Carpal tunnel neuropathy caused by injury: reconstruction of the transverse carpal ligament for the complex carpal tunnel syndromes.

A comprehensive surgical and therapy program for the management of carpal tunnel neuropathy caused by injury has been proposed. The program is based on the restoration of the gliding interface between the median nerve trunk, the flexor tendons of the fingers, and the inner gliding surface of the transverse carpal ligament. The development of these new gliding surfaces is achieved by a surgery program of circumferential mesoepineurolysis of the median nerve in the hand and wrist followed by an anatomic reconstruction of the transverse carpal ligament. This biologic process is completed by a postoperative program of immediate hand function and median nerve gliding. Three hundred consecutive surgical patients were studied to confirm that the elastic mobilization of the median nerve actually doubled after a comprehensive nerve mobilization, thus supporting the ligament closure and early nerve gliding. Patients who have been available for repeat electromyographic (EMG) study at four to six months show EMG improvement that supports the clinical improvement. Finally, mobilization of the median nerve as described in the study has shown nerve revascularization within 30 seconds after tourniquet release and biologic recovery signals in the postoperative nerve gliding period and has proven to be, from the nerve nutrition standpoint, a safe procedure. The reliability that has been achieved in median nerve recovery is due to the anatomic reconstruction of the entire transverse carpal ligament. This surgical technique has proven to be the step necessary to produce a symbiotic alignment of the median nerve and the flexor tendon gliding anatomy.(ABSTRACT TRUNCATED AT 250 WORDS)