Thenar and Hypothenar Muscle Coverage on the Transverse Carpal Ligament

2021 ◽  
Author(s):  
Farah Alsafar ◽  
Zong-Ming Li
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Transverse Carpal Ligament ◽  
Thenar Muscle ◽  
Cross Sectional ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Release Surgery ◽  
Automated Algorithms ◽  
Hypothenar Muscle

Abstract Background The purpose of the study was to examine the coverage of thenar and hypothenar muscles on the transverse carpal ligament (TCL) in the radioulnar direction through in vivo ultrasound imaging of the carpal tunnel. We hypothesized that the TCL distance covered by the thenar muscle would be greater than that by the hypothenar muscle, and that total muscle coverage on the TCL would be greater than the TCL-alone region. Methods Ultrasound videos of human wrist were collected on 20 healthy subjects. Automated algorithms were used to extract the distal cross-sectional image of the trapezium-hamate level. Manual tracing of the anatomical features was conducted. Results Thenar muscles covered a significantly larger distance (11.9 ± 1.8 mm) as compared with hypothenar muscles (1.7 ± 0.8 mm) (p < 0.001). The TCL covered by thenar and hypothenar muscles was greater than the TCL-alone length (p < 0.001). The thenar and hypothenar muscle coverage on the TCL, as normalized to the total TCL length, was 61.0 ± 7.5%. Conclusions More than 50% of the TCL at the distal carpal tunnel is covered by thenar and hypothenar muscles. Knowledge of muscular attachments to the TCL improves our understanding of carpal tunnel syndrome etiology and can guide carpal tunnel release surgery.

Endoscopic Carpal Tunnel Release

2019 ◽  
pp. 989-994
Author(s):  
Antony Hazel ◽  
Neil F. Jones
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Hand Surgery ◽  
Anatomical Landmarks ◽  
Transverse Carpal Ligament ◽  
Palmar Arch ◽  
Endoscopic Carpal Tunnel Release ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Release Surgery ◽  
Open Carpal Tunnel Release

Conventional open carpal tunnel release surgery is one of most successful procedures in hand surgery and has been demonstrated to be an effective treatment for carpal tunnel syndrome. However, a known sequelae in some individuals who undergo the procedure is “pillar” pain. In an effort to avoid this condition and help people return to work more quickly, the endoscopic technique was developed. Endoscopic carpal tunnel release offers a minimally invasive alternative to other traditional techniques with similar outcomes. By placing the incision proximal to the transverse carpal ligament there is potential for decreased scar sensitivity and pillar pain. The technique is technically demanding. The superficial palmar arch and common digital nerve to the ring and middle fingers are at risk for injury during the procedure. With adherence to anatomical landmarks and the proper visualization, the surgery may be safely performed.

Stiffness of the Transverse Carpal Ligament Under the Influence of Collagenase

2011 ◽  
Author(s):  
Ryan K. Prantil ◽  
Tracy A. Mondello ◽  
Suk H. Yu ◽  
Khurram Pervaiz ◽  
Savio L-Y. Woo ◽  
...  
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Geometrical Model ◽  
Sectional Area ◽  
Transverse Carpal Ligament ◽  
Cross Sectional ◽  
Peptide Bonds ◽  
Stiffness Reduction ◽  
Operative Complications ◽  
Tunnel Syndrome

Forming the palmar roof of the carpal tunnel, the transverse carpal ligament (TCL) continues to be the surgical target for carpal tunnel release which aims to relieve the symptoms of patients with carpal tunnel syndrome. However, the surgical procedures may cause several biomechanical and anatomical problems for the carpal tunnel [1]. Therefore, an alternative, aimed at preserving the TCL, might alleviate patients’ post-operative complications. Using a geometrical model, Li et al. showed that the cross-sectional area of the carpal tunnel can be effectively increased by TCL elongation [2]. Theoretically, stiffness reduction could facilitate a ligament’s capability to elongate. Past studies have shown that the utilization of the collagenase enzyme altered the mechanical properties of a soft tissue [3, 4]. It also has been used to treat Dupuytren’s Contracture [5] because collagenase breaks the peptide bonds within collagen fibers [6]. The usage of collagenase could effectively reduce the stiffness of the TCL allowing for the ligament to elongate and for the median nerve to decompress. Thus, the purpose of our study is to determine the effect of collagenase on the stiffness of the TCL. We hypothesize that the stiffness of the ligament will progressively decrease due to the enzymatic effect of collagenase.

scholarly journals Ultrasonography Findings in Severe Carpal Tunnel Syndrome

Hand ◽  
2018 ◽  
Vol 15 (1) ◽  
pp. 64-68
Author(s):  
Gideon Nkrumah ◽  
Alan R. Blackburn ◽  
Robert J. Goitz ◽  
John R. Fowler
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Nerve Conduction Studies ◽  
Cross Sectional ◽  
Younger Patients ◽  
Tunnel Syndrome ◽  
Sensory Latency ◽  
Pisiform Bone

Background: Increasing severity of carpal tunnel syndrome (CTS), as graded by nerve conduction studies (NCS), has been demonstrated to predict the speed and completeness of recovery after carpal tunnel release (CTR). The purpose of this study is to compare the cross-sectional area (CSA) of the median nerve in patients with severe and nonsevere CTS as defined by NCS. Methods: Ultrasound CSA measurements were taken at the carpal tunnel inlet at the level of the pisiform bone by a hand fellowship–trained orthopedic surgeon. Severe CTS on NCS was defined as no response for the distal motor latency (DML) and/or distal sensory latency (DSL). Results: A total of 274 wrists were enrolled in the study. The median age was 51 years (range: 18-90 years), and 72.6% of wrists were from female patients. CSA of median nerve and age were comparatively the best predictors of severity using a linear regression model and receiver operator curves. Using cutoff of 12 mm2 for severe CTS, the sensitivity and specificity are 37.5% and 81.9%, respectively. Conclusions: Ultrasound can be used to grade severity in younger patients (<65 years) with a CTS-6 score of >12.

Experimentally and Theoretically Narrowing Carpal Arch Width to Increase the Area Formed by the Transverse Carpal Ligament

2011 ◽  
Author(s):  
Suk H. Yu ◽  
Tracy A. Mondello ◽  
Zong-Ming Li
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Transverse Carpal Ligament ◽  
Cross Sectional ◽  
Arch Width ◽  
Endoscopic Release ◽  
Volar Aspect ◽  
Tunnel Syndrome

Carpal tunnel syndrome is conventionally treated by open and endoscopic release surgeries in which transecting the transverse carpal ligament (TCL) relieves mechanical insults around the median nerve. The TCL release surgeries yield an increase in the tunnel cross-sectional area particularly within the volar aspect of the tunnel, the arch area, where the median nerve is located. As a result of increased arch area, post-operative follow-up studies using MRI confirmed a significant volar migration of the median nerve [1]. However, transecting the TCL compromises critical biomechanical roles of the carpal tunnel [2], and therefore, it is imperative to investigate an alternative method for treating carpal tunnel syndrome patients while preserving the TCL. Li et al. suggested that increasing the TCL length and narrowing the carpal arch width (CAW) as potential alternatives for increasing the arch area [3]. However, the data from their application of palmarly directed forces to the TCL from inside of the tunnel showed that the TCL length remained relatively constant while the carpal bones were mobilized to increase the arch area [3]. The purpose of this study was to investigate the relationship between CAW narrowing and the TCL-formed arch area by experimental and geometrical modeling.

Two-portal endoscopic carpal tunnel release surgery: report of early experience

1997 ◽  
Vol 3 (1) ◽  
pp. E7 ◽  
Author(s):  
Cynthia B. Piccirilli ◽  
Christopher I. Shaffrey ◽  
Jacob N. Young ◽  
LaVerne R. Lovell
Keyword(s):  
Learning Curve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Early Experience ◽  
Prospective Analysis ◽  
Transverse Carpal Ligament ◽  
Steep Learning Curve ◽  
Endoscopic Carpal Tunnel Release ◽  
Carpal Tunnel Release Surgery ◽  
Very High

Endoscopic carpal tunnel release is increasingly performed to treat median nerve entrapment neuropathy at the transverse carpal ligament. Proponents of these procedures claim that there are early postoperative advantages to be gained by the patient in the form of decreased pain and weakness, thus facilitating an earlier return to function. However, serious complications associated with the use of these techniques have been reported, especially during the surgeon's purported initial steep learning curve. A prospective analysis of the authors' first 51 cases using a two-portal endoscopic technique was conducted to determine whether these learning curve complications occurred. The authors did experience a learning curve; however, it was not significant. They encountered no serious complications and patient satisfaction was very high. It is concluded that the procedure is relatively easy to learn and safe to perform.

Patient-reported outcomes of carpal tunnel release surgery in patients with bilateral severe carpal tunnel syndrome

2017 ◽  
Vol 42 (9) ◽  
pp. 932-936 ◽  
Author(s):  
C. Q. Y. Tang ◽  
S. W. H. Lai ◽  
S. C. Tay
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Complete Resolution ◽  
Patient Reported Outcomes ◽  
Operative Time ◽  
Carpal Tunnel Release ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Release Surgery

This retrospective study examined whether the presenting complaint of numbness is relieved post-operatively in severe carpal tunnel syndrome and also assessed any correlation between outcomes of the first and second procedures in staged bilateral carpal tunnel releases. Carpal tunnel release (60 open and 38 endoscopic) was done in 49 patients with bilateral severe carpal tunnel syndrome. There was complete resolution of numbness post-operatively in 77% ( n = 75) of hands. The median post-operative time before complete resolution of numbness was 21 days (IQR 8 to 21; range 3 to 482). The likelihood of complete resolution of symptoms after the second carpal tunnel release in patients with complete resolution of symptoms after the first carpal tunnel release was 22 (95% CI: 4 to 131) times that of the likelihood of improvement in patients with incomplete resolution of symptoms after the first carpal tunnel release. Level of evidence: IV

INVESTIGATION OF SEGMENTAL CARPAL TUNNEL PRESSURE IN PATIENTS WITH IDIOPATHIC CARPAL TUNNEL SYNDROME — IS IT NECESSARY TO RELEASE THE DISTAL APONEUROTIC PORTION OF THE FLEXOR RETINACULUM IN ENDOSCOPIC CARPAL TUNNEL RELEASE SURGERY?

Hand Surgery ◽  
2007 ◽  
Vol 12 (03) ◽  
pp. 205-209 ◽  
Author(s):  
Keiichi Murata ◽  
Hiroshi Yajima ◽  
Naoki Maegawa ◽  
Koji Hattori ◽  
Yoshinori Takakura
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Guide Wire ◽  
Carpal Tunnel Release ◽  
Endoscopic Carpal Tunnel Release ◽  
Flexor Retinaculum ◽  
Before And After ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Release Surgery

Segmental carpal tunnel pressure was measured in 12 hands of 11 idiopathic carpal tunnel syndrome patients before and after two-portal endoscopic carpal tunnel release. We aimed to determine at which part of the carpal tunnel the median nerve could be compressed, and to evaluate whether carpal tunnel pressure could be reduced sufficiently at all segments of the carpal tunnel after the surgery. Pressure measurements were performed using a pressure guide wire. The site with the highest pressure corresponded to the area around the hamate hook; the pressure in the area distal to the flexor retinaculum could be pathogenically high (more than 30 mmHg) before the surgery. The two-portal endoscopic carpal tunnel release achieved sufficient pressure reduction in all segments of the carpal tunnel when the flexor retinaculum and the fibrous structure between the flexor retinaculum and the palmar aponeurosis were completely released.

Endoscopic treatment of carpal tunnel syndrome: a critical review

1998 ◽  
Vol 88 (5) ◽  
pp. 817-826 ◽  
Author(s):  
David F. Jimenez ◽  
Scott R. Gibbs ◽  
Adam T. Clapper
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Critical Review ◽  
Carpal Tunnel Release ◽  
Content Type ◽  
Endoscopic Techniques ◽  
Endoscopic Carpal Tunnel Release ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Release Surgery ◽  
Fine Print

Object. The goal of this paper is to present a critical review of the endoscopic procedures currently in use for the treatment of carpal tunnel syndrome. Endoscopic techniques and outcomes are discussed. Methods. An extensive review of published articles on the subject of endoscopic carpal tunnel release surgery is presented, encompassing six endoscopic techniques used to treat carpal tunnel syndrome. Since the first report in 1987, 7091 patients have undergone 8068 operations. The overall success rate has been 96.52%, with a complication rate of 2.67% and a failure rate of 2.61%. The mean time to return to work in patients not receiving Workers' Compensation was 17.8 days, ranging between 10.8 and 22.3 days. The most common complications were transient paresthesias of the ulnar and median nerves. Other complications included superficial palmar arch injuries, reflex sympathetic dystrophy, flexor tendon lacerations, and incomplete transverse carpal ligament division. In many studies in which open and endoscopic techniques were compared, it was reported that patients in the the latter group experienced significantly less pain and returned to work and activities of daily living earlier. Conclusions. Success and complication rates of endoscopic carpal tunnel release surgery are similar to those for standard open procedures.

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