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Increased Compliance of the Carpal Tunnel after Carpal Tunnel Release
Dong Hee Kim, MD; Tamara L. Marquardt; Joseph N. Gabra; Zhilei Liu Shen; Peter J. Evans; William H. Seitz; Zong-Ming Li; Cleveland Clinic
Cleveland Clinic, Cleveland, OH, USA


The purpose of this study was to investigate the morphologic changes of a released carpal tunnel in response to variations of carpal tunnel pressure. Pressure within the carpal tunnel is known to be elevated in patients with carpal tunnel syndrome and dependent on wrist posture. Previously, increased carpal tunnel pressure has been shown to affect the morphology of the carpal tunnel with an intact transverse carpal ligament. However, the pressure-morphology relationship of the carpal tunnel after carpal tunnel release has not been explored.

Materials & Methods

In this study, endoscopic carpal tunnel release was performed on cadaveric hand specimens after the carpal tunnel contents were removed. The carpal tunnel pressure was dynamically increased through the infusion of water from 10 to 120 mmHg. Simultaneously, carpal tunnel cross-sectional images were captured by an ultrasound system (Figure 1) and pressure measurements were recorded by a pressure transducer.


Figure1.Ultrasound images of the transected TCL (dotted line) at 10 mmHg (A) and 120 mmHg (B)


It was found that carpal tunnel pressure significantly affected carpal arch area (p<0.001), with an increase of more than 62 mm2 at a pressure of 120 mmHg (Figure 2). Carpal arch height, length, and width were also found to significantly change with carpal tunnel pressure (p<0.05).  As carpal tunnel pressure increased, carpal arch height and length increased, but the carpal arch width decreased.

Figure 2. Relative change of the carpal arch area at different pressures


Analyses of the pressure-morphology relationship for a released carpal tunnel revealed a 9 times greater compliance than that previously reported for a carpal tunnel with an intact transverse carpal ligament. This decrease in stiffness was likely due to the separation of the edges of the transected transverse carpal ligament as pressure increased. The relative increase in carpal tunnel compliance after release may be a contributing factor that relieves the carpal tunnel pressure in patients with carpal tunnel syndrome.

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