Biomechanical models for the pathogenesis of specific distal upper extremity disorders

Moore, James S.

doi:10.1002/ajim.10037

Cited by 48 publications

(10 citation statements)

References 76 publications

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“…Aside from the carpal tunnel contents, the morphological and mechanical changes (e.g. hypertrophying and stiffening) of the TCL may be a causative factor in CTS [11, 26, 30, 37, 42]. Such pathological changes of the TCL may reduce the amount of space available to the carpal tunnel contents or compromise the inherent compliance of the carpal tunnel structure, both of which may negatively implicate the median nerve.…”

Section: Introductionmentioning

confidence: 99%

Thickness and Stiffness Adaptations of the Transverse Carpal Ligament Associated With Carpal Tunnel Syndrome

Marquardt

Gabra

Evans

et al. 2016

J. Musculoskelet. Res.

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The purpose of this study was to investigate the morphological and mechanical properties of the transverse carpal ligament (TCL) in patients with carpal tunnel syndrome (CTS). Thickness and stiffness of the TCL in eight female CTS patients and eight female control subjects were examined using ultrasound imaging modalities. CTS patients had a 30.9% thicker TCL than control subjects. There was no overall difference in TCL stiffness between the two groups, but the radial TCL region was significantly stiffer than the ulnar region within the CTS group and such a regional difference was not found for the controls. The increased thickness and localized stiffness of the TCL for CTS patients may contribute to CTS symptoms due to reduction in carpal tunnel space and compliance. Advancements in ultrasound technology provide a means of understanding CTS mechanisms and quantifying the morphological and mechanical properties of the TCL in vivo.

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Section: Introductionmentioning

confidence: 99%

Thickness and Stiffness Adaptations of the Transverse Carpal Ligament Associated With Carpal Tunnel Syndrome

Marquardt

Gabra

Evans

et al. 2016

J. Musculoskelet. Res.

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“…The transverse carpal ligament (TCL) plays an important role in regulating carpal tunnel mechanics [1]. In particular, hypertrophy of the TCL has been postulated as one of the underlying pathogenic mechanisms of carpal tunnel syndrome [2]. Imaging studies have shown that the TCLs were thickened in individuals with carpal tunnel syndrome [3].…”

Section: Introductionmentioning

confidence: 99%

Carpal Tunnel Expansion by Palmarly Directed Forces to the Transverse Carpal Ligament

Tang

Chakan

et al. 2009

Journal of Biomechanical Engineering

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This study investigated the expansion of the carpal tunnel resulting from the application of palmarly directed forces to the transverse carpal ligament (TCL) from inside the carpal tunnel. Ten fresh-frozen cadaveric hands were dissected to evacuate the carpal tunnel and thus to expose the TCL. A custom lever device was built to apply forces, ranging from 10 to 200 N, to the TCL. Without force application, the carpal tunnel area was 148.4 ± 36.8 mm2. The force application caused the TCL to form arches with an increase in cross-sectional areas of 33.3 ± 5.6 mm2 at 10 N and 48.7 ± 11.4 mm2 at 200 N, representing respective increases of 22.4% and 32.8% relative to the initial carpal tunnel area. The TCL length remained constant under the applied forces. It was found that the TCL arch formation was due to the narrowing of the arch width, which resulted from the migration of the bony insertion sites of the TCL. A geometrical model of the carpal tunnel was then developed to elucidate the relationships among the arch width, TCL length, arch height, and arch area. The model illustrated the effectiveness of carpal tunnel expansion by TCL elongation or arch width narrowing.

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“…For example, studies have shown pathological changes of the TCL including its stiffening and hypertrophying [16–18, 20]. Hypertrophy of the TCL and/or tendons limits the available space within the carpal tunnel for the median nerve and promotes carpal tunnel stenosis, an etiological factor of carpal tunnel syndrome [28–30]. The findings from this study show that increased finger loading and the deviated posture of wrist flexion amplify the TCL-tendon interaction, thereby potentially increasing the risk of maladaptation.…”

Section: Discussionmentioning

confidence: 99%

In vivo tissue interaction between the transverse carpal ligament and finger flexor tendons

Gabra

Gordon

Marquardt

et al. 2016

Medical Engineering & Physics

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The transverse carpal ligament (TCL) is a component of the flexor pulley system of the wrist, keeping the flexor tendons in place by resisting their volar displacement. The purpose of this study was to investigate the in vivo biomechanical interaction between the TCL and flexor tendons in response to tendon tensioning with the wrist at various postures. In eight healthy subjects, the flexor digitorum superficialis and profundus tendons were tensioned by isometrically applying loads (5, 10, and 15 N) to the index finger while the wrist posture was at 20° extension, neutral, 20° flexion, and 40° flexion. The TCL and flexor tendons were imaged at the distal carpal tunnel cross section using ultrasound. The volar-dorsal positions of the tendons, TCL arch height, and TCL-tendon distances were calculated. With increasing wrist flexion, the flexor tendons moved volarly, the TCL arch height increased, and the TCL-tendon distances decreased, indicating that the flexor tendons contacted the TCL and pushed it volarly. The TCL-tendon interaction was amplified by the combination of finger loading and wrist flexion. This study provides in vivo evidence of the biomechanical interaction between the TCL and flexor tendons. Repetitive TCL-tendon interactions may implicate the interacting tissues and the median nerve resulting in tissue maladaptation and nerve compression.

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Biomechanical models for the pathogenesis of specific distal upper extremity disorders

Cited by 48 publications

References 76 publications

Thickness and Stiffness Adaptations of the Transverse Carpal Ligament Associated With Carpal Tunnel Syndrome

Thickness and Stiffness Adaptations of the Transverse Carpal Ligament Associated With Carpal Tunnel Syndrome

Carpal Tunnel Expansion by Palmarly Directed Forces to the Transverse Carpal Ligament

In vivo tissue interaction between the transverse carpal ligament and finger flexor tendons

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