Highlights
- •Carpal arch and median nerve morphology and position changed with wrist deviations.
- •Arch-nerve positioning relationship changed with wrist deviation.
- •Morphological and positional changes were dependent on wrist deviation directions.
- •Minimal changes were observed in deviations associated with dart-throwing motion.
- •Findings have implications for pathomorphological and pathokinematic changes.
Abstract
Background
Carpal tunnel and median nerve dynamically change with wrist motion. The purpose of
this study was to investigate the morphological changes and positional migration of
the carpal arch and median nerve, as well as nerve-arch positional relationship associated
with wrist deviation in healthy volunteers.
Methods
Twenty asymptomatic male volunteers performed wrist motion from neutral to deviated
positions combining flexion-extension and radioulnar deviation. Ultrasound images
of the carpal arch and median nerve at the distal carpal tunnel were collected during
wrist motion. Morphological and positional parameters of the carpal arch and median
nerve were derived from the ultrasound images.
Findings
Carpal arch height, area, and palmar bowing of the transverse carpal ligament (TCL)
increased with flexion related wrist motion and decreased with extension related motion
(P < 0.05). Arch width increased with radial flexion and decreased with extension and
ulnar extension (P < 0.05). Median nerve circularity increased with flexion and radial flexion but decreased
with extension, ulnar extension, and ulnar deviation (P < 0.05). Nerve centroid displaced ulnarly with radial deviation, radial flexion,
and radial extension and displaced radially with ulnar deviation, ulnar flexion, and
ulnar extension (P < 0.05). Nerve centroid displaced in the dorsal direction with flexion and radial
flexion, but in the palmar direction with extension (P < 0.05). Nerve-TCL distance increased with flexion related motion and decreased with
extension relation motion (P < 0.05).
Interpretation
The current study advances our understanding the effect of wrist motion on the carpal
tunnel and its contents, which has implications for pathomorphological and pathokinematic
changes associated with wrist disorders.
Keywords
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References
- Some biomechanical aspects of the carpal tunnel.J. Biomech. 1979; 12: 567-570
- An MRI evaluation of carpal tunnel dimensions in healthy wrists: implications for carpal tunnel syndrome.Clin. Biomech. 2006; 21: 816-825
- Clinical Mechanics of the Hand.Mosby Incorporated, 1999
- Use of sonography in carpal tunnel syndrome surgery.Neurol. Med. Chir. 2007; 47: 109-115
- In vivo radiocarpal kinematics and the dart thrower’s motion.JBJS. 2005; 87: 2729-2740
- Risk factors for carpal tunnel syndrome.Am. J. Epidemiol. 1990; 132: 1102-1110
- A histological and immunohistochemical study of the subsynovial connective tissue in idiopathic carpal tunnel syndrome.JBJS. 2004; 86: 1458-1466
- Dynamic changes of the transverse carpal arch during flexion-extension of the wrist: effects of sectioning the transverse carpal ligament.The Journal of hand surgery. 1992; 17: 1017-1019
- Reduced movement of median nerve in carpal tunnel during wrist flexion in patients with non-specific arm pain.Lancet. 1999; 354: 217-218
- Median nerve compression can be detected by magnetic resonance imaging of the carpal tunnel.Neurosurgery. 1997; 41: 76-83
- Anatomical relations in the carpal tunnel: a computed tomographic study.Journal of Hand Surgery. 1987; 12: 1-4
- The effects of tendon load and posture on carpal tunnel pressure.The Journal of hand surgery. 1997; 22: 628-634
- Pathophysiology of nerve compression.Hand Clin. 2002; 18: 231-241
- Carpal arch and median nerve changes during radioulnar wrist compression in carpal tunnel syndrome patients.J. Orthop. Res. 2016; 34: 1234-1240
- Effect of grip type, wrist motion, and resistance level on pressures within the carpal tunnel of normal wrists.J. Orthop. Res. 2014; 32: 524-530
- The scaphotrapezio-trapezoidal joint. Part 2: a kinematic study.The Journal of hand surgery. 2000; 25: 911-920
- The scaphotrapezio-trapezoidal joint. Part 1: an antomic and radiographic study.The Journal of hand surgery. 2000; 25: 899-910
- The triquetrum-hamate joint: an anatomic and in vivo three-dimensional kinematic study.The Journal of hand surgery. 2003; 28: 797-805
- Idiopathic carpal tunnel syndrome: histologic study of flexor tendon synovium.The Journal of hand surgery. 1990; 15: 497-503
- Carpal tunnel changes and median nerve compression during wrist flexion and extension seen by magnetic resonance imaging.The Journal of hand surgery. 1990; 15: 934-939
- Prevalence and work-relatedness of self-reported carpal tunnel syndrome among US workers: analysis of the Occupational Health Supplement data of 1988 National Health Interview Survey.Am. J. Ind. Med. 1995; 27: 451-470
- Altered median nerve deformation and transverse displacement during wrist movement in patients with carpal tunnel syndrome.Acad. Radiol. 2014; 21: 472-480
- Transverse ultrasound assessment of median nerve deformation and displacement in the human carpal tunnel during wrist movements.Ultrasound Med. Biol. 2014; 40: 53-61
- Scaphoid and lunate motion during a wrist dart throw motion.The Journal of hand surgery. 2004; 29: 418-422
- The dart-throwing motion of the wrist: is it unique to humans?.The Journal of hand surgery. 2006; 31: 1429-1437
- Changes in carpal tunnel shape during wrist joint motion MRI evaluation of normal volunteers.The Journal of Hand Surgery: British & European Volume. 1993; 18: 620-623
Article info
Publication history
Published online: October 31, 2019
Accepted:
October 29,
2019
Received:
July 5,
2019
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
