title: Changes in carpal tunnel compliance with incremental flexor retinaculum release.
abstract: BACKGROUND
  Flexor retinaculum transection is a routine surgical treatment for carpal tunnel syndrome, yet the biomechanical and clinical sequelae of the procedure remain unclear. We investigated the effects of flexor retinaculum release on carpal tunnel structural compliance using cadaveric hands.
  
  
  METHODS
  The flexor retinaculum was incrementally and sequentially released with transections of 25, 50, 75, and 100 % of the transverse carpal ligament, followed by the distal aponeurosis and then the antebrachial fascia. Paired outward 10 N forces were applied to the insertion sites of the transverse carpal ligament at the distal (hamate-trapezium) and proximal (pisiform-scaphoid) levels of the carpal tunnel. Carpal tunnel compliance was defined as the change in carpal arch width normalized to the constant 10 N force.
  
  
  RESULTS
  With the flexor retinaculum intact, carpal tunnel compliance at the proximal level, 0.696 ± 0.128 mm/N, was 13.6 times greater than that at the distal level, 0.056 ± 0.020 mm/N. Complete release of the transverse carpal ligament was required to achieve a significant gain in compliance at the distal level (p < 0.05). Subsequent release of the distal aponeurosis resulted in an appreciable additional increase in compliance (43.0 %, p = 0.052) at the distal level, but a minimal increase (1.7 %, p = 0.987) at the proximal level. Complete flexor retinaculum release provided a significant gain in compliance relative to transverse carpal ligament release alone at both proximal and distal levels (p < 0.05).
  
  
  CONCLUSIONS
  Overall, complete flexor retinaculum release increased proximal compliance by 52 % and distal compliance by 332 %. The increase in carpal tunnel compliance with complete flexor retinaculum release helps explain the benefit of carpal tunnel release surgery for patients with carpal tunnel syndrome.
authors.affiliation: Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, 44195, OH, USA.
authors.forename: Rubina
authors.initials: R
authors.lastname: Ratnaparkhi
authors.affiliation: Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, 44195, OH, USA.
authors.forename: Kaihua
authors.initials: K
authors.lastname: Xiu
authors.affiliation: Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, 44195, OH, USA.
authors.forename: Xin
authors.initials: X
authors.lastname: Guo
authors.affiliation: Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, 44195, OH, USA. liz4@ccf.org.
authors.forename: Zong-Ming
authors.initials: ZM
authors.lastname: Li
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D002102:Cadaver; D002348:Carpal Bones / Q000503:physiopathology*; D002349:Carpal Tunnel Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003187:Compliance / Q000502:physiology; D019299:Decompression, Surgical / Q000379:methods; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D008023:Ligaments, Articular / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography
keywords: Antebrachial fascia; Carpal tunnel release; Compliance; Distal aponeurosis; Transverse carpal ligament