The transverse carpal ligament is the volar roof of the carpal tunnel. Gross observation shows that the ligament appears to have fibers that roughly orient in the transverse direction. A closer anatomical examination shows that the ligament also has oblique fibers. Knowledge of the fiber orientation of the transverse carpal ligament is valuable for further understanding the ligament's role in regulating the structural function of the carpal tunnel. The purpose of this study is to quantify collagen fiber orientation within the transverse carpal ligament using the small angle light scattering technique. Eight transverse carpal ligament samples from cadaver hands were used in this study. Individual 20-μm sections were cut evenly along the thickness of the transverse carpal ligament. Sections of three thickness levels (25%, 50%, and 75% from the volar surface) were collected for each transverse carpal ligament. Fibers were grouped in the following orientation ranges: transverse, longitudinal, oblique in the pisiform-trapezium (PT), and oblique in the scaphoid-hamate (SH) directions. In analyzing the fiber percentages, the orientation types for the different thickness levels of the ligament showed that the transverse fibers were the most prominent (>60.7%) followed by the PT oblique (18.6%), SH oblique (13.0%), and longitudinal (8.6%) fibers.
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http://dx.doi.org/10.1002/ca.21257 | DOI Listing |
Plast Surg (Oakv)
February 2025
Division of Plastic and Reconstructive Surgery, Memorial University, St. John's, Newfoundland, Canada.
Given the proximity and shared structures of Guyon's canal and the carpal tunnel, compression of the ulnar nerve is a rarely observed but possible complication of carpal tunnel release. In this case report, a patient underwent previous carpal tunnel release and immediately experienced ipsilateral hand weakness in keeping with an ulnar nerve compression syndrome. Clinical, electrodiagnostic, and magnetic resonance imaging findings after carpal tunnel release demonstrated a compression or injury to the deep motor branch of the ulnar nerve not previously present.
View Article and Find Full Text PDFHand Surg Rehabil
January 2025
Unidade do Punho e Mão, Hospital Cuf Tejo, Lisboa, Portugal; Centre Hospitalier Régional Universitaire de Nîmes, Department of Orthopaedic Surgery, Nîmes, France; Orthopaedic Group Ormeau Pyrénées, Polyclinique de L'Ormeau - ELSAN, Tarbes, France.
Compression of the median nerve in the carpal tunnel is a frequent pathology with severe functional impact. An ultrasound-guided technique was developed to preserve structures, diminish scar fibrosis and enable fast return to full activity. Its advantages are safety and low additional cost.
View Article and Find Full Text PDFRadiol Med
January 2025
Neuromuscular Imaging Ordinationszentrum Döbling, Heiligenstädter Straße 46-48, 1190, Vienna, Austria.
Purpose: Thread release of the carpal tunnel is the most recent of several minimally invasive ultrasound-guided carpal tunnel release techniques. The purpose of this article is to provide a step-by-step guide for minimally invasive, ultrasound-guided thread release of the carpal tunnel focused on transecting the transverse carpal ligament with minimal damage to the palmar aponeurosis on anatomical specimens.
Methods: Fifteen ultrasound-guided carpal tunnel thread releases were performed on the wrists of soft-embalmed anatomical specimens, which were dissected immediately after the intervention.
J Orthop
July 2025
Department of Hand Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
Aims And Objectives: Dynamic incursion of lumbrical muscle proximal to the distal edge of transverse carpal ligament (TCL) has been long debated for its role in causing median nerve compression in the carpal tunnel. This study aims to evaluate the pattern of lumbrical incursion into the carpal tunnel in various finger positions and determine their extent of presence and relationship with respect to the TCL and to each other in the carpal tunnel.
Materials & Methods: Dissection of 30 fresh frozen cadaveric hands was done to map the lumbrical muscles.
J Hand Surg Asian Pac Vol
January 2025
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Surgeons use anatomical landmarks like the scaphoid tubercle, pisiform, trapezial tubercle and hook of hamate, along with Kaplan cardinal line (KCL) to avoid injury to the recurrent motor branch (RMB) of the median nerve during carpal tunnel release. The presence of transverse muscle fibres (TMF) overlying the transverse carpal ligament (TCL) may suggest proximity of the RMB, but their anatomical relationship is unclear. In this study, we evaluated the accuracy of anatomical landmarks to the RMB, TMF origin and insertion, and examined the relationship between TMF presence and RMB running patterns.
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