title: What does the transverse carpal ligament contribute to carpal stability?
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.
authors.affiliation: Department of Orthopedic Surgery, Monica Hospital, Antwerp, Belgium.
authors.forename: Matthias
authors.initials: M
authors.lastname: Vanhees
authors.affiliation: Department of Orthopedic Surgery, Monica Hospital, Antwerp, Belgium ; MoRe Foundation, Antwerp, Belgium ; University Hospital Antwerp, Antwerpen, Belgium.
authors.forename: Frederik
authors.initials: F
authors.lastname: Verstreken
authors.affiliation: Department of Orthopedic Surgery, Monica Hospital, Antwerp, Belgium ; MoRe Foundation, Antwerp, Belgium ; Erasme University Hospital, Université Libre Bruxelles, Brussels, Belgium.
authors.forename: Roger
authors.initials: R
authors.lastname: van Riet
keywords: carpal stability; carpal tunnel release; carpal tunnel syndrome; flexor retinaculum; transverse carpal ligament