Skip to main content
SpringerLink
Log in
Book cover

Carpal Tunnel Syndrome and Related Median Neuropathies pp 245–248Cite as

Biomechanical Effects of Transverse Carpal Ligament Release

  • Chapter
  • First Online:

  • 2258 Accesses

Abstract

The release of the transverse carpal ligament (TCL) causes only a slight widening of the carpal arch owing to the strong intercarpal ligaments. Palmar displacement of the released TCL contributes most of the postoperative increase in carpal tunnel volume. The TCL plays an important role in the digital flexor tendon pulley system at the wrist; it prevents bowstringing of the digital flexor tendons and allows maximum finger flexion while the wrist is flexed. Therefore, palmar displacement of the flexor tendons after TCL release increases the entrance angle and friction of the flexor tendons at the A1 pulley in all fingers. This increase is considered a cause of trigger finger. Release of the TCL also causes palmar displacement of some thenar muscle origins and shortens these muscles. Ensuing muscle imbalances might be related to pain at the base of the thenar area.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Garcia-Elias M, An KN, Cooney WP, Linscheid RL, Chao EY. Transverse stability of the carpus. An analytical study. J Orthop Res. 1989;7(5):738–43.

    Article  CAS  PubMed  Google Scholar 

  2. Stuchin SA. Wrist anatomy. Hand Clin. 1992;8(4):603–9.

    CAS  PubMed  Google Scholar 

  3. Landsmeer JM. Studies in the anatomy of articulation. I. The equilibrium of the “intercalated” bone. Acta Morphol Neerl Scand. 1961;3:287–303.

    CAS  PubMed  Google Scholar 

  4. Isogai S, Murakami G, Wada T, Akita K, Yamashita T, Ishii S. Laminar configuration of the transverse carpal ligament. J Orthop Sci. 2002;7(1):79–83.

    Article  PubMed  Google Scholar 

  5. Ishiko T, Puttlitz CM, Lotz JC, Diao E. Scaphoid kinematic behavior after division of the transverse carpal ligament. J Hand Surg [Am]. 2003;28(2):267–71.

    Article  Google Scholar 

  6. Garcia-Elias M, An KN, Cooney III WP, Linscheid RL, Chao EY. Stability of the transverse carpal arch: an experimental study. J Hand Surg [Am]. 1989;14(2 Pt 1):277–82.

    Article  CAS  Google Scholar 

  7. Tengrootenhuysen M, van Riet R, Pimontel P, Bortier H, Van Glabbeek F. The role of the transverse carpal ligament in carpal stability: an in vitro study. Acta Orthop Belg. 2009;75(4):467–71.

    PubMed  Google Scholar 

  8. Vanhees M, Verstreken F, van Riet R. What does the transverse carpal ligament contribute to carpal stability? J Wrist Surg. 2015;4(1):31–4.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Garcia-Elias M, Sanchez-Freijo JM, Salo JM, Lluch AL. Dynamic changes of the transverse carpal arch during flexion-extension of the wrist: effects of sectioning the transverse carpal ligament. J Hand Surg [Am]. 1992;17(6):1017–9.

    Article  CAS  Google Scholar 

  10. Fisk GR. The influence of the transverse carpal ligament (flexor retinaculum) on carpal stability. Ann Chir Main. 1984;3(4):297–9.

    Article  CAS  PubMed  Google Scholar 

  11. Gartsman GM, Kovach JC, Crouch CC, Noble PC, Bennett JB. Carpal arch alteration after carpal tunnel release. J Hand Surg [Am]. 1986;11(3):372–4.

    Article  CAS  Google Scholar 

  12. Viegas SF, Pollard A, Kaminksi K. Carpal arch alteration and related clinical status after endoscopic carpal tunnel release. J Hand Surg [Am]. 1992;17(6):1012–6.

    Article  CAS  Google Scholar 

  13. Kato T, Kuroshima N, Okutsu I, Ninomiya S. Effects of endoscopic release of the transverse carpal ligament on carpal canal volume. J Hand Surg. 1994;19(3):416–9.

    Article  CAS  Google Scholar 

  14. Ablove RH, Peimer CA, Diao E, Oliverio R, Kuhn JP. Morphologic changes following endoscopic and two-portal subcutaneous carpal tunnel release. J Hand Surg. 1994;19(5):821–6.

    Article  CAS  Google Scholar 

  15. Richman JA, Gelberman RH, Rydevik BL, Hajek PC, Braun RM, Gylys-Morin VM, et al. Carpal tunnel syndrome: morphologic changes after release of the transverse carpal ligament. J Hand Surg [Am]. 1989;14(5):852–7.

    Article  CAS  Google Scholar 

  16. Armstrong TJ, Chaffin DB. Some biomechanical aspects of the carpal tunnel. J Biomech. 1979;12(7):567–70.

    Article  CAS  PubMed  Google Scholar 

  17. Kline SC, Moore JR. The transverse carpal ligament. An important component of the digital flexor pulley system. J Bone Joint Surg Am. 1992;74(10):1478–85.

    Article  CAS  PubMed  Google Scholar 

  18. Netscher D, Mosharrafa A, Lee M, Polsen C, Choi H, Steadman AK, et al. 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.

    Article  CAS  PubMed  Google Scholar 

  19. Kiritsis PG, Kline SC. 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.

    Article  CAS  Google Scholar 

  20. Ryu JY, Cooney III WP, Askew LJ, An KN, Chao EY. Functional ranges of motion of the wrist joint. J Hand Surg [Am]. 1991;16(3):409–19.

    Article  CAS  Google Scholar 

  21. Harada K, Nakashima H, Teramoto K, Nagai T, Hoshino S, Yonemitsu H. Trigger digits-associated carpal tunnel syndrome: relationship between carpal tunnel release and trigger digits. Hand Surg. 2005;10(2–3):205–8.

    Article  CAS  PubMed  Google Scholar 

  22. Hombal JW, Owen R. Carpal tunnel decompression and trigger digits. Hand. 1970;2(2):192–6.

    Article  CAS  PubMed  Google Scholar 

  23. Karalezli N, Kutahya H, Gulec A, Toker S, Karabork H, Ogun TC. Transverse carpal ligament and forearm fascia release for the treatment of carpal tunnel syndrome change the entrance angle of flexor tendons to the A1 pulley: the relationship between carpal tunnel surgery and trigger finger occurrence. Sci World J. 2013;2013:630617.

    Google Scholar 

  24. Kung J, Budoff JE, Wei ML, Gharbaoui I, Luo ZP. The origins of the thenar and hypothenar muscles. J Hand Surg (Br). 2005;30(5):475–6.

    Article  CAS  Google Scholar 

  25. Fuss FK, Wagner TF. Biomechanical alterations in the carpal arch and hand muscles after carpal tunnel release: a further approach toward understanding the function of the flexor retinaculum and the cause of postoperative grip weakness. Clin Anat. 1996;9(2):100–8.

    Article  CAS  PubMed  Google Scholar 

  26. Brooks JJ, Schiller JR, Allen SD, Akelman E. Biomechanical and anatomical consequences of carpal tunnel release. Clin Biomech. 2003;18(8):685–93.

    Article  Google Scholar 

  27. Seradge H, Seradge E. Piso-triquetral pain syndrome after carpal tunnel release. J Hand Surg [Am]. 1989;14(5):858–62.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, Japan

    Souichi Ohta

Authors
  1. Souichi Ohta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Souichi Ohta .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Boston University/Boston Medical Center, Boston, Massachusetts, USA

    Scott F. M. Duncan

  2. Department of Orthopaedic Surgery, Kindai University Hospital, Osaka, Japan

    Ryosuke Kakinoki

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Ohta, S. (2017). Biomechanical Effects of Transverse Carpal Ligament Release. 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_25

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-57010-5_25

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-57008-2

  • Online ISBN: 978-3-319-57010-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation