The transverse carpal ligament. An important component of the digital flexor pulley system.

Kline, Samuel C.; Moore, J. Russell

doi:10.2106/00004623-199274100-00006

Cited by 58 publications

(35 citation statements)

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“…Tendon moment arms were calculated according to the formula that excursion along an arc on a circle equals the radius of the circle multiplied by the subtended angle of the arc in radians (2,3.5, [17][18][19]. Moment arms of the wrist motors derived from excursions of the tendons during 120" of flexion-extension and 50" of radioulnar deviation were defined as the average moment arm.…”

Section: Methodsmentioning

confidence: 99%

“…The potential of individual muscles to produce maximal forces is determined primarily by muscle architecture (15,21). Mechanical advantages of the muscles depend on the moment arms of the tendons across the joint (1,2,5, 18,19). Loss of scaphoid integrity may change the motion center of the entire carpus, and fracture deformities may alter excursions of the surrounding tendons.…”

mentioning

confidence: 99%

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Biomechanical changes of the wrist flexor and extensor tendons following loss of scaphoid integrity

Tang

Ryu

Han

et al. 1997

Journal Orthopaedic Research

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Loss of integrity of the scaphoid may change the motion center of the entire carpus, and deformities from scaphoid fractures may alter the location of motor tendons of the wrist, thus altering their biomechanics. The goal of this study was to clarify biomechanical changes in these tendons following loss of scaphoid integrity. Excursions and moment arms of the principal flexor and extensor tendons of the wrist were investigated in seven cadaveric upper extremities in intact wrists after simulation of scaphoid waist fracture and after removal of the proximal scaphoid. Excursions of the flexor carpi radialis and ulnaris, extensor carpi radialis longus and brevis, and extensor carpi ulnaris tendons were measured with rotary potentiometers during wrist flexion-extension and radioulnar deviation. Simultaneously, wrist joint angulation was recorded. Moment arms of the tendons were derived from tendon excursions and joint motion. After scaphoid fracture, the moment arms of the flexor carpi radialis and extensor carpi ulnaris tendons increased significantly during wrist flexion-extension, whereas the moment arms of the extensor carpi radialis longus and brevis tendons decreased significantly. After proximal scaphoid excision, the moment arms of the extensor carpi radialis longus and brevis tendons again decreased significantly during wrist flexion-extension. The moment arms of the flexor carpi radialis and extensor carpi radialis brevis tendons increased significantly during radioulnar deviation, whereas those of the wrist motors on the ulnar side decreased. These findings indicate the importance of the integrity of the scaphoid in maintaining normal biomechanics of motor tendons of the wrist. An increase in the moment arm of the radial wrist flexor along with a decrease in moment arms of the radial extensors constitutes as etiology for persistent angulation of the scaphoid and the humpback deformity. In addition, disturbing the biomechanics of the wrist motor tendons predisposes the carpal joints to abnormal loading, potentially contributing to the development of carpal joint degeneration.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Biomechanical changes of the wrist flexor and extensor tendons following loss of scaphoid integrity

Tang

Ryu

Han

et al. 1997

Journal Orthopaedic Research

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“…Functionally, the TCL keeps the tendons close to the wrist joint axis to maximize finger flexion with minimal tendon excursion [13]. This function is especially evident with bowstringing of the flexor tendons following carpal tunnel release surgery [13, 15], implying the existence of a biomechanical interaction between the flexor tendons and the TCL for the intact, native condition. The positional changes of the TCL and tendons suggest that the tendons contacted and imparted forces on the TCL resulting in their parallel movement.…”

Section: Discussionmentioning

confidence: 99%

“…However, the interaction between the flexor tendons and the TCL remains unclear. The TCL provides mechanical advantages for the flexor tendons, acting as a pulley for the tendons during wrist flexion [12] and maintaining the moment arms of the flexor tendons at the wrist to prevent bowstringing [13]. The functional role of the TCL brings about a biomechanical interaction between the ligament and the tendons.…”

Section: Introductionmentioning

confidence: 99%

“…The functional role of the TCL brings about a biomechanical interaction between the ligament and the tendons. Implications of this tissue interaction have been suggested by histological adaptation of carpal tunnel tissues [14] and by the altered movement of the flexor tendons after transection of the TCL in carpal tunnel release surgery [13, 15]. …”

Section: Introductionmentioning

confidence: 99%

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In vivo tissue interaction between the transverse carpal ligament and finger flexor tendons

Gabra

Gordon

Marquardt

et al. 2016

Medical Engineering & Physics

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The transverse carpal ligament (TCL) is a component of the flexor pulley system of the wrist, keeping the flexor tendons in place by resisting their volar displacement. The purpose of this study was to investigate the in vivo biomechanical interaction between the TCL and flexor tendons in response to tendon tensioning with the wrist at various postures. In eight healthy subjects, the flexor digitorum superficialis and profundus tendons were tensioned by isometrically applying loads (5, 10, and 15 N) to the index finger while the wrist posture was at 20° extension, neutral, 20° flexion, and 40° flexion. The TCL and flexor tendons were imaged at the distal carpal tunnel cross section using ultrasound. The volar-dorsal positions of the tendons, TCL arch height, and TCL-tendon distances were calculated. With increasing wrist flexion, the flexor tendons moved volarly, the TCL arch height increased, and the TCL-tendon distances decreased, indicating that the flexor tendons contacted the TCL and pushed it volarly. The TCL-tendon interaction was amplified by the combination of finger loading and wrist flexion. This study provides in vivo evidence of the biomechanical interaction between the TCL and flexor tendons. Repetitive TCL-tendon interactions may implicate the interacting tissues and the median nerve resulting in tissue maladaptation and nerve compression.

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Restoration of function of the thumb flexor apparatus requires repair of the oblique and one adjacent flexor tendon pulley

Esplin

Tencer

Hanel

et al. 1996

Journal Orthopaedic Research

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Damage to the pulleys of the thumb flexor apparatus may cause bow-stringing of the tendon and affect muscle function. An experiment using the hands and distal forearms of cadavers was designed to determine which damaged pulleys increase excursion length of the flexor tendon with constant tendon and resisting loads. Each specimen was mounted to a loading frame with a dead weight pinned to the tip of the thumb. The thumb flexor tendon was clamped to an actuator that applied a fixed load and measured excursion of the tendon. Ranges of motion of the thumb joint were also measured. The thumb flexor apparatus of each specimen was tested intact first, with the hand in flexed, neutral, and extended positions; then it was tested with progressive sectioning of pulleys from proximal to distal in one group and from distal to proximal in a second group. The length of excursion increased significantly with all pulleys cut but there was no effect on overall range of motion of the thumb. With proximal to distal sectioning, no change in tendon excursion occurred when the flexor retinaculum and the first annular pulleys were cut, until the oblique pulley was sectioned, leaving only the second annular pulley intact (range, 1.17 - 1.31 times that of intact excursion, dependent on position of the hand). With distal to proximal sectioning, tendon excursion was not affected when the second annular and oblique pulleys were cut but did increase when the first annular pulley was sectioned, leaving only the flexor retinaculum intact (range, 1.28 - 1.36 times that of intact excursion). Dependent on the location of damage, therefore, an intact oblique or first annular pulley can maintain normal excursion of the tendon.

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The transverse carpal ligament. An important component of the digital flexor pulley system.

Cited by 58 publications

References 0 publications

Biomechanical changes of the wrist flexor and extensor tendons following loss of scaphoid integrity

Biomechanical changes of the wrist flexor and extensor tendons following loss of scaphoid integrity

In vivo tissue interaction between the transverse carpal ligament and finger flexor tendons

Restoration of function of the thumb flexor apparatus requires repair of the oblique and one adjacent flexor tendon pulley

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