# A scoping review of the impact of transverse carpal ligament sectioning on the thumb carpometacarpal joint: Does it increase the risk of ostearthritis?

## TL;DR

This review examines if cutting the transverse carpal ligament during surgery increases the risk of thumb joint arthritis by changing hand biomechanics.

## Contribution

The study provides a scoping review of biomechanical effects of carpal tunnel release on the thumb joint and its potential link to arthritis.

## Key findings

- CTR leads to morphologic and biomechanical changes in the carpal arch.
- Changes in carpal arch configuration may increase ligamentous stress and accelerate ligamentous laxity.
- Altered force distribution around the trapezium could contribute to articular wear and thumb CMC pain.

## Abstract

We aimed to review the effects of carpal tunnel ligament sectioning on the thumb carpometacarpal (CMC) joint with the hypothesis that carpal tunnel release (CTR) may result in biomechanical changes at the thumb CMC joint predisposing an individual to pain and or accelerated articular wear.

This review was performed using the Pubmed and Medline databases from January 1, 1970 to January 7, 2023. Articles that examine the thumb CMC joint after CTR were categorized as cadaveric, clinical, or computational studies. The anatomy, pathophysiology, and treatment of both CMC arthritis and carpal tunnel syndrome (CTS) were included to provide context for our results. These studies were synthesized to describe the effects of CTR on the thumb CMC joint.

The search resulted in 1093 articles for possible inclusion. After screening abstracts and removing duplicates, 48 articles were included in this review. Common themes from this review include: widening and differences in configuration of the carpal arch following CTR, and changes in the positioning and movement of the carpal bones—leading to differences in the forces and contact stressors across articulations. We also review how these changes may lead to thumb CMC pain and could contribute to articular wear.

There are morphologic and biomechanical changes that occur across the carpal arch after CTR. These changes may be associated with differences in intrinsic hand muscle function, increased ligamentous stress, and accelerated ligamentous laxity - leading to alterations in the distribution of force around the trapezium and to its articular cartilage.