Carpal Canal Pressures after Volar Plating of Distal Radius Fractures

Fuller, David; Barrett, Michele; Marburger, Robert; Hirsch, Ronald L.

doi:10.1016/j.jhsb.2005.10.013

Cited by 32 publications

(18 citation statements)

References 15 publications

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“…Although the mean intracarpal tunnel pressures for the active hand before ligament division were substantially greater than those reported previously, the mean pressures after ligament division for both the relaxed and active hands were comparable with those previously reported. 1,2,4,5,7,12,25 This significant reduction in intracarpal tunnel pressure supports the hypothesis that considerable contact pressures exist against the deep surface of the TCL before its release.…”

Section: Discussionsupporting

confidence: 68%

Dynamics of Intracarpal Tunnel Pressure in Patients With Carpal Tunnel Syndrome

Goss

Agee

2010

The Journal of Hand Surgery

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Section: Discussionsupporting

confidence: 68%

Dynamics of Intracarpal Tunnel Pressure in Patients With Carpal Tunnel Syndrome

Goss

Agee

2010

The Journal of Hand Surgery

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“…Regarding the pathology of CTS, chronic compression of the MN in the carpal tunnel and elevation of carpal tunnel pressure have been reported, 10,11 but the onset time of CTS complicating DRF varies from development after injury to acute and delayed onset after surgery, and the pathology is still controversial. 12 Fuller et al reported that carpal tunnel pressure elevation was observed after VLP fixation of DRF, 4 and Nourbakhsh and Tan reported a case of MN disorder caused by adhesion between the MN and surrounding tissue in the surgical wound after VLP fixation. 13 Furthermore, Wang et al reported that the incidence of CTS was significantly lower in patients treated with intramedullary nailing on comparison of the postoperative outcome between patients treated with plate fixation and intramedullary nailing, and stimulation by the plate may cause CTS.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Regarding the developmental mechanism of VLP-associated MN disorder, direct compression and injury to the MN and elevation of carpal tunnel pressure have been reported, but the mechanism has not yet been clarified. 2,4 Our hypothesis is that carpal tunnel pressure elevation will be observed after VLP fixation of DRF, and it leads to MN disorder after surgery with VLP. In this study, elasticity of the MN at the proximal inlet of the carpal tunnel was quantified using ultrasound elastography (EG) (real-time tissue EG) and compared between the operation and healthy sides in patients after surgery for DRF using VLP to investigate MN disorder after surgery with VLP.…”

Section: Introductionmentioning

confidence: 99%

A Survey of the Median Nerve Elasticity after Volar Locking Plate Fixation Using Ultrasound Elastography

Sugiyama

Naïto

Miyamoto

et al. 2020

Journal of Hand and Microsurgery

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Background Median nerve disorder is one of the complications after surgery using volar locking plate (VLP) for distal radius fracture (DRF). In this study, elasticity of the median nerve was quantified using ultrasound elastography (EG) (real-time tissue EG) and compared between the operation and healthy sides in patients after surgery for DRF using VLP. Materials and Methods The subjects of this study were 28 patients (4 males and 24 females; mean age: 58.5 years) who could be followed up for more than 6 months after surgery for DRF and were able to be examined by EG. We evaluated median nerve elasticities on the operation and healthy sides using EG on the final follow-up. Results The median nerve strain ratios were 3.97 ± 2.99 on the operation side and 3.91 ± 1.51 on the healthy side, showing no significant difference in elasticity of the median nerve between the operation and healthy sides. Conclusion Median nerve disorder, which is a complication after surgery with VLP, can be objectively detected using EG capable of evaluating median nerve elasticity externally to detect medial nerve degeneration while degeneration of the median nerve. Thus, EG may be used as a useful diagnostic tool to prevent complications and decide on appropriate timing of VLP extraction.

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“…Although an increase in carpal tunnel pressure is a characteristic of CTS, the increase in pressure varies according to hand motion, activity, and position, in addition to the measurement methods chosen 10, 29–33. The carpal tunnel pressure in the patients with CTS typically exceeds a threshold of 30 mmHg,34–38 but levels of 100 mmHg or more can be attained at 90° of wrist dorsiflexion 8.…”

Section: Discussionmentioning

confidence: 99%

Gliding resistance of flexor tendon associated with carpal tunnel pressure: A biomechanical cadaver study

Zhao

Ettema

Berglund

et al. 2010

Journal Orthopaedic Research

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ABSTRACT:The purpose of this study was to investigate the effect of carpal tunnel pressure on the gliding characteristics of flexor tendons within the carpal tunnel. Eight fresh human cadaver wrists and hands were used. A balloon was inserted into the carpal tunnel to elevate the pressure. The mean gliding resistance of the middle finger flexor digitorum superficialis tendon was measured with the following six conditions: (1) as a baseline, before balloon insertion; (2) balloon with 0 mmHg pressure; (3) 30 mmHg; (4) 60 mmHg; (5) 90 mmHg; (6) 120 mmHg. The gliding resistance of flexor tendon gradually increased as the carpal tunnel pressure was elevated. At pressures above 60 mmHg, the increase in gliding resistance became significant compared to the baseline condition. This study helps us to understand the relationship between carpal tunnel pressure, which is elevated in the patient with carpal tunnel syndrome (CTS) and tendon gliding resistance, which is a component of the work of flexion. These findings suggest that patients with CTS may have to expend more energy to accomplish specific motions, which may in turn affect symptoms of hand pain, weakness and fatigue, seen commonly in such patients. © Carpal tunnel syndrome (CTS) in one of the most common compression neuropathies, with an estimated lifetime risk of 10% and a prevalence of about 3%.1-3 It is generally accepted that repetitive hand motion is a risk factor for CTS. [4][5][6][7] While the etiology of CTS is in most cases idiopathic, it is known that CTS is a result of increased pressure within the carpal tunnel, which is a confined anatomic space bounded by the carpal bones on the dorsal side, the trapezium on the radial side, the hook of the hamate on the ulnar side and the flexor retinaculum on the volar side. [8][9][10] However, while the effect of increase pressure on the median nerve has been well studied, the effect of pressure on tendon function has received little attention, even though tendons make up the majority of the cross section of the carpal tunnel contents. The purpose of this study was to investigate the effect of pressure changes on the gliding resistance of a representative tendon, the middle finger flexor digitorum superficialis (FDS), within the carpal tunnel in a human cadaver model. We hypothesized that the gliding resistance would increase with carpal tunnel pressure elevation. MATERIALS AND METHODSAfter IRB review and approval, eight human fresh frozen cadavers, amputated approximately 15 cm proximal to the wrist joint, were harvested and thawed at room temperature immediately prior to testing. The cadaver donors included five males and three females, with an average age of 76 years (range 40-91). There were five right and three left upper extremities. A medical record review was performed on each cadaver donor, to obtain demographic data and to be sure the individual did not have a recorded antemortem diagnosis of CTS. The FDS tendons of the second, third, and fourth digits were exposed proximal and distal to the flexor re...

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Carpal Canal Pressures after Volar Plating of Distal Radius Fractures

Cited by 32 publications

References 15 publications

Dynamics of Intracarpal Tunnel Pressure in Patients With Carpal Tunnel Syndrome

Dynamics of Intracarpal Tunnel Pressure in Patients With Carpal Tunnel Syndrome

A Survey of the Median Nerve Elasticity after Volar Locking Plate Fixation Using Ultrasound Elastography

Gliding resistance of flexor tendon associated with carpal tunnel pressure: A biomechanical cadaver study

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