Morphological analysis of the transverse carpal ligament

Transection of the transverse carpal ligament (TCL) for carpal tunnel syndrome is commonly performed, yet actual knowledge of TCL morphology is rudimentary and the anatomical terminology is inconsistently used. The purpose of this study was to perform a morphological analysis of the TCL, to redefine the anatomical terminology concerning the TCL and surrounding structures, and to evaluate any correlation between external, measurable hand dimensions, and TCL dimensions. A silicone casting technique and digitization were employed to measure the morphology of the TCL in cadaveric specimens and to construct a three-dimensional TCL model. The TCL was the thickest distally at the midline and ulnar segments and the thickest proximally at the radial segment. External hand dimensions did not significantly correlate with TCL dimensions. The TCL thickness distribution is variable along the radioulnar axis. The thickness of the TCL was 2.1 ± 0.8 mm, ranging from 1.3 to 3.0 mm.