REIDER PART 125
Chapter 4 Hand and Wrist 115
Figurę 4-20. A, B, and C, Volar aspcct of thc wrist. A, distal flcxion crease;
By abductor pollicis longus; C, palmaris longus; D, flexor carpi radialis; £, median nerve; F, pisiform; G, flexor carpi ulnaris; H, ulnar artery and nerve; /, radial artery; /, scaphoid tubercle; JC, trapezium; /0 basilar joint; M, iongitudinal interthenar crease; jV, flexor digitorum tendons; O, hook of the hamate; P, Guyon s canal; Q, proximal and distal margins of the transverse carpal liga-ment.
the fifth metacarpal should be most clearly appreciated from this perspective. Volar to the metacarpal, the fleshy prominence of the hypothenar eminence bulges toward the examiner. Morę proximally, the bony prominence of the head of the distal ulna is usually visible on the dor-sum of the wrist. An increase in this normal prominence may be due to degenerative arthritis of the distal radioul-nar joint, rheumatoid synovitis, or a tear of the TFCC. In severe cases of rheumatoid arthritis, the carpal bones may sublux volarly with respect to the distal ulna and radius. This subluxation occurs morę on the ulnar side than on the radial side, thus accentuating thc prominence of the distal ulna. This condition is known as capita ulna syndrome (Fig. 4—24).
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