Carpal Tunnel Release: Do We Understand the Biomechanical Consequences?

Abstract

Carpal tunnel release is a very common procedure performed in the United States. While the procedure is often curative, some patients experience postoperative scar sensitivity, pillar pain, grip weakness, or recurrent median nerve symptoms. Release of the carpal tunnel has an effect on carpal anatomy and biomechanics, including increases in carpal arch width and carpal tunnel volume and changes in muscle and tendon mechanics. Our understanding of how these biomechanical changes contribute to postoperative symptoms is still evolving. We review the relevant morphometric and biomechanical changes that occur following release of the transverse carpal ligament.

Keywords

carpal tunnel release - transverse carpal ligament - carpal canal - biomechanics - pillar pain

• References

• 1 Einhorn N, Leddy JP. Pitfalls of endoscopic carpal tunnel release. Orthop Clin North Am 1996; 27 (2) 373-380
• 2 Pacek CA, Tang J, Goitz RJ, Kaufmann RA, Li ZM. Morphological analysis of the carpal tunnel. Hand (NY) 2010; 5 (1) 77-81
• 3 Gartsman GM, Kovach JC, Crouch CC, Noble PC, Bennett JB. Carpal arch alteration after carpal tunnel release. J Hand Surg Am 1986; 11 (3) 372-374
• 4 Ludlow KS, Merla JL, Cox JA, Hurst LN. Pillar pain as a postoperative complication of carpal tunnel release: a review of the literature. J Hand Ther 1997; 10 (4) 277-282
• 5 Brooks JJ, Schiller JR, Allen SD, Akelman E. Biomechanical and anatomical consequences of carpal tunnel release. Clin Biomech (Bristol, Avon) 2003; 18 (8) 685-693
• 6 Cobb TK, Dalley BK, Posteraro RH, Lewis RC. Anatomy of the flexor retinaculum. J Hand Surg Am 1993; 18 (1) 91-99
• 7 Manley M, Boardman M, Goitz RJ. The carpal insertions of the transverse carpal ligament. J Hand Surg Am 2013; 38 (4) 729-732
• 8 Seradge H, Seradge E. Piso-triquetral pain syndrome after carpal tunnel release. J Hand Surg Am 1989; 14 (5) 858-862
• 9 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) 738-743
• 10 Amadio PC. The first carpal tunnel release?. J Hand Surg [Br] 1995; 20 (1) 40-41
• 11 Scholten RJ, Mink van der Molen A, Uitdehaag BM, Bouter LM, de Vet HC. Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst Rev 2007; (4) CD003905
• 12 Tanabe T, Okutsu I. An anatomical study of the palmar ligamentous structures of the carpal canal. J Hand Surg [Br] 1997; 22 (6) 754-757
• 13 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) 1017-1019
• 14 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) 1012-1016
• 15 Roger B, Chaise F, Laval-Jeantet M. X-ray computed tomographic analysis of structural changes of the carpal bones, after section of the anterior annular ligament [in French]. J Radiol 1985; 66 (11) 693-697
• 16 Schmitt R, Lucas D, Buhmann S, Lanz U, Schindler G. Morphometry using computerized tomography of the wrist in idiopathic carpal tunnel syndrome. Comparison of pre- and postoperative findings [in German]. Handchir Mikrochir Plast Chir 1988; 20 (1) 41-46
• 17 Richman JA, Gelberman RH, Rydevik BL, Gylys-Morin VM, Hajek PC, Sartoris DJ. Carpal tunnel volume determination by magnetic resonance imaging three-dimensional reconstruction. J Hand Surg Am 1987; 12 (5 Pt 1) 712-717
• 18 Richman JA, Gelberman RH, Rydevik BL , et al. Carpal tunnel syndrome: morphologic changes after release of the transverse carpal ligament. J Hand Surg Am 1989; 14 (5) 852-857
• 19 Ablove RH, Peimer CA, Diao E, Oliverio R, Kuhn JP. Morphologic changes following endoscopic and two-portal subcutaneous carpal tunnel release. J Hand Surg Am 1994; 19 (5) 821-826
• 20 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) 416-419
• 21 Guo X, Fan Y, Li ZM. Effects of dividing the transverse carpal ligament on the mechanical behavior of the carpal bones under axial compressive load: a finite element study. Med Eng Phys 2009; 31 (2) 188-194
• 22 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) 277-282
• 23 Hunter JM. Recurrent carpal tunnel syndrome, epineural fibrous fixation, and traction neuropathy. Hand Clin 1991; 7 (3) 491-504
• 24 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) 100-108
• 25 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) 173-180
• 26 Wilson KM. Double incision open technique for carpal tunnel release: an alternative to endoscopic release. J Hand Surg Am 1994; 19 (6) 907-912
• 27 Tung WL, Zhao C, Yoshii Y, Su FC, An KN, Amadio PC. Comparative study of carpal tunnel compliance in the human, dog, rabbit, and rat. J Orthop Res 2010; 28 (5) 652-656