-Original-

Three-dimensional Analysis of the Attachment and Path of the Transverse Carpal Ligament

Mitsuhiko Nanno¹, Takuya Sawaizumi², Norie Kodera², Yuji Tomori² and Shinro Takai²

¹Department of Orthopaedic Surgery, Nippon Medical School Musashi Kosugi Hospital
²Department of Orthopaedic Surgery, Nippon Medical School

Purpose: The purpose of this study was to describe and evaluate the detailed anatomic locations and areas of ligamentous attachments and paths of the transverse carpal ligament (TCL) on a three-dimensional (3-D) surface model.
Methods: Ten fresh-frozen cadaver wrists were used to dissect and identify the TCL. Their ligament attachments and whole bone surfaces were digitized three-dimensionally and their areas evaluated. The attachments of each ligament were represented in a model combining CT surfaces overlaid by a digitized 3-D surface, and were also visually depicted with a different color for each on 3-D images of the bones.
Results: The TCL was found to be composed of two or three discrete ligaments. Both the trapezium-hook of hamate ligament and the trapezium-pisiform ligament were identified in all ten specimens. The scaphoid-pisiform ligament was found in only two of the ten specimens. The average areas of the attachments of the TCL were 42.7 mm² on the trapezium, 30.0 mm² on the hook of hamate, 21.6 mm² on the pisiform, and 12.7 mm² on the scaphoid.
Conclusions: The anatomic 3-D attachment sites of the TCL were visually shown qualitatively, and their areas quantified. This 3-D information offers further knowledge and understanding of the anatomy and biomechanics of the TCL. It could also help in the accurate assessment of radiographic images and treatment of various wrist injuries and diseases when performing such procedures as carpal tunnel release, Guyon's canal release, trapeziectomy, hook of hamate excision, or arthroscopy.

J Nippon Med Sch 2015; 82: 130-135

Keywords
anatomy, attachment, transeverse carpal ligament, carpal tunnel, hand

Correspondence to
Mitsuhiko Nanno, Department of Orthopaedic Surgery, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan
nanno-mi@ga2.so-net.ne.jp

Received, October 28, 2014
Accepted, February 17, 2015