Effects of slight flexion-extension and radial-ulnar deviation postures on carpal tunnel volume


      • Non-neutral posture is a poorly defined risk factor for carpal tunnel syndrome.
      • Three-dimensional computed tomography analysis of carpal tunnel volume.
      • Kinematics of radius and third metacarpal for precise measure of wrist posture
      • Slight flexion-extension does not have significant effect on carpal tunnel volume.
      • Slight ulnar deviation may be a risk factor for carpal tunnel syndrome.



      Non-neutral wrist postures are a commonly reported risk factor for carpal tunnel syndrome. It is unclear how slight flexion-extension and radial-ulnar deviation postures affect the carpal tunnel. The objective was to determine the effects of slight non-neutral postures by quantifying carpal tunnel volume.


      Computed tomography images were collected on ten cadaveric specimens in target postures of −20°, −10°, −5°, 0°, 5°, 10°, and 20° of flexion and − 10°, −5°, 0°, 5°, and 10° of radial-ulnar deviation. Surface meshes of the carpal tunnel, carpal bones, radius, and third metacarpal were generated with manual segmentation. Carpal tunnel volume was calculated as the volume between proximal and distal boundaries defined with anatomical landmarks and the orientation of the tunnel. The precise wrist posture of each scan was determined with inertial-based coordinate systems of the radius and third metacarpal.


      Through multiple linear regression it was determined that, over the observed range of postures, flexion-extension angle does not have a significant effect (p = 0.99) while radial-ulnar deviation angle has a significant effect of −5.9 mm3/degree (p = 0.003). The findings were consistent with previous studies of postural effects on carpal tunnel pressure.


      For the treatment and prevention of carpal tunnel syndrome, results suggest that attention should be given to slight radial-ulnar deviation postures (<10°), while slight flexion-extension postures (<20°) are of lesser consequence to carpal tunnel volume.


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