Abstract
Background The transverse carpal ligament is well known for its involvement in carpal tunnel
syndrome, and sectioning of this ligament remains the definite treatment for this
pathology. Some authors believe that the transverse carpal ligament is an important
stabilizer of the carpal arch, whereas others do not consider it to be significant.
Several studies have been performed, both in vivo and in in vitro. Sectioning of the
transverse carpal ligament does not seem to have any effect on the width of the carpal
arch in the unloaded condition. However, patients will load the arch during their
activities of daily living.
Materials and Methods A cadaveric study was done with distraction of the carpal bones before and after
sectioning the transverse carpal ligament.
Results With the transverse carpal ligament intact, the carpal arch is mobile, with distraction
leading up to 50% widening of the arch. Sectioning of the transverse carpal ligament
resulted in a significant widening of the carpal arch by a further 30%.
Conclusions Loading of the carpal arch after sectioning of the transeverse carapal ligament leads
to a significant increase in intracarpal mobility. This will inevitably influence
carpal kinematics in the patient and might be responsible for some complications after
simple carpal tunnel releases, such as pillar pain, palmar tenderness, and loss of
grip strength.
Keywords
transverse carpal ligament - flexor retinaculum - carpal tunnel release - carpal stability
- carpal tunnel syndrome
