J Wrist Surg 2022; 11(02): 150-153
DOI: 10.1055/s-0041-1735887
Scientific Article

Thenar and Hypothenar Muscle Coverage on the Transverse Carpal Ligament

Farah Alsafar
1   Hand Research Laboratory, Department of Orthopaedic Surgery, University of Arizona College of Medicine, Tucson, Arizona
1   Hand Research Laboratory, Department of Orthopaedic Surgery, University of Arizona College of Medicine, Tucson, Arizona
› Author Affiliations
Funding This research was funded by NIH/NIAMS R01AR068278.


Background The purpose of the study was to examine the coverage of thenar and hypothenar muscles on the transverse carpal ligament (TCL) in the radioulnar direction through in vivo ultrasound imaging of the carpal tunnel. We hypothesized that the TCL distance covered by the thenar muscle would be greater than that by the hypothenar muscle, and that total muscle coverage on the TCL would be greater than the TCL-alone region.

Methods Ultrasound videos of human wrist were collected on 20 healthy subjects. Automated algorithms were used to extract the distal cross-sectional image of the trapezium-hamate level. Manual tracing of the anatomical features was conducted.

Results Thenar muscles covered a significantly larger distance (11.9 ± 1.8 mm) as compared with hypothenar muscles (1.7 ± 0.8 mm) (p < 0.001). The TCL covered by thenar and hypothenar muscles was greater than the TCL-alone length (p < 0.001). The thenar and hypothenar muscle coverage on the TCL, as normalized to the total TCL length, was 61.0 ± 7.5%.

Conclusions More than 50% of the TCL at the distal carpal tunnel is covered by thenar and hypothenar muscles. Knowledge of muscular attachments to the TCL improves our understanding of carpal tunnel syndrome etiology and can guide carpal tunnel release surgery.

Publication History

Received: 30 June 2021

Accepted: 03 August 2021

Article published online:
01 October 2021

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