Practical anatomy of the carpal tunnel

Area of Science:

• Anatomy
• Surgical Anatomy
• Orthopedic Surgery

Background:

• The carpal tunnel's narrowest point is at the hamate hook, with the median nerve as the most superficial structure.
• Understanding the spatial relationships between the median nerve, ulnar bursa, flexor tendons, and surgical instruments is vital.
• Topographical landmarks are essential for accurate surgical approaches.

Purpose of the Study:

• To review the anatomy of the carpal tunnel and surrounding structures.
• To emphasize the clinical applications of this anatomy in endoscopic and open carpal tunnel release surgery.
• To highlight the importance of anatomical knowledge for surgical success and complication avoidance.

Main Methods:

• Detailed review of anatomical structures within and surrounding the carpal tunnel.
• Emphasis on topographical landmarks, including the hook of the hamate and thenar branch of the median nerve.
• Discussion of the transverse carpal ligament, its layers, and adjacent structures.

Main Results:

• The ring finger axis is a key landmark for surgical planning.
• A distinct fascial layer palmar to the transverse carpal ligament can be preserved to maintain pinch strength.
• Variations in median nerve branching and potential injury sites during surgery were identified.

Conclusions:

• Thorough anatomical knowledge of the carpal tunnel is essential for safe and effective endoscopic and open carpal tunnel release.
• Accurate identification of structures and their relationships minimizes surgical complications.
• Optimal patient outcomes depend on a surgeon's precise understanding of carpal tunnel anatomy.