Anatomy Of The Flexor Carpi Radialis Muscle - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describing the anatomy of the Flexor Carpi Radialis muscle.
Origin: from the medial epicondyle of the humerus.
Insertion: into the base if the 2nd and 3rd metacarpal bones.
About 80% of the tendon will insert into the second metacarpal base, and 20% inserts into the 3rd metacarpal base.
The FCR muscle or tendon is not a structure included within the carpal tunnel.
Innervation: it is supplied by the median nerve (C6-C7).
It is a wrist flexor predominantly C7.
Action: flexion and abduction of the hand at the wrist, it is a primary wrist flexor.
Its tendon starts approximately 15cm proximal to the wrist joint as a musculotendinous unit and is purely tendonous at 7-8cm distally.
Important points related to the FCR:
• Relationship between the FCR, the Palmaris Longus, and the Median Nerve.
The FCR is close to the median nerve.
The median nerve sits ulnarly ti the FCR.
Deep laceration of the FCR at the level of the wrist could injure the median nerve.
Dissection between the Palmaris Longus and the FCR can cause injury to the palmar cutaneous branch of the median nerve.
• FCR Tendonitis.
Inflammation of the tendon that occurs with golfers, racket sports, or manual labor due to repetitive wrist flexion.
Could be stenosing tenosynovitis in the in the fibro – osseous tunnel.
It may occur on its own or due to fracture, arthritis or from a cyst.
The highest incidence of tendonitis occur in females in the 5th decade of life to arthritis, especially scaphotrapezial arthritis.
Pain in the radial volar aspect of the wrist.
MRI will show inflammation around the tendon.
Treatment:
1- Splint / NSAIDs.
2- Injection for the diagnosis and treatment.
3- Surgical release is the last resort.
• The median nerve block and injection.
• Tendon transfer:
The FCR is used in radial or interosseous nerve palsy to restore finger extension (FCR to the Extensor Digitarum to restore extension of the fingers).
• Medial epicondylitis:
Usually affect the origin of the Pronator Teres and the Flexor Carpi Radialis.

Henry approach of the radius (volar approach):
Proximally it goes between the Brachioradialis (radial nerve) and the Pronator Teres (median nerve).
Distally it goes between the Brachioradialis (radial nerve) and the FCR (median nerve).
This approach is usually used for reduction and fixation of distal radius fractures.
The incision will be in-line with the FCR.
Open the sheath radially and retract the tendon ulnarly.
Incise the sheath dorsally.
Be aware of the palmar cutaneous branch of the median nerve which arises 5cm proximal to the wrist and runs ulnar to the FCR.

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