Dynamics of Intracarpal Tunnel Pressure in Patients With Carpal Tunnel Syndrome

Goss, Ben C.; Agee, John M.

doi:10.1016/j.jhsa.2009.09.019

Cited by 48 publications

(43 citation statements)

References 32 publications

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“…Pressures within the carpal tunnel can rise substantially during finger and wrist motion (Goss and Agee 2010, Luchetti, Schoenhuber 1998). However, other studies have shown that this pressure elevation is primarily due to contact pressure, and not fluid pressure (Ko and Brown 2007, Smith, Sonstegard 1977).…”

Section: Discussionmentioning

confidence: 99%

Transverse Ultrasound Assessment of Median Nerve Deformation and Displacement in the Human Carpal Tunnel during Wrist Movements

Wang

Zhao

Passe

et al. 2014

Ultrasound in Medicine & Biology

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The symptoms of carpal tunnel syndrome, a compression neuropathy of the median nerve at the wrist, are aggravated by wrist motion, but the effect of these motions on median nerve motion are unknown. In order to better understand the biomechanics of the abnormal nerve, it is first necessary to understand normal nerve movement. The purpose of this study was to evaluate the deformation and displacement of the normal median nerve at the proximal carpal tunnel level on transverse ultrasound images during different wrist movements, in order to have a baseline for comparison with abnormal movements. Dynamic ultrasound images were obtained in both wrists of 10 asymptomatic volunteers during wrist maximal flexion, extension and ulnar deviation. In order to simplify the analysis, the initial and final shape and position of the median nerve were measured and analyzed. The circularity of the median nerve was significantly increased and the aspect ratio and perimeter were significantly decreased in the final image compared to that in the first image during wrist flexion with finger extension, wrist flexion with finger flexion and wrist ulnar deviation with finger extension (p<0.01). There were significant differences in median nerve displacement vector between finger flexion, wrist flexion with finger extension and wrist ulnar deviation with finger extension (all p<0.001). The mean amplitudes of the median nerve motion in wrist flexion with finger extension (2.36±0.79 NU), wrist flexion with finger flexion (2.46±0.84 NU) and wrist ulnar deviation with finger extension (2.86±0.51 NU) were higher than those in finger flexion (0.82±0.33 NU), wrist extension with finger extension (0.77±0.46 NU) and wrist extension with finger flexion (0.81±0.58 NU) (p<0.0001). In the normal carpal tunnel, wrist flexion and ulnar deviation could induce significant transverse displacement and deformation of the median nerve.

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Section: Discussionmentioning

confidence: 99%

Transverse Ultrasound Assessment of Median Nerve Deformation and Displacement in the Human Carpal Tunnel during Wrist Movements

Wang

Zhao

Passe

et al. 2014

Ultrasound in Medicine & Biology

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“…The high compliance of a released carpal tunnel is clinically important to the understanding of how the carpal tunnel adapts to increases in carpal tunnel pressure. For example, it has been shown that carpal tunnel pressure is highly dependent on the wrist posture 16, 19 and the tension of the flexor tendons during hand activities. The relative increases in carpal tunnel compliance and cross-sectional area, after release, may be potential contributing factors to the relief of the carpal tunnel pressure during hand activities.…”

Section: Discussionmentioning

confidence: 99%

Pressure–morphology relationship of a released carpal tunnel

Kim

Marquardt

Gabra

et al. 2012

Journal Orthopaedic Research

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The purpose of this study was to investigate morphological changes of a released carpal tunnel in response to variations of carpal tunnel pressure. Pressure within the carpal tunnel is known to be elevated in patients with carpal tunnel syndrome and dependent on wrist posture. Previously, increased carpal tunnel pressure was shown to affect the morphology of the carpal tunnel with an intact transverse carpal ligament. However, the pressure-morphology relationship of the carpal tunnel after release of the transverse carpal ligament has not been investigated. Carpal tunnel release (CTR) was performed endoscopically on cadaveric hands and the carpal tunnel pressure was dynamically increased from 10 to 120 mmHg. Simultaneously, carpal tunnel cross-sectional images were captured by an ultrasound system and pressure measurements were recorded by a pressure transducer. It was found that carpal tunnel pressure significantly affected carpal arch area (p<0.001), with an increase >62 mm2 at 120 mmHg. Carpal arch height, length, and width were also found to significantly change with carpal tunnel pressure (p<0.05). As carpal tunnel pressure increased, carpal arch height and length increased, but the carpal arch width decreased. Analyses of the pressure-morphology relationship for a released carpal tunnel revealed a nine times greater compliance than that previously reported for a carpal tunnel with an intact transverse carpal ligament. This change of structural properties as a result of transecting the transverse carpal ligament helps explain the reduction of carpal tunnel pressure and relief of symptoms for patients after CTR surgery.

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“…A higher intracarpal pressure has been reported in CTS during those tasks [29]. Grip-and pinch activities increase the intracarpal pressure [29,30] and cause greater stress to the median nerve, explaining the pain that was reported while performing grip and pinch tasks. Patients reported postoperatively very little pain during grip-and pinch force demonstrating that the condition of the nerve was normalized.…”

Section: Discussionmentioning

confidence: 91%