A 12-Year Experience Using the Brown Two-Portal Endoscopic Procedure of Transverse Carpal Ligament Release in 14,722 Patients: Defining a New Paradigm in the Treatment of Carpal Tunnel Syndrome

2007 ◽  
Vol 120 (7) ◽  
pp. 1911-1921 ◽  
Author(s):  
Christopher L. Hankins ◽  
Michael G. Brown ◽  
Randolph A. Lopez ◽  
Andrew K. Lee ◽  
Joseph Dang ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Endoscopic Procedure ◽  
Transverse Carpal Ligament ◽  
New Paradigm ◽  
Tunnel Syndrome

Palmar Musculature: Does It Affect the Development of Carpal Tunnel Syndrome? A Pilot Study

2021 ◽  
Author(s):  
Trevor Simcox ◽  
Lauren Seo ◽  
Kevin Dunham ◽  
Shengnan Huang ◽  
Catherine Petchprapa ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Correlation Coefficient ◽  
Carpal Tunnel ◽  
Case Control Study ◽  
Anatomical Variation ◽  
Case Control ◽  
Transverse Carpal Ligament ◽  
Large Variability ◽  
Tunnel Syndrome ◽  
Control Study

Abstract Background The etiology of carpal tunnel syndrome (CTS) is multifactorial. Static mechanical characteristics of CTS have been described, but dynamic (muscular) parameters remain obscure. We believe that musculature overlying the transverse carpal ligament may have an effect on carpal tunnel pressure and may explain the prevalence of CTS in manual workers. Questions/Purposes To utilize magnetic resonance imaging (MRI) imaging to estimate the amount of muscle crossing the area of the carpal tunnel and to compare these MRI measurements in patients with and without documented CTS. Methods A case–control study of wrist MRI scans between January 1, 2018, and December 1, 2019, was performed. Patients with a diagnosis of CTS were matched by age and gender with controls without a diagnosis of CTS. Axial MRI cuts at the level of the hook of the hamate were used to measure the thenar and hypothenar muscle depth overlying the carpal tunnel. Muscle depth was quantified in millimeters at three points: midcapitate, capitate–hamate border, capitate–trapezoid border. Average depth was calculated by dividing the cross-sectional area (CSA) by the transverse carpal ligament width. Statistical analysis included Student's t-test, chi-square test, and Pearson's correlation coefficient calculation. Results A total of 21 cases and 21 controls met the inclusion criteria for the study. There were no significant differences in demographics between case and control groups. The location and depth of the musculature crossing the carpal tunnel were highly variable in all areas evaluated. A significantly positive correlation was found between proximal median nerve CSA and muscle depth in the capitate–hamate area (correlation coefficient = 0.375; p = 0.014). CSA was not significantly associated with chart documented CTS. Conclusions We found large variability in our measurements. This likely reflects true anatomical variation. The significance of our findings depends on the location of the muscles and the line of pull and their effect on the mechanics of the transverse carpal ligament. Future research will focus on refining measurement methodology and understanding the mechanical effect of the muscular structure and insertions on carpal tunnel pressure. Level of Evidence This is a Level 3, case–control study.

Cross-Sectional Area of the Median Nerve Characterized by Ultrasound in Patients With Carpal Tunnel Syndrome Before and After the Release of the Transverse Carpal Ligament

2013 ◽  
Vol 29 (3) ◽  
pp. 116-121 ◽  
Author(s):  
Benedito F. Pimentel ◽  
Claudia A. Abicalaf ◽  
Larissa Braga ◽  
Walter M. Albertoni ◽  
Carlos H. Fernandes ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Transverse Carpal Ligament ◽  
Cross Sectional ◽  
Before And After ◽  
Tunnel Syndrome

Carpal Tunnel Syndrome Treated with a Diode Laser: A Controlled Treatment of the Transverse Carpal Ligament

2008 ◽  
Vol 26 (6) ◽  
pp. 551-557 ◽  
Author(s):  
Wen-Dien Chang ◽  
Jih-Huah Wu ◽  
Joe-Air Jiang ◽  
Chun-Yu Yeh ◽  
Chien-Tsung Tsai
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Diode Laser ◽  
Carpal Tunnel ◽  
Transverse Carpal Ligament ◽  
Controlled Treatment ◽  
Tunnel Syndrome

Carpal Tunnel Syndrome in Chronic Renal Dialysis Patients: Clinical Evaluation of 62 Hands and Results of Operative Treatment

1987 ◽  
Vol 12 (3) ◽  
pp. 366-374
Author(s):  
M. NAITO ◽  
K. OGATA ◽  
T. GOYA
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Renal Dialysis ◽  
Transverse Carpal Ligament ◽  
Dialysis Patients ◽  
Pneumatic Tourniquet ◽  
Catheter Technique ◽  
Tunnel Syndrome ◽  
Venous Fistula ◽  
A Prospective Study

A prospective study was performed on 62 hands in 45 consecutive patients on chrome dialysis carpal tunnel syndrome developed within an average of 116 months after formation of the arterio-venous fistula. We measured the intra-carpal canal pressure by the wick catheter technique and performed neurography. At operation, a markedly thickened transverse carpal ligament was usually found. A pneumatic tourniquet was applied in all except three cases, whose functioning fistulae were made of implants, but no complications such as obturation of the fistulae occurred. Thirty-three (76.7%) of 43 cases had good results. Full recovery of sensibility was obtained in all hands in which symptoms had been present for less than two years. There was no benefit from operation in two patients (4.7%), both of whom had symptoms for more than two years.

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.

Carpal Tunnel Syndrome in Chronic Renal Dialysis Patients: Clinical Evaluation of 62 Hands and Results of Operative Treatment

1992 ◽  
Vol 17 (6) ◽  
pp. 703-703
Author(s):  
M. Naito ◽  
K. Ogata ◽  
T. Goya
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Renal Dialysis ◽  
Transverse Carpal Ligament ◽  
Dialysis Patients ◽  
Pneumatic Tourniquet ◽  
Catheter Technique ◽  
Tunnel Syndrome ◽  
Venous Fistula ◽  
A Prospective Study

A prospective study was performed on 62 hands in 45 consecutive patients on chrome dialysis carpal tunnel syndrome developed within an average of 116 months after formation of the arterio-venous fistula. We measured the intra-carpal canal pressure by the wick catheter technique and performed neurography. At operation, a markedly thickened transverse carpal ligament was usually found. A pneumatic tourniquet was applied in all except three cases, whose functioning fistulae were made of implants, but no complications such as obturation of the fistulae occurred. Thirty-three (76.7%) of 43 cases had good results. Full recovery of sensibility was obtained in all hands in which symptoms had been present for less than two years. There was no benefit from operation in two patients (4.7%), both of whom had symptoms for more than two years.

Stimulation Across the Transverse Carpal Ligament in Carpal Tunnel Syndrome

PM&R ◽  
2016 ◽  
Vol 8 (9) ◽  
pp. S153
Author(s):  
Stephen Kishner ◽  
Chadwick P. Murphy ◽  
Margaret C. Maxi ◽  
Malia G. Cali ◽  
Donald E. Mercante
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Transverse Carpal Ligament ◽  
Tunnel Syndrome

Comparison of the Clinical Effectiveness of Ultrasound-Guided Corticosteroid Injection with and without Needle Release of the Transverse Carpal Ligament in Carpal Tunnel Syndrome

2017 ◽  
Vol 78 (1-2) ◽  
pp. 33-40 ◽  
Author(s):  
Xuan-Yan Guo ◽  
Mao-xiang Xiong ◽  
Yu Zhao ◽  
Fan-Ding He ◽  
Xue-Qing Cheng ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Corticosteroid Injection ◽  
Clinical Effectiveness ◽  
Transverse Carpal Ligament ◽  
Ultrasound Guided ◽  
Tunnel Syndrome
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