How To Tell If You Are Lost

This approach is based on the key landmark of the flexor carpi radialis (FCR) tendon. If you do not see the tendon, which is an easily identifiable structure, you are lost to one side or the other. If you are deep to the subcutaneous tissue and do not see any tendons, you are typically too far radial. If you go through the flexor retinaculum and see multiple tendons, you are too far ulnarward. This approach should not be carried deep until the FCR tendon is identified.

You can clearly see the fat surrounding the radial artery if you drift too far radially. If you drift too far ulnarward, you will see the multiple tendons in the carpal canal.

If you are in the deep structures and are too far proximal, you will see the transverse red fibers of the pronator quadratus. If you are lost too far distally, you will see the thenar muscle origin coming off the transverse carpal ligament.

Transverse Carpal Ligament

FIGURE 20—1 The standard skin incision for the Russe approach to the volar scaphoid.

FIGURE 20—3 The radial artery lies immediately lateral to the tendon. It does not require dissection in this approach. However, caution must be exercised in retracting on the radial side.

IH Flexor Carpi Radialis

B Radial Artery

B Wrist Capsule

El Flexor Retinaculum

B Finger Flexor Muscle and Tendon Under Retinaculum

FIGURE 20—2 The flexor carpi radialis tendon is mobilized from its sheath and retracted radially.

Wrist Tendon And Its Sheath

FIGURE 20—4 The flexor carpi radialis tendon has been mobilized distally and is retracted radially, exposing the volar wrist joint capsule.

B Capitate

B Scaphoid

B Radius

B Finger Flexor Tendons

Radial Arteri And Tendon

FIGURE 20—3 The radial artery lies immediately lateral to the tendon. It does not require dissection in this approach. However, caution must be exercised in retracting on the radial side.

Flexor Retinaculum Wrist
FIGURE 20—6 The wrist joint capsule has been opened, exposing the scaphoid. The radioscaphoid articulation, as well as the scaphocapitate articulation, can be well visualized.

i v ifm

FIGURE 20—5 The flexor carpi radialis is retracted to the ulnar side of the wrist. The flexor retinaculum is seen, below which lie the flexor tendons to the fingers and the median nerve.

13 Flexor Carpi Radialis

El Radial Artery

□ Wrist Capsule

D Flexor Retinaculum

□ Finger Flexor Muscle and Tendon Under Retinaculum

FIGURE 20—7 The flexor retinaculum has been opened to demonstrate the flexor tendons lying immediately adjacent to this incision. You will see these tendons if you are too ulnarward in your dissection.

Q Capitate

D Scaphoid

Q Finger Flexor Tendons

How Tell Thumb Has Torn Ligament

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  • eleonora
    What is finger joint capsule?
    7 years ago

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