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Morphological and positional changes of the carpal arch and median nerve associated with wrist deviations

  • Kishor Lakshminarayanan
    Affiliations
    Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
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  • Rakshit Shah
    Affiliations
    Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA

    Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH, USA
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  • Zong-Ming Li
    Correspondence
    Corresponding author at: University of Arizona, Department of Orthopaedic Surgery, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA.
    Affiliations
    Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA

    Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, USA

    Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA

    Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH, USA

    Hand Research Laboratory, Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ, USA
    Search for articles by this author

      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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