The flexor retinaculum (transverse carpal ligament) forms the roof of the carpal tunnel, converting the carpal groove into the carpal tunnel through which nine flexor tendons and the median nerve pass. Carpal tunnel syndrome from median nerve compression under the retinaculum is the most common entrapment neuropathy, affecting 3-6% of the adult population.
Maintains the carpal tunnel contents; acts as an origin for the thenar and hypothenar intrinsic muscles; the carpal tunnel roof
Carpal tunnel release — division of the flexor retinaculum — is the most commonly performed orthopaedic procedure. Endoscopic (single or dual portal) and open techniques achieve comparable outcomes. The safe division line is ulnar to the ring finger ray axis to avoid the recurrent motor branch of the median nerve. Post-release pillar pain over the divided ligament edges resolves by 6-12 weeks.
Median nerve compression under the flexor retinaculum producing nocturnal hand paraesthesia and thenar wasting managed with splinting, injection, and carpal tunnel release.
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