Abstract
Carpal tunnel syndrome (CTS) is a common condition treated by carpal tunnel release (CTR), which is the division of the transverse carpal ligament (TCL). Concerns have arisen regarding increased carpal canal volume and possibly decreased grip strength (due to flexor tendon bowstringing) after surgery, and several authors have described different techniques of reconstruction of the TCL over the years. This chapter examines the data supporting and against flexor retinaculum reconstruction after CTR and the surgical techniques of TCL reconstruction. It appears that the available evidence for reconstruction of the transverse ligament following carpal tunnel release is limited and that many of the theoretical problems may not translate clinically. Reconstruction of the TCL does not seem to adversely affect the improvement in paresthesia after surgery. Some studies do support a quicker recovery in the short-term postoperative period with TCL reconstruction, but its overall benefit to functional outcome in the long-term remains largely unproven.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Rossignol M, Stock S, Patry L, Armstrong B. Carpal tunnel syndrome: what is attributable to work? Occup Environ Med. 1997;54(7):519–23.
Das SK, Brown HG. In search of complications in carpal tunnel decompression. Hand. 1976;8:243–9.
Gartsman GM, Kovach JC, Crouch CC, Noble PC, Bennett JB. Carpal arch alteration after carpal tunnel release. J Hand Surg. 1986;11(3):372–4.
Llurch A. El syndrome del tunnel carpino. Barcelona: Editorial Mitre; 1987.
Gellman H, Kan D, Gee V, Kuschner SH, Botte MJ. Analysis of pinch and grip strength after carpal tunnel release. J Hand Surg. 1989;14(5):863–4.
Viegas SF, Pollard A, Kaminsi K. Carpal arch alteration and related clinical status after endoscopic carpal tunnel release. J Hand Surg. 1992;17A:1012–6.
Chow JCY. Endoscopic release of the carpal ligament: a new technique for carpal tunnel syndrome. Arthroscopy. 1989;5:19–24.
Richman JA, Gelberman RH, Rydevik BL, Hajek PC, Braun RM, Gylys-Morin VM, Berthoty D. Carpal tunnel syndrome: morphologic changes after release of the transverse carpal ligament. J Hand Surg Am. 1989;14(5):852–7.
Kato T, Kuroshima N, Okutsu I, Ninomiya S. Effects of endoscopic release of the transverse carpal ligament on carpal canal volume. J Hand Surg Am. 1994;19(3):416–9.
Ablove RH, Peimar CA, Diao E. Morphologic changes following endoscopic and two-portal subcutaneous carpal tunnel release. J Hand Surg. 1994;19A:821–6.
Aslani H, Zafarani Z, Najafi A, Alizadeh K, Farjad R, Ghahremani S, Mosavvari M, Lahiji FA. Comparison of morphologic consequences of open and endoscopic carpal tunnel release. Clin Neurol Neurosurg. 2014;120:96–8.
Netscher D, Lee M, Thornby J, Polsen C. The effect of division of the transverse carpal ligament on flexor tendon excursion. J Hand Surg Am. 1997;22(6):1016–24.
Netscher D, Mosharrafa A, Lee M, Polsen C, Choi H, Steadman AK, Thornby J. Transverse carpal ligament: its effect on flexor tendon excursion, morphologic changes of the carpal canal, and on pinch and grip strengths after open carpal tunnel release. Plast Reconstr Surg. 1997;100(3):636–42.
Pavlidis L, Chalidis BE, Demiri E, Dimitriou CG. The effect of transverse carpal ligament lengthening on carpal tunnel volumetry: a comparison between four techniques. Ann Plast Surg. 2010;65(5):480–4.
Kiritsis P, Kline S. biomechanical changes after carpal tunnel release: a cadaveric model for comparing open, endoscopic, and step-cut lengthening techniques. J Hand Surg Am. 1995;20(2):173–80.
Lluch A. Abordaje palmar en el tratamiento del sÃndrome del túnel carpiano. Revisión personal a largo plazo de 147 manos. Rev Esp Cir Mano. 1984;12:7–32.
Lluch A. Reconstruction of the flexor retinaculum. In: Carpal tunnel syndrome. Berlin: Springer Science & Business Media; 2008.
Hunter JM. Reconstruction of the transverse carpal ligament to restore median nerve gliding. The rationale of a new technique for revision of recurrent median nerve neuropathy. Hand Clin. 1996;12(2):365–78.
Sennwald G. Operative technique for opening the carpal tunnel. In: The wrist: anatomical and pathophysiological approach to diagnosis and treatment. Berlin/Heidelberg: Springer; 1987. pp. 192–3.
Kapandji AI. Plastic surgical enlargement of the anterior annular carpal ligament in the treatment of carpal tunnel syndrome. Ann Chir Main Memb Super. 1990;9(4):305–13. discussion 314
Jakab E, Ganos D, Cook FW. Transverse carpal ligament reconstruction in surgery for carpal tunnel syndrome: a new technique. J Hand Surg Am. 1991;16(2):202–6.
Duché R, Trabelsi A. The Canaletto®™ implant for reconstructing transverse carpal ligament in carpal tunnel surgery. Surgical technique and cohort prospective study about 400 Canaletto cases versus 400 cases with open carpal tunnel surgery. Chir Main. 2010;29(6):352–9.
Karlsson MK, Lindau T, Hagberg L. Ligament lengthening compared with simple division of the transverse carpal ligament in the open treatment of carpal tunnel syndrome. Scand J Plast Reconstr Surg Hand Surg. 1997;31(1):65–9.
Netscher D, Dinh T, Cohen V, Thornby J. Division of the transverse carpal ligament and flexor tendon excursion: open and endoscopic carpal tunnel release. Plast Reconstr Surg. 1998;102(3):773–8.
Netscher D, Steadman AK, Thornby J, Cohen V. Temporal changes in grip and pinch strength after open carpal tunnel release and the effect of ligament reconstruction. J Hand Surg Am. 1998;23(1):48–54.
Xu L, Huang F, Hou C. Treatment for carpal tunnel syndrome by coronal Z-type lengthening of the transverse carpal ligament. J Pak Med Assoc. 2011;61(11):1068.
Zhang X, Li Y, Wen S, Zhu H, Shao X, Yu Y. Carpal tunnel release with subneural reconstruction of the transverse carpal ligament compared with isolated open and endoscopic release. Bone Joint J. 2015;97(2):221–8.
Zhang X, Li Y, Wen S, Zhu H, Shao X, Yu Y. Carpal tunnel release with subneural reconstruction of the transverse carpal ligament compared with isolated open and endoscopic release. Bone Joint J. 2015;97-B(2):221–8.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this chapter
Cite this chapter
Montanez, A., Wang, A. (2017). Reconstruction of the Flexor Retinaculum. In: Duncan, S., Kakinoki, R. (eds) Carpal Tunnel Syndrome and Related Median Neuropathies. Springer, Cham. https://doi.org/10.1007/978-3-319-57010-5_24
Download citation
DOI: https://doi.org/10.1007/978-3-319-57010-5_24
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-57008-2
Online ISBN: 978-3-319-57010-5
eBook Packages: MedicineMedicine (R0)