ArticlesAnatomyUpper limbWrist and handCarpal tunnel

ArticlesAnatomyUpper limbWrist and handCarpal tunnel

Carpal tunnel

Author: Sara Ferreira, MD • Reviewer: Gordana Sendić, MD
Last reviewed: October 30, 2023
Reading time: 5 minutes

The carpal tunnel is a narrow osteofibrous canal located on the palmar side of the wrist, found deep to the flexor retinaculum. The floor of the carpal tunnel is composed of the carpal bones, which is how it got its name.

The carpal tunnel serves as a passageway for structures passing between the anterior forearm and the hand. It transmits the median nerve and the tendons of the flexor pollicis longus, flexor digitorum superficialis and flexor digitorum profundus muscles.

In some circumstances, the narrowing of the carpal tunnel can cause an entrapment of the median nerve, a common condition known as the carpal tunnel syndrome.

In this article, we will explore the anatomy and functions of the carpal tunnel.

Key facts about the carpal tunnel
Definition	Passageway found on anterior wrist for structures passing between anterior forearm and hand
Boundaries	Floor: Carpal groove Roof: Flexor retinaculum
Contents	Flexor digitorum superficialis tendons Flexor digitorum profundus tendons Flexor pollicis longus tendon Median nerve

Contents

Boundaries
Contents
Clinical relations
1. Carpal tunnel syndrome
Sources

+ Show all

Boundaries

The floor of the carpal tunnel is formed by the carpal groove (or carpal arch), a deep arch formed by the palmar aspect of the carpal bones. This arch is bounded medially by the pisiform bone and the hook of the hamate, and laterally by the tubercles of the scaphoid and trapezium bones.

The roof of the carpal tunnel is formed by the flexor retinaculum (also known as transverse carpal ligament), a thick connective tissue ligament. This ligament bridges the space between the medial and lateral ends of the carpal arch, converting the arch into a tunnel.

Contents

The carpal tunnel contains the median nerve and nine tendons: four tendons of the flexor digitorum superficialis, the four tendons of the flexor digitorum profundus, and the tendon of the flexor pollicis longus.

The tendons are enveloped by synovial tendinous sheaths that allow free movement between them. The eight tendons of the flexor digitorum profundus and flexor digitorum superficialis are surrounded by a single synovial sheath, while the tendon of flexor pollicis longus is surrounded by its own synovial sheath. The flexor retinaculum holds all these tendons in place.

The flexor carpi radialis tendon does not pass through the carpal tunnel. It is enveloped by an individual synovial sheath and passes through its own tubular compartment within the lateral aspect of the flexor retinaculum.

The ulnar artery, the ulnar nerve, and the tendon of the palmaris longus are anterior to the flexor retinaculum and do not pass through the carpal tunnel. The ulnar artery and nerve are contained within the so-called Guyon canal which is located superficial to the flexor retinaculum and deep to the palmar carpal ligament, a thickened portion of the antebrachial fascia on the anterior part of the wrist.

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Clinical relations

Carpal tunnel syndrome

Carpal tunnel syndrome refers to a group of signs and symptoms that result from the compression of the median nerve as it travels through the carpal tunnel. It can be caused by any factor that narrows the tunnel, such as a wrist fracture or swelling of the long tendons that pass through the carpal tunnel.

Risk factors for this condition include diabetes, obesity, pregnancy, arthritis, trauma and occupational biomechanical factors.

Common symptoms include pain and paresthesia and, less commonly, weakness in the median nerve distribution (sensory innervation to the skin of the palmar side of the thumb, index finger, middle finger and half of the ring finger; motor innervation to the muscles of the thenar eminence). The radial aspect of the palm is supplied by the palmar cutaneous branch of the median nerve, which leaves the nerve proximal to the wrist. This branch travels superficially to the flexor retinaculum and is therefore spared in carpal tunnel syndrome.

Treatment options include the use of splints, corticosteroid injections and, in severe cases, surgical decompression of the carpal tunnel.

Sources

All content published on Kenhub is reviewed by medical and anatomy experts. The information we provide is grounded on academic literature and peer-reviewed research. Kenhub does not provide medical advice. You can learn more about our content creation and review standards by reading our content quality guidelines.

Drake RL, Vogl AW, Mitchell WMA. Gray’s anatomy for students (4th ed.) 2020.
Moore, K. L., Dalley, A. F., & Agur, A. Clinically oriented anatomy (8th ed.) 2017.

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