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Effects of simple section of transverse carpal ligament on intercarpal stability in carpal tunnel surgery

Hakan Gurbuz, Suleyman Semih Dedeoglu, Yunus Imren, Ali Cagrı Tekin, Mustafa Caglar Kir, Yasin Guler.

Abstract
The aim was to evaluate effects of simple section of transverse carpal ligament on intercarpal stability by radiological parameters in patients with carpal tunnel syndrome those are refractory to conservative treatment. Patients with suspected diagnosis of carpal tunnel syndrome upon medical history and physical examination underwent neurodiagnostic tests (EMG). All 47 subjects, comprising 39 female and 8 male patients, were operated, followed, and assessed by the same surgical team between January 2014 and May 2015 after written informed consent was obtained. Wrist range of motion and general physical examination findings were recorded at both preoperatively and postoperative week 8. Besides, conventional MRI were obtained at the same time points. Trapeziohamate distance, scaphopisiform distance, scapholunate angle, and carpal angle were measured preoperatively and at 12thweek postoperatively. The mean age of the subjects was 49(range: 36-65).Mean preoperative trapeziohamate distance was measured as 25.2 mm (range:20-33), while postoperative trapeziohamate distance was 26.4 mm (range:22-34), (p=0.031). Mean preoperative scaphopisiform distance was 32 mm (range:23-34), as compared to postoperative scaphopisiform distance being 33.6 mm (range:24- 36) (p=0.001). While mean scapholunate angle was 44°(range: 36-60) preoperatively, it was measured as 45.1° (range: 33-60) in the postoperative period (p=0.001). Both preoperative and postoperative mean carpal angles was 127° (range 118-134 and 119-134, respectively). Simple section of transverse carpal ligament is associated with a significant increase in carpal arch distance. We consider that whether or not increases in intercarpal distances may lead to a degenerative process at the wrist in future warrants further research.

Key words: Instability, carpal tunnel syndrome, magnetic resonance imaging, carpal bones



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