Three-Dimensional Carpal Kinematics after Carpal Tunnel Release
24. November 2015
14. Januar 2016
19. Februar 2016 (online)
Background Carpal tunnel release (CTR) has been shown to change carpal arch morphology. However, the effect of CTR on the three-dimensional kinematics of the carpal bones has not been demonstrated.
Purpose This study examined whether release of the transverse carpal ligament (TCL) would alter the three-dimensional kinematics of the carpus, specifically the bony attachments of the TCL.
Methods The in vitro kinematics of the carpus was studied in five fresh-frozen cadaveric wrists before and after CTR using three-dimensional computed tomography. The specimens were evaluated in three positions: neutral, 60 degrees of flexion, and 60 degrees of extension.
Results The data indicate that carpal arch width increases significantly in all positions after CTR as measured between the trapezium and hamate. Second, the trapezium–hamate distance increases in both a translational and rotational component after CTR. Additionally, the pisiform rotates away from the triquetrum after CTR.
Conclusions Carpal kinematics is significantly altered with a CTR, especially on the ulnar side of the wrist.
Clinical Relevance Although the kinematic changes are small, they may be clinically significant and potentially responsible for pillar pain or postoperative loss of grip strength.
Keywordscarpal arch width - carpal kinematics - carpal bone contours - carpal tunnel release - transverse carpal ligament
This investigation was performed at Department of Orthopaedics, Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
- 1 Einhorn N, Leddy JP. Pitfalls of endoscopic carpal tunnel release. Orthop Clin North Am 1996; 27 (2) 373-380
- 2 Palmer DH, Hanrahan LP. Social and economic costs of carpal tunnel surgery. Instr Course Lect 1995; 44: 167-172
- 3 Braun RM, Rechnic M, Fowler E. Complications related to carpal tunnel release. Hand Clin 2002; 18 (2) 347-357
- 4 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
- 5 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
- 6 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
- 7 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
- 8 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
- 9 Bromley GS. Minimal-incision open carpal tunnel decompression. J Hand Surg Am 1994; 19 (1) 119-120
- 10 Lee WP, Plancher KD, Strickland JW. Carpal tunnel release with a small palmar incision. Hand Clin 1996; 12 (2) 271-284
- 11 Crisco JJ, McGovern RD, Wolfe SW. Noninvasive technique for measuring in vivo three-dimensional carpal bone kinematics. J Orthop Res 1999; 17 (1) 96-100
- 12 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
- 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 Am 1994; 19 (3) 416-419