Preliminary Assessment of Pisotriquetral Joint Kinematics Following Transverse Carpal Ligament Release: A Cadaveric Pilot Study

Introduction Transverse carpal ligament (TCL) release is the standard treatment for carpal tunnel syndrome; however, its potential to alter carpal biomechanics is unclear. Specifically, it has been hypothesized that TCL transection may destabilize the pisotriquetral (PT) joint or unmask latent arthritis. This pilot study investigated the immediate kinematic effects of TCL transection on the PT joint in an embalmed cadaveric model. Methods Six embalmed cadaveric wrists were mounted on a custom stabilization apparatus. Colored markers were affixed to the ulna, pisiform, and fourth metacarpal bones to track the motion vectors. Wrist kinematics were recorded via video analysis before and after complete TCL transection under simulated maximal flexor carpi ulnaris (FCU) contraction. Changes in wrist flexion, extension, and relative PT angle were quantified. Results In this cohort, TCL release did not result in statistically significant changes in kinematic parameters. The mean difference in wrist extension was -2.83° (95% CI: -9.72° to 4.05°; p = 0.34). The mean difference in wrist flexion was -2.84° (95% CI: -10.57° to 4.88°; p = 0.39). The PT angular relationship remained consistent pre- and post-release (mean difference: -0.01°; 95% CI: -2.84° to 2.82°; p = 0.99). Conclusions Within the limitations of a small sample size and embalmed tissue model, complete TCL release did not produce gross kinematic alterations in the PT joint. While these preliminary findings suggest that the intrinsic ligamentous stability of the pisiform is maintained post-release, larger studies utilizing fresh-frozen specimens are required to rule out subtle instability patterns that may contribute to postoperative ulnar-sided wrist pain.