Transverse carpal ligament reconstruction in surgery for carpal tunnel syndrome: a new technique

We present a two-year follow-up of a technique to reconstruct the transverse carpal ligament in surgery for carpal tunnel syndrome. The transverse carpal ligament is exposed through a four to five centimeter palmar incision in line with the axis of the ring finger. The ligament is divided in step-wise fashion, creating a distal radially-based flap and a proximal ulnarly-based flap. The apices of these flaps are approximated, lengthening the ligament six to ten millimeters. All seventy-three patients (one hundred-four hands) reported substantial improvement with 93% having complete resolution of symptoms. Ninety-seven percent returned to work (average disability, two months). There were no recurrences or significant operative complications. In those with unilateral reconstruction (60%), there was no diminution in grip strength (p less than 0.05). This technique of transverse carpal ligament reconstruction stabilizes the transverse carpal arch, provides protection to the median nerve, prevents bowstringing of the flexor tendons, and maximizes postoperative grip strength.