The Carpal Tunnel—Exposed

Perspectives: The Carpal Tunnel—Exposed

View of the carpal canal and proximal palm following removal of the transverse carpal ligament and supporting fascial structures (top = proximal). The median nerve (MN) is typically volar to the extrinsic digital flexor tendons, and its relationship to the superficial palmar arterial arch (SA) is demonstrated. This “complete” SA, with its contributions from the palmar branch of the radial artery (seen here coursing through the superficial muscle fibers of the thenar eminence) and the ulnar artery, is volar to the MN and the flexor tendons. The MN branches, including the recurrent motor branch (RB**), are dorsal to the SA until the distal palm, at which point the common digital nerves become volar/palmar to the digital arteries. (©Leversedge FJ, Goldfarb CA, Boyer MI. Reprinted with permission: Leversedge FJ, Goldfarb CA, Boyer MI. A Pocketbook Manual of Hand and Upper Extremity Anatomy-Primus Manus. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2010:104.)