Transverse Carpal Ligament

Sucher BM, Hinrichs RN. Manipulative treatment of carpal tunnel syndrome biomechanical and osteopathic intervention to increase the length of the transverse carpal ligament. J Am Osteopath Assoc 1998 98 679-686. 

The wrist is crossed by flexor and extensor tendons which course along its ventral and dorsal aspects respectively. Among them, nine flexor tendons and nine extensor tendons move toward the fingers without any attachment to the carpal bones two primary wrist flexors and three wrist extensors insert onto the distal carpal row and the metacarpals and one tendon, the palmaris longus tendon, attaches to the transverse carpal ligament and to the palmar aponeurosis. 

The palmaris longus tendon is a long thin tendon which passes in the midline and superficial to the transverse carpal ligament (Fig. 10.5). Distally, it splits into diverging bundles which intermingle with... 

Fig. 10.31a,b. Median nerve beyond the carpal tunnel, a Transverse 12-5 MHz US image obtained beyond the distal edge of the transverse carpal ligament with b gross anatomic correlation reveals the division of the main trunk of the median nerve (MN) into three branches (1,2, 3), the common palmar digital nerves... 

The Guyon tunnel is located in a medial and superficial position relative to the carpal tunnel. It is delimited hy the dorsal aspect of the transverse carpal ligament and the superficial palmar carpal ligament on the radial side, and hy the lateral aspect of the pisiform on the ulnar side. The transverse carpal ligament and the pisiform are easily detected with US. On the contrary, the superficial palmar carpal ligament is very thin and difficult to visualize. Once the curvilinear shape of the pisiform is found, care should he taken to identify the ulnar... 

Fig. 10.54 a,b. Carpal tunnel syndrome in tenosynovitis of flexor tendons. Same case as illustrated in Fig. 10.53. a,b Transverse 12-5 MHz US images obtained a at the distal radius and b at the proximal carpal tunnel level. Note that an abundant anechoic effusion (asterisks) in the sheath of flexor tendon (ft) is better demonstrated at the distal radius rather than inside the carpal tunnel. This finding is related to a lesser degree of sheath compliance within the restricted space of the tunnel. In b, carpal tunnel disease is mostly indicated by the abnormal bulging of the transverse carpal ligament (arrowheads). MN, median nerve... 

Fig.l0.91a,b. Schwannoma of the median nerve, a Longitudinal reconstructed and b transverse 10-5 MHz US images over the carpal tunnel demonstrate an elongated hypoechoic mass (arrows) in continuity with the median nerve (MN) in a patient presenting with soft-tissue swelling over the ventral wrist and mild symptoms related to carpal tunnel disease. The bulk of the tumor develops proximal to the transverse carpal ligament sparing some fascicles of the nerve (arrowheads), ft, flexor tendons I, lunate R, radius... 

The thenar muscles are innervated by the recurrent branch of the median nerve and are basically responsible for the complex movement of the thumb. They include the superficial abductor pollicis brevis, the flexor pollicis brevis and the deep opponens pollicis muscles. The abductor pollicis brevis is a broad flat muscle located on the more lateral side of the thenar eminence. It arises from the radial side of the transverse carpal ligament and the tubercle of the trapezium and inserts into the base of the proximal phalanx. The flexor pollicis brevis is located medial to the abductor pollicis and has two muscular bellies the superficial head arises from the transverse carpal ligament and the tubercle of the trapezium, the deep head (first palmar interosseous muscle) from the trapezoid and the capitate. Both heads insert through the radial sesamoid over the metacar-... 

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