Normal variations in position and relations of the median nerve in the carpal tunnel: A cross‐sectional observational study using clinical magnetic resonance imaging

Sanmugalingam, Nimalan; Rault, Marcus E.G.; Toms, Andoni P.

doi:10.1002/ca.23458

Cited by 4 publications

(4 citation statements)

References 28 publications

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“…Other dynamic imaging studies of the carpal tunnel have been done using imaging systems including magnetic resonance imaging and ultrasound. [31][32][33][34][35][36][37] Wang et al 32 reported a significant reduction of dorsal translation of the MN in patients with CTS compared to non-CTS controls (n = 20 CTS cases; and n = 10 controls), whereas van Doesburg et al 38 observed no significant alternations in MN excursion between patients with CTS and healthy volunteers with fist motion. However, for other hand movements, including wrist flexion, studies have shown that the nerve displacement magnitude is less in patients with CTS compared to healthy individuals.…”

Section: Discussionmentioning

confidence: 99%

Carpal Tunnel Syndrome Treatment and the Subsequent Alterations in Median Nerve Transverse Mobility

Hosseini-Farid

Schrier

Starlinger

et al. 2020

J of Ultrasound Medicine

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Objectives-The mobility (transverse movement) of the median nerve (MN) is decreased in patients with carpal tunnel syndrome and can be measured noninvasively by ultrasound. To date, there are few prognostic features to help predict the outcome of 2 commonly performed treatments: surgical carpal tunnel release and corticosteroid injection. This study aimed to assess the changes in nerve mobility after the intervention and to correlate this with treatment and the disease severity.Methods-A total of 181 patients with carpal tunnel syndrome with different electrophysiologic severities were recruited and assessed by dynamic ultrasound scanning of the MN before and after treatment. The dynamic ultrasound images were collected while the patients performed finger and wrist flexion.Results-For both injection and carpal tunnel release, the nerve displacement increased with wrist flexion, from a mean AE SD of 7.0 AE 2.4 to 7.9 AE 2.7 mm (P < .005). Patients who underwent surgery showed greater improvement (P < .005) in nerve mobility compared to those who underwent injection. We also observed that the increase in nerve mobility was predominantly in patients with more nerve damage at baseline.Conclusions-This study shows that the dynamic behavior of the MN changes in response to treatment and lays a foundation for future studies to assess the prognostic potential of nerve mobility measurement.

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Section: Discussionmentioning

confidence: 99%

Carpal Tunnel Syndrome Treatment and the Subsequent Alterations in Median Nerve Transverse Mobility

Hosseini-Farid

Schrier

Starlinger

et al. 2020

J of Ultrasound Medicine

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“…The median nerve usually enters the carpal tunnel radially, either superficial to the flexor digitorum superficialis tendons or between the flexor digitorum superficialis and flexor pollicis longus tendons, although nerve positioning may vary. 10 The roof of the carpal tunnel is the flexor retinaculum, also known as the transverse carpal ligament, that attaches to the scaphoid and triquetrum proximally and the trapezium and hamate distally. The floor of the carpal tunnel is made up of the proximal and distal carpal rows.…”

Section: Median Nerve Anatomymentioning

confidence: 99%

“…65 Both US and MRI can demonstrate an abnormal nerve course, focal nerve caliber change, and surrounding soft tissue edema (►Fig. 10). MRI can also demonstrate T2 hyperintense signal of the nerve, suggesting injury/neuritis.…”

Section: Wartenberg's Syndromementioning

confidence: 99%

Nerve Imaging in the Wrist

Daniels

Tolla

Azad

et al. 2022

Semin Musculoskelet Radiol

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Neuropathic symptoms involving the wrist are a common clinical presentation that can be due to a variety of causes. Imaging plays a key role in differentiating distal nerve lesions in the wrist from more proximal nerve abnormalities such as a cervical radiculopathy or brachial plexopathy. Imaging complements electrodiagnostic testing by helping define the specific lesion site and by providing anatomical information to guide surgical planning. This article reviews nerve anatomy, normal and abnormal findings on ultrasonography and magnetic resonance imaging, and common and uncommon causes of neuropathy.

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“…Additionally, the tendon of the flexor pollicis longus (FPL) and the MN are passing through the CT [ 10 ]. Normally, the MN is located between the FR and the FDS, but its position within the CT may vary [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Pilot Cadaveric Study of Anatomical Variations of the Median Nerve at the Wrist in the Lithuanian Population

Neumann¹,

Suchomlinov²

2023

Cureus

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Introduction: Carpal tunnel syndrome (CTS) is known as one of the most common neurological disorders in the human body. Nowadays, the prevalence in the general population ranges between 1% and 5%. Due to its high prevalence and increasing incidence of carpal tunnel surgery, the anatomical variations of the median nerve at the wrist are important to know to avoid iatrogenic injury of the nerve. Purpose: The objective of this study was to evaluate the anatomical variation of the median nerve at the level of the wrist in the Lithuanian population with a focus on its thenar motor branch based on the classifications of Lanz. Material and methods: A cadaveric study was performed, and 30 wrists of 15 adult Lithuanian cadavers ranging from 70 to 89 years of age were dissected and examined. Eight female and seven male cadavers were included in the study. Any anatomical finding was documented, and the results were compared with the classification of Lanz as well as with the data found in the literature. Results: All hands showed different patterns in comparison to the standard anatomical variation Lanz type 0. The most common result was dedicated to Lanz group 4A. Nineteen out of 30 hands (63%, p<0.01) had an accessory branch proximal to the carpal tunnel, while one of these hands showed a third thenar motor branch. Five hands (16%) were dedicated to Lanz group 2 with an accessory branch distal to the carpal tunnel. One hand (3%) showed a variation close to Lanz group 2, but in this case, the thenar motor branch had its origin under the flexor retinaculum instead of proximal to it. Two hands each (6%) were classified by Lanz groups 1B and 3A. Additionally, one variation showed a pattern of a combination of Lanz types 3A and 3B. The bifid median nerve had a connecting branch in between which started distal to the flexor retinaculum. Two anatomical variations (6%) were not described by the classification of Lanz.

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Normal variations in position and relations of the median nerve in the carpal tunnel: A cross‐sectional observational study using clinical magnetic resonance imaging

Cited by 4 publications

References 28 publications

Carpal Tunnel Syndrome Treatment and the Subsequent Alterations in Median Nerve Transverse Mobility

Carpal Tunnel Syndrome Treatment and the Subsequent Alterations in Median Nerve Transverse Mobility

Nerve Imaging in the Wrist

Pilot Cadaveric Study of Anatomical Variations of the Median Nerve at the Wrist in the Lithuanian Population

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