Purpose
We sought to determine surgeon-pathologist agreement with respect to distinguishing
between a previously undivided transverse carpal ligament (TCL) and scar during revision
carpal tunnel release (CTR). Additionally, we aimed to describe the histologic findings
of the TCL and flexor tenosynovium during revision CTR.
Methods
All patients undergoing revision CTR for persistent or recurrent CTS by a single surgeon
between 2013 and 2019 were included. An intraoperative assessment was made as to the
presence of scar versus a previously undivided TCL by the surgeon. Two pathology specimens
(1 consisting of flexor retinaculum and 1 consisting of tenosynovium) were sent for
histopathological analysis with hematoxylin-eosin staining. The pathologist’s assessment
of the flexor retinaculum specimen was categorized as either “ligamentous” if a previously
undivided TCL was identified or “nonligamentous” if scar or any other tissue was identified.
The surgeon’s intraoperative assessment served as the reference standard when comparing
the histologic assessment.
Results
A total of 40 patients underwent 46 revision CTRs. The histologic assessment agreed
with the surgeon’s intraoperative assessment of a previously undivided TCL versus
a scar in 30 of 46 (65%) cases. In 12 of 46 (26%) revision cases, the surgeon determined
that there was a previously undivided TCL. In these 12 cases, the pathologist identified
a ligament 17% of the time.
Conclusions
Surgeon-pathologist agreement is low with respect to determining previously undivided
TCLs versus nonligamentous tissue in the setting of revision CTR. The results of this
investigation suggest that pathologists (with limited clinical information) have difficulty
confirming the clinical diagnosis of persistent CTS with previously unreleased TCL
when using routine hematoxylin-eosin staining. Routine biopsy of the TCL during revision
CTR may be of limited clinical utility, as it does not alter the diagnosis or management
in these cases.
Type of study/level of evidence
Diagnostic III.
Key words
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Article info
Publication history
Published online: September 18, 2021
Accepted:
July 16,
2021
Received:
January 3,
2021
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
