Anatomical Snuff Box

*Anatomical snuff box is a triangular depression on the lateral aspect of wrist immediately distal to the radial styloid process, that becomes prominent when thumb is fully extended. *The Contents of anatomical snuff box are : - Cephalic vein - Radial artery - Superficial radial nerve *Floor of the anatomical snuff box is formed by : - Radial styloid - Scaphoid (smooth convex articular surface) - Trapezium - Base of First metacarpal *BOUNDARIES OF ANATOMICAL SNUFF BOX : - Lateral/Anterior wall ~Abductor Pollicis Longus (Radially) ~Extensor Pollicis Brevis (Medially) - Medial/Posterior wall ~Extensor Pollicis Longus

The innervation of the hands should be assessed: damage to the median nerve: alters sensation in the palm, thumb, index finger, middle finger and half of the ring finger causes the muscles of the thenar eminence to become weak and wasted if the damage is due to the carpal tunnel syndrome, the sensation to the palm is spared damage to the ulnar nerve: o alters sensation to the palm, the dorsum of the hand, the little finger and half of the ring finger o causes a claw deformity in the little and ring fingers because of loss of innervation to their interossei and lumbrical muscles 1

damage to the radial nerve: o may alter sensation over the dorsum of the hand in the region of the anatomical snuff box o causes wrist drop due to paralysis of the wrist extensors exacerbation of paraesthesia over the distribution of the median nerve following full flexion of the wrists for 2 min is characteristic of the carpal tunnel syndrome

Topographic Anatomy Structure/Space antebrachial fascia (N459,N479,TG202) anterior compartment (N449,TG2-23) posteror compartment (N449,TG2-29) anatomical snuffbox (N444,N450,TG229) Boundaries anterior and posterior thickening forming the extensor retinaculum; immediatel distal but deeper to the palmar carpal ligament it forms the flexor retinaculum separated from the posteror compartment by the interosseous membrane (N439,TG2-21) separated from the anterior compartment by the interosseous membrane (N439,TG2-21) at the base of the thumb; bordered laterally by the tendons of abductor pollicis longus and extensor pollicis brevis, medially by tendon of extensor pollicis longus Significance formation of the carpal tunnel through which the median n. and flexor tendons pass

also called the flexor compartment

also called the extensor compartment

branches of superficial radial n. cross the snuffbox; radial artery lies deeply in snuffbox; scaphoid can be palpated there in cases of suspected fracture

The anatomical snuffbox is a triangular depression found on the lateral aspect of the dorsum of the hand, at the level of the carpal bones. The radial nerve passes diagonally through the anatomical snuffbox, on its path into the hand. Borders Lateral border: Tendons of the abductor pollicis longus and extensor pollicis brevis Medial border: Tendon of the extensor pollicis longus Proximal border: Styloid process of the radius Base: Carpal bones (scaphoid and trapezium) Roof: Skin It is important to note that the tendons of the muscles form the borders, not the muscles themselves.

Fig 9.1 Borders of the anatomical snuffbox Clinical Relevance: Tenderness in the Anatomical Snuffbox In the anatomical snuffbox, the scaphoid and the radius articulate to form part of the wrist joint. In the event of a blow to the wrist (e.g falling on a outstretched hand), the scaphoid takes most of the force. Therefore, if localised pain is reported in the anatomical snuffbox, a fracture of the scaphoid is the most likely cause. This need to be dealt with quickly, as this fracture usually cuts off the blood supply to the proximal part of the scaphoid bone, leading to necrosis.