Thickness and Stiffness Adaptations of the Transverse Carpal Ligament Associated With Carpal Tunnel Syndrome

Marquardt, Tamara L.; Gabra, Joseph N.; Evans, Peter; Seitz, William H.; Li, Zong Ming

doi:10.1142/s0218957716500196

Cited by 20 publications

(16 citation statements)

References 45 publications

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“…Carpal tunnel syndrome (CTS) is a common complaint causing hand disability in people of working age [1][2][3]. CTS is suggested to be caused by compression of the median nerve in the carpal tunnel under the transverse carpal ligament due to thickening of the ligament or other structures surrounding the median nerve [4,5]. In the chronic condition, compression and irritation of the median nerve is followed by tingling, numbness, and pain in the innervation area of the median nerve.…”

Section: Introductionmentioning

confidence: 99%

Use of conservative therapy before and after surgery for carpal tunnel syndrome

Multanen

Uimonen

Repo

et al. 2021

BMC Musculoskelet Disord

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Background Conservative therapies are typically offered to individuals who experience mild or intermittent symptoms of carpal tunnel syndrome (CTS) or postoperatively to subjects who have undergone carpal tunnel release. Although long-term studies report mostly positive results for carpal tunnel release, knowledge on the need for conservative treatments following surgery is scarce. The aim of this retrospective cohort study was to examine the use of conservative therapies before and after carpal tunnel releasing surgery. Methods Of 528 patients who underwent carpal tunnel release surgery in the study hospital during the study period, 259 provided sufficiently completed questionnaires (response rate 49 %). The patients completed a questionnaire battery including a sociodemographic, medical history and symptom questionnaire, the Boston Carpal Tunnel Syndrome Questionnaire, 6-item CTS symptoms scale and EuroQoL 5D. Frequencies of conservative therapies pre- and postoperatively were calculated. Association between Pain VAS and satisfaction with treatment were examined in patient groups according to the use of conservative therapies. Results Of all patients, 41 (16 %) reported receiving only preoperative, 18 (7 %) reported receiving only postoperative, 157 (60 %) reported receiving both pre- and postoperative conservative therapies and 43 (17 %) did not receive any therapies. Preoperative use of conservative therapies was more common in females than males (82 % vs. 64 %; p = 0.002), but postoperatively no significant gender difference was observed. The patients who received conservative therapies were younger than non-users in both the preoperative (median age 59 vs. 66; p < 0.001) and postoperative (59 vs. 66; p = 0.04) phases. The patients reported high satisfaction with their treatment and simultaneous improvement in Pain VAS scores. Those receiving conservative therapies only preoperatively reported the highest satisfaction. Conclusions While the use of conservative therapies decreased after surgery, a large proportion of the patients received these adjunct interventions. Patients reported high satisfaction with their treatment one year post surgery. Pain outcome seems to be closely related to satisfaction with treatment. Level of Evidence Level III.

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Section: Introductionmentioning

confidence: 99%

Use of conservative therapy before and after surgery for carpal tunnel syndrome

Multanen

Uimonen

Repo

et al. 2021

BMC Musculoskelet Disord

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“…The TCL may become thicker and stiffer in response to repetitive muscle-ligament interaction during thumb activities (Mhanna et al, 2016), leading to a more restrictive carpal tunnel and abnormal compression of the median nerve. Indeed, it has been shown that carpal tunnel syndrome is associated with TCL hypertrophy (John et al, 1983;Marquardt et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, mechanobiological responses due to repetitive muscle-ligament interaction could alter the material properties of the ligament (Magnusson, Narici, Maganaris, & Kjaer, 2008;Woo, Gomez, Woo, & Akeson, 1982), leading to increases in TCL thickness and stiffness (Mhanna, Marquardt, & Li, 2016). Changes to the TCL's material properties have been suggested as a possible etiology for CTS (John, Nau, Nahser, Reinhardt, & Venjakob, 1983;Marquardt, Gabra, Evans, Seitz, & Li, 2016). Finally, transecting the TCL as a surgical treatment for carpal tunnel syndrome unavoidably disrupts the muscle-ligament structure and function, which may explain postoperative complications such as weakened grip strength (Brooks, Schiller, Allen, & Akelman, 2003;Fuss & Wagner, 1996).…”

Section: Introductionmentioning

confidence: 99%

Biometry of thenar muscle origins on the flexor retinaculum

Loss

2020

Clinical Anatomy

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The transverse carpal ligament (TCL), the main part of the flexor retinaculum, serves as an anchor for the thenar muscles: abductor pollicis brevis (APB), superficial head of the flexor pollicis brevis (sFPB), and opponens pollicis (OPP). Biomechanically, the thenar muscles rely on their TCL anchoring to transmit muscle contractions distally for thumb force and motion production, and reciprocally, muscle contraction interacts with the TCL at the proximal end through the origins. However, scarce knowledge exists regarding the distribution pattern of the thenar muscle origins. The purpose of this study was to understand the anatomical interface between the thenar muscles and TCL by examining the origin distributions of the individual muscles. Ten cadaveric specimens were dissected for digitization of the muscle origins and TCL volar surface. Digitized data were used for mesh reconstruction and calculation of surface areas and centroids. The origin areas for APB, sFPB, and OPP were 105.8 ± 30.3, 64.6 ± 15.2, and 245.9 ± 70.7 mm 2 , respectively. The surface area of the TCL was 386.2 ± 86.9 mm 2. The origin areas of APB and OPP on the TCL were comparable, 18.4 ± 4.8% and 17.3 ± 9.6% of the TCL area, respectively. The origin locations for APB, sFPB, and OPP were in proximal-radial quadrant of the TCL, on distal aponeurosis outside the TCL, and around the ridge of trapezium, respectively. The knowledge of the anatomical interface provides a foundation for the understanding of biomechanical interactions between the muscles and ligaments and pathomechanical implications.

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“…Studies of TCL stiffness adaptation (Marquardt et al, 2016) and released carpal tunnel by TCL dissection (Kim et al, 2013) suggest that the change in TCL mechanical property might affect the compliance of carpal tunnel potentially contributing or alleviating median nerve compression. The TCL mechanical property manipulation could also be achieved by injecting collagenase reducing ligament stiffness by over 50% after 3-hour treatment (Prantil et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

“…The mechanical environment of the carpal tunnel is the main determinant for compression neuropathy of the median nerve. Increases in tissue thickness and stiffness of the TCL have been shown in patients with carpal tunnel syndrome (Miyamoto et al 2013; Marquardt et al, 2016), suggesting the etiological mechanisms of the neuropathy. The mechanical role of the TCL in median nerve compression is also illustrated by carpal tunnel release surgery, in which the TCL is transected to reduce the mechanical constraint of the carpal tunnel as a means of nerve decompression.…”

Section: Introductionmentioning

confidence: 99%

Finite element analysis for transverse carpal ligament tensile strain and carpal arch area

Yao

Erdemir

2018

Journal of Biomechanics

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Mechanics of carpal tunnel soft tissue, such as fat, muscle and transverse carpal ligament (TCL), around the median nerve may render the median nerve vulnerable to compression neuropathy. The purpose of this study was to understand the roles of carpal tunnel soft tissue mechanical properties and intratunnel pressure on the TCL tensile strain and carpal arch area (CAA) using finite element analysis (FEA). Manual segmentation of the thenar muscles, skin, fat, TCL, hamate bone, and trapezium bone in the transverse plane at distal carpal tunnel were obtained from B-mode ultrasound images of one cadaveric hand. Sensitivity analyses were conducted to examine the dependence of TCL tensile strain and CAA on TCL elastic modulus (0.125-10 MPa volar-dorsally; 1.375-110 MPa transversely), skin-fat and thenar muscle initial shear modulus (1.6-160 kPa for skin-fat; 0.425-42.5 kPa for muscle), and intratunnel pressure (60-480 mmHg). Predictions of TCL tensile strain under different intratunnel pressures were validated with the experimental data obtained on the same cadaveric hand. Results showed that skin, fat and muscles had little effect on the TCL tensile strain and CAA changes. However, TCL tensile strain and CAA increased with decreased elastic modulus of TCL and increased intratunnel pressure. The TCL tensile strain and CAA increased linearly with increased pressure while increased exponentially with decreased elastic modulus of TCL. Softening the TCL by decreasing the elastic modulus may be an alternative clinical approach to carpal tunnel expansion to accommodate elevated intratunnel pressure and alleviate median nerve compression neuropathy.

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Thickness and Stiffness Adaptations of the Transverse Carpal Ligament Associated With Carpal Tunnel Syndrome

Cited by 20 publications

References 45 publications

Use of conservative therapy before and after surgery for carpal tunnel syndrome

Use of conservative therapy before and after surgery for carpal tunnel syndrome

Biometry of thenar muscle origins on the flexor retinaculum

Finite element analysis for transverse carpal ligament tensile strain and carpal arch area

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