Article
Identification of the flexor retinaculum on the basis of superficial landmarks
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Published: | October 10, 2016 |
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Outline
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Objectives: The most common reason for persistence or recurrence of symptoms after carpal tunnel release (CTR) has proven to be incomplete division of the flexor retinaculum (FR) - a circumstance that may be traced back to inadequate visualisation of the ligament as during minimal incision techniques.
Therefore, the aim of our study was to project the borders of the FR onto superficial landmarks to enable the surgeon complete division of the FR with or without direct sight.
Methods: The study sample included 60 hands, gained from 51 human adult cadavers which had been embalmed using Thiel's method. We opted for the radial and the ulnar styloid processes as well as the radial margin of the ring finger at the palmar digital crease as the points of reference. The two styloid processes were linked by a horizontal line. Further, a longitudinal line was laid through the ring finger's radial side. Afterwards, these were intersected which resulted in the reference point "A" on the forearm. As the second basing point "B", the radial side of the ring finger at the palmar digital crease was chosen. Next, dissection and measurement of the FR was carried out with regard to the reference points. The taken measurements were converted to proportions with regard to the respective total length between point "A" and "B" alongside the longitudinal line through the radial side of the ring finger.
Results and Conclusion: The breadth of the FR covered 48% of this length. Its distal margin was located at 48% of this line, starting at the radial margin of the palmar digital crease of the ring finger and its proximal border began at a proportion of 96% with reference to the starting point at this length.
Our results indicate that the FR can be completely divided through dissection alongside the proximal half of our reference line.