Flexor Retinaculum of The Hand - Clinical Significance

Clinical Significance

In carpal tunnel syndrome, inflammation of one of the nine tendons passing through the carpal tunnel causes pressure against the flexor retinaculum. However, the flexor retinaculum, being a sheath of tough connective tissue, has very limited stretching capabilities and is unable to accommodate the space necessary to relieve such pressure. Due to this increased pressure with no room to expand against either the bones of the wrist or the flexor retinaculum, the median nerve is ultimately compressed, resulting in the symptoms of carpal tunnel syndrome.

In treating carpal tunnel syndrome with surgical intervention (usually done after all non-surgical methods of treatment have been exhausted), the flexor retinaculum is always the structure targeted to relieve pressure in the carpal tunnel. In these surgeries, the flexor retinaculum is either simply severed or it is lengthened. When surgery is done to divide the flexor retinaculum (which is by far the more common procedure), scar tissue will eventually fill the gap left by surgery. The intent is that this will lengthen the flexor retinaculum enough to accommodate inflamed or damaged tendons and reduce the effects of compression on the median nerve. In a 2004 double blind-study, researchers concluded that there was no perceivable benefit gained from lengthening the flexor retinaculum during surgery and so division of the ligament remains the preferred method of surgery.