AN ANATOMICAL STUDY OF THE PALMAR LIGAMENTOUS STRUCTURES OF THE CARPAL CANAL

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.