Download PDF
J Wrist Surg 2015; 04(01): 031-034
DOI: 10.1055/s-0034-1398486
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

What Does the Transverse Carpal Ligament Contribute to Carpal Stability?

Matthias Vanhees
1   Department of Orthopedic Surgery, Monica Hospital, Antwerp, Belgium
,
Frederik Verstreken
1   Department of Orthopedic Surgery, Monica Hospital, Antwerp, Belgium
2   MoRe Foundation, Antwerp, Belgium
3   University Hospital Antwerp, Antwerpen, Belgium
,
Roger van Riet
1   Department of Orthopedic Surgery, Monica Hospital, Antwerp, Belgium
2   MoRe Foundation, Antwerp, Belgium
4   Erasme University Hospital, Université Libre Bruxelles, Brussels, Belgium
› Author Affiliations
Further Information

Publication History

Publication Date:
13 February 2015 (online)

    Permissions and Reprints

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

Note

This work was performed at the Department of Orthopedic Surgery, Monica Hospital, Stevenslei 20, 2100 Antwerp, Belgium.


 

  • References

  • 1 Cobb TK, Dalley BK, Posteraro RH, Lewis RC. Anatomy of the flexor retinaculum. J Hand Surg Am 1993; 18 (1) 91-99
    CrossrefPubMedGoogle Scholar
  • 2 Stecco C, Macchi V, Lancerotto L, Tiengo C, Porzionato A, De Caro R. Comparison of transverse carpal ligament and flexor retinaculum terminology for the wrist. J Hand Surg Am 2010; 35 (5) 746-753
    PubMedGoogle Scholar
  • 3 Doyle JR. Palmar and digital flexor tendon pulleys. Clin Orthop Relat Res 2001; (383) 84-96
    PubMedGoogle Scholar
  • 4 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) 1478-1485
    CrossrefPubMedGoogle Scholar
  • 5 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) 467-471
    PubMedGoogle Scholar
  • 6 Fisk GR. The influence of the transverse carpal ligament (flexor retinaculum) on carpal stability. Ann Chir Main 1984; 3 (4) 297-299
    CrossrefPubMedGoogle Scholar
  • 7 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
    CrossrefPubMedGoogle Scholar
  • 8 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
    CrossrefPubMedGoogle Scholar
  • 9 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
    CrossrefPubMedGoogle Scholar
  • 10 Berger RA, Crowninshield RD, Flatt AE. The three-dimensional rotational behaviors of the carpal bones. Clin Orthop Relat Res 1982; (167) 303-310
    PubMedGoogle Scholar
  • 11 Gabra JN, Domalain M, Li ZM. Movement of the distal carpal row during narrowing and widening of the carpal arch width. J Biomech Eng 2012; 134 (10) 101004
    CrossrefPubMedGoogle Scholar
  • 12 Ruby LK, Cooney III WP, An KN, Linscheid RL, Chao EY. Relative motion of selected carpal bones: a kinematic analysis of the normal wrist. J Hand Surg Am 1988; 13 (1) 1-10
    CrossrefPubMedGoogle Scholar
  • 13 Xiu KH, Kim JH, Li ZM. Biomechanics of the transverse carpal arch under carpal bone loading. Clin Biomech (Bristol, Avon) 2010; 25 (8) 776-780
    CrossrefPubMedGoogle Scholar
  • 14 Garcia-Elias M. Kinetic analysis of carpal stability during grip. Hand Clin 1997; 13 (1) 151-158
    PubMedGoogle Scholar
  • 15 Kauer JM. Functional anatomy of the wrist. Clin Orthop Relat Res 1980; (149) 9-20
    PubMedGoogle Scholar
  • 16 Linscheid RL, Dobyns JH. Dynamic carpal stability. Keio J Med 2002; 51 (3) 140-147
    CrossrefPubMedGoogle Scholar
  • 17 Mayfield JK, Johnson RP, Kilcoyne RF. The ligaments of the human wrist and their functional significance. Anat Rec 1976; 186 (3) 417-428
    CrossrefPubMedGoogle Scholar
  • 18 Mayfield JK. Wrist ligamentous anatomy and pathogenesis of carpal instability. Orthop Clin North Am 1984; 15 (2) 209-216
    PubMedGoogle Scholar
  • 19 Ruby LK. Carpal instability. Instr Course Lect 1996; 45: 3-13
    PubMedGoogle Scholar
  • 20 Sennwald GR, Zdravkovic V, Kern HP, Jacob HA. Kinematics of the wrist and its ligaments. J Hand Surg Am 1993; 18 (5) 805-814
    CrossrefPubMedGoogle Scholar
  • 21 Short WH, Werner FW, Fortino MD, Palmer AK, Mann KA. A dynamic biomechanical study of scapholunate ligament sectioning. J Hand Surg Am 1995; 20 (6) 986-999
    CrossrefPubMedGoogle Scholar
  • 22 Taleisnik J. The ligaments of the wrist. J Hand Surg Am 1976; 1 (2) 110-118
    CrossrefPubMedGoogle Scholar
  • 23 Taleisnik J. Current concepts review. Carpal instability. J Bone Joint Surg Am 1988; 70 (8) 1262-1268
    PubMedGoogle Scholar
  • 24 Volz RG, Lieb M, Benjamin J. Biomechanics of the wrist. Clin Orthop Relat Res 1980; (149) 112-117
    PubMedGoogle Scholar
  • 25 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
    CrossrefPubMedGoogle Scholar
  • 26 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
    CrossrefPubMedGoogle Scholar
  • 27 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) 267-271
    CrossrefPubMedGoogle Scholar
  • 28 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
    CrossrefPubMedGoogle Scholar
  • 29 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
    CrossrefPubMedGoogle Scholar