Carpal Tunnel Release: Do We Understand the Biomechanical Consequences?

Morrell, Nathan T.; Harris, Andrew P.; Skjong, Christian; Akelman, Edward

doi:10.1055/s-0036-1580088

Cited by 1 publication

(3 citation statements)

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“…3 Changes to the width of the carpal arch and the volume of the carpal tunnel have been reported; however, little research has identified any biomechanical consequences that may arise after releasing the TCL. 3 In a biomechanical study, the carpal arch has been shown to remain stable after isolated TCL excision; however, when combined with release of at least one palmar intercarpal ligament a gross instability can be created. 8 Oka et al 9 published a case report describing a 74-year-old woman with rheumatoid arthritis presenting with recurrent CTS and progressive palmar swelling 6 months after a prior decompression.…”

Section: Discussionmentioning

confidence: 99%

“…After surgical decompression, the carpal tunnel has demonstrated morphologic changes to its size and shape. 3 Changes to the width of the carpal arch and the volume of the carpal tunnel have been reported; however, little research has identified any biomechanical consequences that may arise after releasing the TCL. 3 In a biomechanical study, the carpal arch has been shown to remain stable after isolated TCL excision; however, when combined with release of at least one palmar intercarpal ligament a gross instability can be created.…”

Section: Discussionmentioning

confidence: 99%

“…Biomechanical studies have demonstrated differential stresses throughout the intercarpal joints and biomechanical changes in hand musculature after release. 3 Further reviews of the literature have described increased laxity of the proximal carpal bones after decompression. 4 The consequences of the altered wrist mechanics on carpal stability and arthritic wear is not well researched.…”

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confidence: 99%

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Volar Lunate Dislocation Causing Secondary Carpal Tunnel Syndrome: A Case Report

Gabig,

Cooke,

Roundy

et al. 2023

J Wrist Surg

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Background Failure of carpal tunnel release is an uncommon occurrence with unique pathologies that may impede proper diagnosis and treatment. Symptoms are most often attributed to an inadequate release of the transverse carpal ligament or pathologic scar tissue resultant of the primary decompression. Case Description In this report, we describe the case of a 79-year-old male with a history of scaphoid lunate advanced collapse and a prior carpal tunnel decompression presenting with worsening right wrist function and new right palmar mass. The patient had no significant antecedent trauma, and clinical workup revealed volar dislocation of the lunate. After failed conservative treatment and multiple ultrasound-guided corticosteroid injections, the patient was successfully treated surgically with carpal tunnel release, tenosynovectomy, and lunate excision. Literature Review Volar lunate dislocation without a traumatic mechanism is rare. Progressive carpal destabilization and volar subluxation is not a commonly reported cause of secondary carpal tunnel symptoms. Isolated reports in the literature have been published with nearly identical presentations. Kamihata et al reported a patient, with a history of carpal tunnel decompression, presenting with numbness and tingling in her right hand without traumatic injury. A displaced lunate was found to abut the flexor tendons and median nerve. Ott et al further reported an atraumatic lunate dislocation and palmar swelling 4 weeks after a carpal tunnel release. Clinical Relevance In the setting of existing arthritic degeneration, carpal tunnel release may destabilize the carpus and predispose patients to carpal dislocation. Further research is required to understand the risks associated with this instability leading to lunate dislocations secondary to carpal tunnel release.

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