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Dorsal Approach to the Wrist

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- See Compartments: a href="/muscles-tendons/extensor-tunnel-i/">I/a>, a href="/bones/hand/extensor-carpi-radialis-longus/">II/a>, a href="/bones/hand/extensor-pollicis-longus/">III/a>, a href="/muscles-tendons/extensor-digitorum-communis/">IV/a>, a href="/muscles-tendons/extensor-digiti-minimi-quniti/">V/a>, a href="/bones/extensor-carpi-ulnaris/">VI/a> and a href="/ortho/9430">approach to the distal radius/a>;a href="/ortho/anatomy_of_the_upper_limb_6">img alt="" align="right" src="/image4/armm9a.jpg"/>/a>br/>
strong>- Technique:/strong>br/>
    - straight dorsal incision centered over the wrist;br/>
          - because the skin is loose over the dorsum of the wrist, contractures are uncommon;br/>
    - incise skin and subcutaneous tissue down to the retinaculum;br/>
          - careful to preserve dorsal veins and nerves;br/>
    - full thickness flaps are raised both medially and laterally;br/>
    - extensor retinculum is identified:br/>
         - retinaculum runs from the anterolateral aspect of the radius to the pisiform and the triquetrum;br/>
         - depending on the procedure the extensor retinaculum can be "step cut" or can incised thru the second or 6th compartment;br/>
         - in either case, the extensor retinaculum can be passed underneath the tendons (as may be needed  to cover hardware) w/ little or no postoperative bowstringing;br/>
                - bowstringing is not a problem since wrist extension tends to occur w/ finger flexion, and therefore the axis remains near the carpi;br/>
    - a href="/nerves/posterior-interosseous-nerve/">posterior interosseous nerve/a> is identified just proximal to Lister's tubercle;br/>
                - nerve can be cauterized for denervation;br/>
    - wrist joint can be entered thru a anatomically based ligament spliting incision effecting a radial-based "V" flap: (a href="/joints/wrist/ligaments-of-the-wrist/">ligaments of the wrist/a>)br/>
                - proximally  incision splits dorsal radiotriquetral ligament (proceding in an ulnar-distal direction);br/>
                - distally the incision splits the dorsal intercarpal ligament (proceding in a direct radial direction);br/>
                - radially based capsular flap is elevated, exposing the carpibr/>
p>a onclick=",'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="">A Method of Defining Palpable Landmarks for the Ligament-Splitting Dorsal Wrist Capsulotomy/a>/p>/div>br/>hr/>br/>br/>br/>Last updated by Clifford R. Wheeless, III, MD on Sunday, March 24, 2013 4:27 pmbr/>


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