Movement of the Distal Carpal Row During Narrowing and Widening of the Carpal Arch Width

Gabra, Joseph N.; Domalain, Mathieu; Li, Zong Ming

doi:10.1115/1.4007634

Cited by 9 publications

(11 citation statements)

References 15 publications

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“…This led to palmar bowing of the transverse carpal ligament and increases in the carpal arch height (CAH) and the carpal arch area (CAA). Additionally, it was shown that inter-carpal joint mobility provides flexibility for CAW narrowing (Gabra et al, 2012, Li et al, 2009), leading to carpal arch formation which benefits the carpal tunnel environment by accommodating physiological variations of pressure in the tunnel. Also, a study examining the morphological changes of the carpal tunnel in response to the carpal tunnel pressure showed that an increase in the tunnel pressure is associated with a decrease in the CAW and an increase in the tunnel circularity, contributing to an increase in the carpal tunnel area (Li et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Narrowing carpal arch width to increase cross-sectional area of carpal tunnel — a cadaveric study

Li¹,

Gabra²,

Marquardt³

et al. 2013

Clinical Biomechanics

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Background Carpal tunnel morphology plays an essential role in the etiology and treatment of carpal tunnel syndrome. The purpose of this study was to observe the morphological changes of the carpal tunnel as a result of carpal arch width narrowing. It was hypothesized carpal arch width narrowing would result in increased height and area of the carpal arch. Methods The carpal arch width of eight cadaveric hands was narrowed by a custom apparatus and cross-sectional ultrasound images were acquired. The carpal arch height and area were quantified as the carpal arch width was narrowed. Correlation and regression analyses were performed for the carpal arch height and area with respect to the carpal arch width. Findings The carpal tunnel became more convex as the carpal arch width was narrowed. The initial carpal arch width, height, and area were 25.7 (SD 1.9) mm, 4.1 (SD 0.6) mm, and 68.5 (SD 14.0) mm2, respectively. The carpal arch height and area negatively correlated with the carpal arch width, with correlation coefficients of −0.974 (SD 0.018) and −0.925 (SD 0.034), respectively. Linear regression analyses showed a 1 mm narrowing of the carpal arch width resulted in proportional increases of 0.40 (SD 0.14) mm in the carpal arch height and 4.0 (SD 2.2) mm2 in the carpal arch area. Interpretation This study demonstrates that carpal arch width narrowing leads to increased carpal arch height and area, a potential mechanism to reduce the mechanical insult to the median nerve and relieve symptoms associated with carpal tunnel syndrome.

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Section: Introductionmentioning

confidence: 99%

Narrowing carpal arch width to increase cross-sectional area of carpal tunnel — a cadaveric study

Li¹,

Gabra²,

Marquardt³

et al. 2013

Clinical Biomechanics

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“…elliptical, of the carpal tunnel. The anisotropic stiffness behavior can also be linked to the directionally dependent anatomical constraints of the wrist such as ligamentous connections and bone congruence (Gabra et al, 2012). The wrist is a complex joint composed of many obscurely shaped bones interconnected by numerous ligaments with multiple articulations.…”

Section: Discussionmentioning

confidence: 99%

“…Prior to experimentation, each specimen was preconditioned by displacing the ridge of the trapezium by 2 mm in a set of the 14 directions; the order of the 14 directions was randomized within a set, and the preconditioning was repeated for 10 sets. A preconditioning magnitude of 2 mm was chosen because it is the largest displacement magnitude used for testing and the carpal arch remains relatively elastic within this amount of displacement (Gabra et al, 2012; Li et al, 2013; Xiu et al, 2010). …”

Section: Methodsmentioning

confidence: 99%

Three-dimensional stiffness of the carpal arch

Gabra

2016

Journal of Biomechanics

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The carpal arch of the wrist is formed by irregularly shaped carpal bones interconnected by numerous ligaments, resulting in complex structural mechanics. The purpose of this study was to determine the three-dimensional stiffness characteristics of the carpal arch using displacement perturbations. It was hypothesized that the carpal arch would exhibit an anisotropic stiffness behavior with principal directions that are oblique to the conventional anatomical axes. Eight (n = 8) cadavers were used in this study. For each specimen, the hamate was fixed to a custom stationary apparatus. An instrumented robot arm applied three-dimensional displacement perturbations to the ridge of trapezium and corresponding reaction forces were collected. The displacement-force data were used to determine a three-dimensional stiffness matrix using least squares fitting. Eigendecomposition of the stiffness matrix was used to identify the magnitudes and directions of the principal stiffness components. The carpal arch structure exhibited anisotropic stiffness behaviors with a maximum principal stiffness of 16.4 ± 4.6 N/mm that was significantly larger than the other principal components of 3.1 ± 0.9 and 2.6 ± 0.5 N/mm (p < 0.001). The principal direction of the maximum stiffness was pronated within the cross section of the carpal tunnel which is accounted for by the stiff transverse ligaments that tightly bind distal carpal arch. The minimal principal stiffness is attributed to the less constraining articulation between the trapezium and scaphoid. This study provides advanced characterization of the wrist's three-dimensional structural stiffness for improved insight into wrist biomechanics, stability, and function.

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“…The difference in compliance in the inward and outward directions is likely due to the direction-dependent stabilizing role of the TCL as well as the other intercarpal ligaments. [20][21][22] The role of the intercarpal ligaments in stabilizing the bony arch was also shown by Garcia-Elias et al, who applied compressive force to the carpal tunnel in the dorsal-palmar direction to quantify the rigidity of the tunnel with and without an intact TCL. 23 In contrast to the compliance in the radio-ulnar direction, 19 the carpal tunnel stiffness in the dorsal-palmar direction 23 was not affected by transecting the TCL because of the other intercarpal ligaments in the tunnel structure.…”

Section: Biomechanics Of the Carpal Tunnelmentioning

confidence: 99%

Biomechanical Role of the Transverse Carpal Ligament in Carpal Tunnel Compliance

Marquardt

Evans

et al. 2014

Jnl Wrist Surg

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The carpal tunnel is a fibro-osseous structure formed by the carpal bones interconnected by numerous ligaments. The eight irregularly shaped carpal bones are intricately arranged with the intercarpal ligaments to establish the medial, lateral, and dorsal boundaries of the tunnel. The proximal row of the carpal bones consists of the pisiform, triquetrum, lunate, and scaphoid, while the distal row comprises the hamate, capitate, trapezoid, and trapezium. The volar aspect of the carpal tunnel is spanned by the transverse carpal ligament (TCL). This band of fibrous tissue inserts radially into the scaphoid tuberosity and trapezial ridge, and ulnarly into the pisiform and the hook of the hamate. The thenar and hypothenar muscles are an integral part of the carpal tunnel structure, because the TCL serves as attachment sites for these hand muscles, 1,2 and contraction of these muscles causes biomechanical interactions with the carpal tunnel via the TCL. 3 AbstractThe transverse carpal ligament (TCL) is a significant constituent of the wrist structure and forms the volar boundary of the carpal tunnel. It serves biomechanical and physiological functions, acting as a pulley for the flexor tendons, anchoring the thenar and hypothenar muscles, stabilizing the bony structure, and providing wrist proprioception. This article mainly describes and reviews our recent studies regarding the biomechanical role of the TCL in the compliant characteristics of the carpal tunnel. First, force applied to the TCL from within the carpal tunnel increased arch height and area due to arch width narrowing from the migration of the bony insertion sites of the TCL. The experimental findings were accounted for by a geometric model that elucidated the relationships among arch width, height, and area. Second, carpal arch deformation showed that the carpal tunnel was more flexible at the proximal level than at the distal level and was more compliant in the inward direction than in the outward direction. The hamate-capitate joint had larger angular rotations than the capitate-trapezoid and trapezoid-trapezium joints for their contributions to changes of the carpal arch width. Lastly, pressure application inside the intact and released carpal tunnels led to increased carpal tunnel cross-sectional areas, which were mainly attributable to the expansion of the carpal arch formed by the TCL. Transection of the TCL led to an increase of carpal arch compliance that was nine times greater than that of the intact carpal tunnel. The carpal tunnel, while regarded as a stabile structure, demonstrates compliant properties that help to accommodate biomechanical and physiological variants such as changes in carpal tunnel pressure.

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Movement of the Distal Carpal Row During Narrowing and Widening of the Carpal Arch Width

Cited by 9 publications

References 15 publications

Narrowing carpal arch width to increase cross-sectional area of carpal tunnel — a cadaveric study

Narrowing carpal arch width to increase cross-sectional area of carpal tunnel — a cadaveric study

Three-dimensional stiffness of the carpal arch

Biomechanical Role of the Transverse Carpal Ligament in Carpal Tunnel Compliance

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