Transverse stability of the carpus. An analytical study

Abstract

The stabilizing structures of the transverse carpal arch were studied utilizing an analytical model based on a rigid body spring model theory. This method was used to calculate the relative motion between carpal bones, the distribution of compressive forces in the intercarpal joints, and the tensions in the ligaments under simulated dorsopalmar compression. The contribution of each ligament against the effect of compression was determined by removing ligaments from the model. A multivariate analysis of variance disclosed that sectioning the flexor retinaculum alone does not significantly modify the distribution of forces in ligaments and joints (p = 0.33), and decreases dorsopalmar carpal stiffness by only 7.8%. In contrast, isolated removal of the palmar hamate-capitate ligament causes a pronounced weakening of the carpal structure, from an average of 232 to 131 N/mm (p less than 0.01). If the flexor retinaculum is removed in addition to releasing one palmar intercarpal ligament, a gross instability of the carpal arch is created.

Load Transmission Through the Wrist in the Extended Position

“…25 Garcia-Elias et al also theoretically and experimentally investigated the biomechanical importance of these ligaments. 26,27 They simulated compression-type injuries to the carpus, whereas our simulation was conducted assuming injuries in the extended position. Although conditions differed, both studies confirmed the importance of palmar intercarpal ligaments for the carpal arch.…”

Biomechanics of the transverse carpal arch under carpal bone loading

“…These treatment and intervention strategies mainly rely on the understanding of the mechanical properties of carpal tunnel. Few studies have been designed to address the basic biomechanics of the carpal tunnel (Garcia-Elias et al, 1989a, Garcia-Elias et al, 1989b, Fuss and Wagner, 1996). The understanding of carpal tunnel mechanics helps to improve the existing strategies and to develop alternatives for the treatment of carpal tunnel syndrome.…”

Bilateral Ulnar Neuropathy Secondary to Volar Displacement of Flexor Tendons Following Open Carpal Tunnel Release: Case Report

“…4,5 Division of the transverse carpal ligament changes the anatomy by increasing the carpal arch width, increasing the carpal tunnel volume, and changing the tendon mechanics. 6 Without the transverse ligament retaining the flexor tendons, the tendons may displace volarly.…”