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01.12.2016 | Research article | Ausgabe 1/2016 Open Access

Journal of Orthopaedic Surgery and Research 1/2016

Changes in carpal tunnel compliance with incremental flexor retinaculum release

Journal of Orthopaedic Surgery and Research > Ausgabe 1/2016
Rubina Ratnaparkhi, Kaihua Xiu, Xin Guo, Zong-Ming Li
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

KX, XG, and ZML designed the experiment; XG completed data collection; RR, KX, XG, and ZML participated in data analysis. All authors (RR, KX, XG, and ZML) participated in data interpretation and manuscript writing. All authors have read and approved the final submitted manuscript.



Flexor retinaculum transection is a routine surgical treatment for carpal tunnel syndrome, yet the biomechanical and clinical sequelae of the procedure remain unclear. We investigated the effects of flexor retinaculum release on carpal tunnel structural compliance using cadaveric hands.


The flexor retinaculum was incrementally and sequentially released with transections of 25, 50, 75, and 100 % of the transverse carpal ligament, followed by the distal aponeurosis and then the antebrachial fascia. Paired outward 10 N forces were applied to the insertion sites of the transverse carpal ligament at the distal (hamate-trapezium) and proximal (pisiform-scaphoid) levels of the carpal tunnel. Carpal tunnel compliance was defined as the change in carpal arch width normalized to the constant 10 N force.


With the flexor retinaculum intact, carpal tunnel compliance at the proximal level, 0.696 ± 0.128 mm/N, was 13.6 times greater than that at the distal level, 0.056 ± 0.020 mm/N. Complete release of the transverse carpal ligament was required to achieve a significant gain in compliance at the distal level (p < 0.05). Subsequent release of the distal aponeurosis resulted in an appreciable additional increase in compliance (43.0 %, p = 0.052) at the distal level, but a minimal increase (1.7 %, p = 0.987) at the proximal level. Complete flexor retinaculum release provided a significant gain in compliance relative to transverse carpal ligament release alone at both proximal and distal levels (p < 0.05).


Overall, complete flexor retinaculum release increased proximal compliance by 52 % and distal compliance by 332 %. The increase in carpal tunnel compliance with complete flexor retinaculum release helps explain the benefit of carpal tunnel release surgery for patients with carpal tunnel syndrome.
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