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Three-Dimensional Carpal Kinematics after Carpal Tunnel Release
Jonathan R Schiller1, Jeffrey J Brooks2, P Kaveh Mansuripur1
1Department of Orthopaedics, Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Journal of Wrist Surgery
|July 29, 2016
Summary
Carpal tunnel release (CTR) significantly alters wrist bone movement, increasing carpal arch width and causing rotation, particularly on the ulnar side. These kinematic changes may explain common postoperative issues like pain and reduced grip strength.
Area of Science:
- Orthopedics
- Biomechanics
- Anatomy
Background:
- Carpal tunnel release (CTR) is known to alter carpal arch morphology.
- The specific impact of CTR on the three-dimensional (3D) kinematics of carpal bones remains under-investigated.
Purpose of the Study:
- To investigate whether surgical release of the transverse carpal ligament (TCL) affects the 3D kinematics of the carpus.
- Focus on the bony attachments of the TCL.
Main Methods:
- In vitro analysis of five fresh-frozen cadaveric wrists.
- 3D computed tomography (CT) was used to assess carpal kinematics before and after CTR.
- Kinematics were evaluated in neutral, 60° flexion, and 60° extension positions.
Main Results:
- CTR significantly increased carpal arch width between the trapezium and hamate across all tested positions.
- The trapezium-hamate distance showed both translational and rotational increases post-CTR.
- The pisiform demonstrated significant rotation away from the triquetrum following TCL release.
Conclusions:
- Carpal kinematics are significantly altered by carpal tunnel release, with notable changes on the ulnar side.
- While subtle, these kinematic shifts may have clinical implications, potentially contributing to pillar pain or decreased postoperative grip strength.
