuse Wrist and Hand Injuries | https://images.app.goo.gl/XgRcfdfVdzcWfp1o7Musculoskeletal Key
figure no1 :Natter _Atlas of human anatomy plate 430
figure no2:moore_clinically oriented anatomy, figure 6.60(extensor muscles of forearm)
Anatomy of the Nerves, Arteries and Veins of the Arm (Upper ...‏Anatomy of the Nerves, Arteries and Veins of the Arm (Upper ...‏
Anterior interosseous artery: Anatomy, branches, supply | Kenhub‏
https://images.app.goo.gl/E6efempRa4LU9tjGA

figure no3 :Extensor Tendon Injuries: Repairs, Tears, & More‏https://images.app.goo.gl/fBuz3eeD51yNNHbh8‏
figure no 4 :Ganglion Cyst of the wrist and hand_Ortholnfo_AAOS
http://orthoinfo.aaos.org
figure no5 Gamer's Thumb: A Looming Injury for ConsoleGamers
http://esportshealthcare.comCommon Video Game Injuries: Gamer's Thumb, wrist and carpal Tunnel pain
http://foothillsrehab.com
figure no6 D evelopment of gymnast wrist. Drawings show how abnormal ...‏https://images.app.goo.gl/8gmSjpVu4v48VBQw7

D evelopment of gymnast wrist. Drawings show how abnormal ...‏‏