Biomechanical and anatomical consequences of carpal tunnel release

Brooks, Jeffrey J.; Schiller, Jonathan R.; Allen, Scott D.; Akelman, Edward

doi:10.1016/s0268-0033(03)00052-4

Cited by 75 publications

(73 citation statements)

References 45 publications

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“…Utilizing our research findings and prior anatomical studies [1,2,5,6], we propose revised definitions of the FR and TCL. The FR exists as a fascial plane that is continuous with the flexor forearm fascia.…”

Section: Discussionmentioning

confidence: 99%

Morphological Analysis of the Transverse Carpal Ligament

Pacek

Chakan

Goitz

et al. 2009

Hand (New York, N,Y.)

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Transection of the transverse carpal ligament (TCL) for carpal tunnel syndrome is commonly performed, yet actual knowledge of TCL morphology is rudimentary and the anatomical terminology is inconsistently used. The purpose of this study was to perform a morphological analysis of the TCL, to redefine the anatomical terminology concerning the TCL and surrounding structures, and to evaluate any correlation between external, measurable hand dimensions, and TCL dimensions. A silicone casting technique and digitization were employed to measure the morphology of the TCL in cadaveric specimens and to construct a three-dimensional TCL model. The TCL was the thickest distally at the midline and ulnar segments and the thickest proximally at the radial segment. External hand dimensions did not significantly correlate with TCL dimensions. The TCL thickness distribution is variable along the radioulnar axis. The thickness of the TCL was 2.1±0.8 mm, ranging from 1.3 to 3.0 mm.

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Section: Discussionmentioning

confidence: 99%

Morphological Analysis of the Transverse Carpal Ligament

Pacek

Chakan

Goitz

et al. 2009

Hand (New York, N,Y.)

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“…There are a number of reasons that may account for these strength decreases, including altered morphology of the carpal tunnel, 9,73 decreased thenar muscle and digital flexor muscle strengths, inhibition of muscle by pain, and scar or pillar pain. After the TCL is cut, the stable point of anchor for the thenar muscles' origin changes.…”

Section: Consequences Of Ctr: What To Expect Following Surgerymentioning

confidence: 99%

“…8,9,34,39,56,62,69,79,80,97 In this author's experience, patients have been referred to physical therapy with a diagnosis of CTS when other conditions coexist and these conditions must be taken into account if intervention strategies 16,94 are to be successful. In some instances, the diagnosis of CTS is made by inexperienced yet well-intentioned clinicians and other disorders must be recognized and properly addressed.…”

mentioning

confidence: 99%

Conservative Interventions for Carpal Tunnel Syndrome

Michlovitz¹

2004

J Orthop Sports Phys Ther

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The assessment and conservative interventions in patients with carpal tunnel syndrome (CTS) are described in this paper. Information about surgical procedures and postoperative care has also been included. It is difficult to make definitive conclusions about the literature regarding success of treatment for CTS due to variations in outcome measures, severity of CTS, and inconsistencies in duration, dosage, and follow-up time for interventions. Based on what is known to date, this author recommends that patients with mild or moderate CTS be provided with a conservative program of splinting the wrist in neutral for nocturnal wear. In addition, intermittent exercise (nerve-gliding exercises) and activity modification, including avoidance of protracted periods of sustained gripping activities and awkward wrist positions, can be useful. This conservative program may be complemented by pain-relieving modalities during times of activity and supplemental participation in other exercise such as yoga. If symptoms are not relieved to the satisfaction of the patient, or they recur, then it is incumbent upon the therapist to refer the patient to a hand surgeon for injection or possible surgical decompression.

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“…As one of its functions, this ligament serves as a pulley for the flexor tendons. 4 Numerous authors have noted that the flexor tendons in the carpal tunnel displace palmarward or volarly after release of the ligament. 1 As a pulley in the flexor tendon system, the transverse carpal ligament prevents this displacement or bowstringing.…”

Section: Discussionmentioning

confidence: 99%

“…1 As a pulley in the flexor tendon system, the transverse carpal ligament prevents this displacement or bowstringing. 4 Complications related to tendon translocation over the hook of the hamate may result in pain, tendon snapping, and weakened grip. 3 Even though tendon translocation and migration of the carpal tunnel contents have previously been observed, compression of the ulnar nerve in Guyon's canal by the displaced carpal tunnel contents is an as yet unreported complication, at least to our knowledge.…”

Section: Discussionmentioning

confidence: 99%

Delayed ulnar neuropathy at the wrist following open carpal tunnel release

et al. 2004

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Open carpal tunnel release is a common and successful treatment of median neuropathy at the wrist (carpal tunnel syndrome). We report a case of delayed ulnar neuropathy at the wrist with onset 2 months after open carpal tunnel release. Clinical findings, electrophysiological studies, magnetic resonance imaging, and surgical exploration demonstrated ulnar nerve compression at Guyon's canal resulting from translocation of the carpal tunnel contents. To our knowledge, this is an unreported complication of open carpal tunnel release that merits wide appreciation.

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Biomechanical and anatomical consequences of carpal tunnel release

Cited by 75 publications

References 45 publications

Morphological Analysis of the Transverse Carpal Ligament

Morphological Analysis of the Transverse Carpal Ligament

Conservative Interventions for Carpal Tunnel Syndrome

Delayed ulnar neuropathy at the wrist following open carpal tunnel release

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