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The Scientific World Journal
Volume 2013, Article ID 630617, 4 pages
Research Article

Transverse Carpal Ligament and Forearm Fascia Release for the Treatment of Carpal Tunnel Syndrome Change the Entrance Angle of Flexor Tendons to the A1 Pulley: The Relationship between Carpal Tunnel Surgery and Trigger Finger Occurence

1Department of Orthopaedics and Traumatology, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
2Department of Orthopaedics and Traumatology, Konya Beyhekim State Hospital, 42100 Selçuklu, Konya, Turkey
3Department of Orthopaedics and Traumatology, Konya Meram Medical Training and Research Hospital, Konya, Turkey
4Geodesy and Photogrammetry Engineering Department, Engineering and Architecture Faculty, Selçuk University, Konya, Turkey
5Private Konya Medicana Hospital, Department of Orthopaedics and Traumatology, Konya, Turkey

Received 20 April 2013; Accepted 4 June 2013

Academic Editors: D. Sakai and Y. K. Tu

Copyright © 2013 Nazım Karalezli et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. The appearance of trigger finger after decompression of the carpal tunnel without a preexisting symptom has been reported in a few articles. Although, the cause is not clear yet, the loss of pulley action of the transverse carpal ligament has been accused mostly. In this study, we planned a biomechanical approach to fresh cadavers. Methods. The study was performed on 10 fresh amputees of the arm. The angles were measured with (1) the transverse carpal ligament and the distal forearm fascia intact, (2) only the transverse carpal ligament incised, (3) the distal forearm fascia incised to the point 3 cm proximal from the most proximal part of the transverse carpal ligament in addition to the transverse carpal ligament. The changes between the angles produced at all three conditions were compared to each other. Results. We saw that the entrance angle increased in all of five fingers in an increasing manner from procedure 1 to 3, and it was seen that the maximal increase is detected in the middle finger from procedure 1 to procedure 2 and the minimal increase is detected in little finger. Discussion. Our results support that transverse carpal ligament and forearm fascia release may be a predisposing factor for the development of trigger finger by the effect of changing the enterance angle to the A1 pulley and consequently increase the friction in this anatomic area. Clinical Relevance. This study is a cadaveric study which is directly investigating the effect of a transverse carpal ligament release on the enterance angle of flexor tendons to A1 pulleys in the hand.