T. Tanabe et I. Okutsu, AN ANATOMICAL STUDY OF THE PALMAR LIGAMENTOUS STRUCTURES OF THE CARPAL CANAL, Journal of hand surgery. British volume, 22B(6), 1997, pp. 754-757
To determine which structures should be divided for complete release o
f the carpal canal, we studied the palmar structures in 12 embalmed an
d eight fresh cadaveric hands. In all hands, fibres run transversely b
etween the thenar and hypothenar facia, distal to the flexor tetinacul
um in a layer separate from it. In fresh cadaveric hands, we first rel
eased only the flexor retinaculum as in endoscopic management of carpa
l tunnel syndrome and then these distal fibres. When the flexor retina
culum was released, the mean distance between the sectioned ends of th
e flexor retinaculum was 1.3 mm. When the distal fibres were also divi
ded, the mean distance was 6.6 mm. We conclude that release of both th
e flexor retinaculum and the distal transversely running fibres is ess
ential for complete release of the carpal canal in endoscopic surgery.