Practical anatomy of the carpal tunnel

Rotman, Mitchell B.; Donovan, James P

doi:10.1016/s0749-0712(01)00003-8

Cited by 94 publications

(73 citation statements)

References 43 publications

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“…It is an anatomical fact that the tunnel becomes progressively narrower from proximal to distal, and is the narrowest at the level of the hook of the hamate, at the distal insertion point of the flexor retinaculum (Rotman and Donovan, 2002;Bianchi and Martinoli, 2007). Moreover, it has been shown that the flexor retinaculum progressively thickens from proximal to distal, and it is the thickest distally and ulnarly, although there is also some thickening proximally and radially (Pacek et al, 2010;Goitz et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

The significance of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome

Csillik

Bereczki

Bora³

et al. 2016

Clinical Neurophysiology

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). The sponsor had no direct involvement in the collection, analysis and interpretation of data and in the preparation of the manuscript. 2 HIGHLIGHTS Median nerve enlargement in CTS is significantly greater at the tunnel outlet than at the inlet  It is postulated that pressure progressively increases from proximal to distal within the tunnel  The addition of outlet measurements increases diagnostic sensitivity and accuracy of CTS 3 ABSTRACT Objective: A retrospective study to investigate the utility of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome (CTS).Methods: 118 hands of 87 patients with electrophysiologically confirmed CTS and 44 control hands of 23 subjects were assessed. Cross-sectional areas (CSA) of the median nerve were measured at the tunnel inlet, outlet, and forearm. Longitudinal diameters (LAPD) were measured at the inlet, proximal tunnel, distal tunnel, and outlet.Results: CSA at the outlet (median: 18 mm 2 ) and its palm-to-forearm-ratio (median: 2.7) were significantly larger than CSA at the inlet (median: 15 mm 2 ) and its wrist-to-forearm-ratio (median: 2.2) (p <0.001). 27% of the hands showed enlargement only at the outlet versus 13% only at the inlet.LAPD jump was significantly greater, suggesting relief of higher pressure, at the outlet / distal tunnel versus inlet / proximal tunnel (p <0.001). Conclusion:Median nerve enlargement in CTS is greater at the tunnel outlet than at the inlet. We postulate that this is explained by the progressive increase of pressure within the tunnel from proximal to distal.Significance: The addition of outlet measurements to inlet measurements increased sensitivity and accuracy of the ultrasonographic diagnosis of CTS by 15% and 10%, respectively.

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Section: Discussionmentioning

confidence: 99%

The significance of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome

Csillik

Bereczki

Bora³

et al. 2016

Clinical Neurophysiology

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“…For standardization; SSCT samples were taken around flexor digitorum superficialis tendon of middle finger, closest and superficial tendon just lying along ulnar side of median nerve without any lumbrical muscle or tendon insertion, the same localization as previous studies have mentioned. [16] …”

Section: Sample Harvestingmentioning

confidence: 99%

Are myofibroblasts activated in idiopathic carpal tunnel syndrome? An immunohistochemical study

Yeşìl¹

2014

Eklem Hastalik Cerrahisi

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Amaç: Bu çalışmada miyofibroblastların idiopatik karpal tünel sendromundaki (KTS) fibrotik süreçte rol oynayıp oynamadığı araştırıldı. Hastalar ve yöntemler: Mart 2010-Ağustos 2010 tarihleri arasında kliniğimizde ameliyat edilen 40 hasta (12 erkek, 28 kadın; ort. yaş 50.85±11.2 yıl; dağılım 30-71 yıl) çalışmaya alındı. Yirmi beş idiopatik KTS hastası çalışma grubuna, 15 travma hastası kontrol grubuna dahil edildi. Katılımcıların hem transvers karpal ligaman hem de subsinovyal bağ dokusundan (SSBD) örnekler alındı ve bunlar immünohistokimyasal yöntem ile analiz edildi. Miyofibroblast varlığını ve damar duvar kalınlığını (alfa düz kas aktin [a-DKA]), kollajen tip IV antikorları, T (CD3) ve B (CD20) lenfositleri incelemek için dört immünohistokimyasal işaretleyici kullanıldı. Bulgular: İdiopatik KTS'nin erken aşamasında olan hastaların SSBD'sinde miyofibroblast varlığı (a-DKA) antikorlarının fibroblastlar ile pozitif reaksiyonu yoluyla gösterildi. Subsinovyal bağ dokusunun vasküler yapısında a-DKA ve kollajen antikor reaksiyonunun anlamlı şekilde artmış olması, çalışma grubunda damar duvar kalınlığı ve vaskülaritenin artmış olduğunu gösterdi (p<0.01). İki grup arasında T ve B lenfosit antikor reaksiyonu açısından anlamlı fark saptanmadı (inflamasyon). Sonuç: Bu çalışmanın bulguları, miyofibroblastların hastalığın erken döneminde aktifleşip hastalığın başlangıcına katkı yapma olasılıkları olduğuna işaret etmektedir. İleride yapılacak daha büyük örneklem sayılı çalışmalar miyofibroblastların idiopatik KTS'deki rolünün anlaşılmasına büyük katkı sağlayacaktır.Anahtar sözcükler: Karpal; fibrozis; idiopatik; miyofibroblast; sendrom.Objectives: This study aims to investigate whether myofibroblasts participate in the fibrotic process of idiopathic carpal tunnel syndrome (CTS). Patients and methods: Forty patients (12 males, 28 females; median age 50.85±11.2 years; range 30 to 71 years) who were operated in our clinic between March 2010 and August 2010 were included in the study. Twenty-five idiopathic CTS patients were assigned to the study group, and 15 trauma patients were assigned to the control group. Samples were taken from both transverse carpal ligament and subsynovial connective tissue (SSCT) of participants and they were analyzed by immunohistochemical method. Four immunohistochemical markers were used to analyze myofibroblast existence and vascular wall thickness (alpha smooth muscle actin [a-SMA]), collagen type IV antibodies, and T (CD3) and B (CD20) lymphocytes. Results: The existence of myofibroblasts (a-SMA) in SSCT of patients who were in early phase of idiopathic CTS was shown through the positive reaction of their antibodies with fibroblasts. A significantly increased reaction of a-SMA and collagen antibodies in vascular structure of SSCT demonstrated increased vascular wall thickness and vascularity in the study group (p<0.01). No significant difference was detected between the two groups in terms of T and B lymphocyte antibody reaction (inflammation). Conclusion: The findings of this study indicate a po...

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“…118 The narrowest region is located about 2.0 to 2.5 cm distal to the origin of the canal and corresponds to the region where constriction or ''hourglass'' deformity of the median nerve is reported during surger y. The superficialis and profundus tendons of the index finger lie immediately dorsal to the median nerve, providing a rationale for stretching these tendons when performing the tethered median nerve test.…”

Section: A Pathophysiologic Basis For Clinical Examinationmentioning

confidence: 99%

“…Anatomical variations in the median nerve itself, as well as anomalous muscles, tendons, or tissue interconnections, have been described as a basis for atypical presentations. 14,51,77,118,129 Nerve fibers have layers of connective tissue. The extensibility of these layers is critical to nerve gliding.…”

Section: A Pathophysiologic Basis For Clinical Examinationmentioning

confidence: 99%

Clinical and Electrodiagnostic Testing of Carpal Tunnel Syndrome: A Narrative Review

MacDermid¹,

Doherty²

2004

J Orthop Sports Phys Ther

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Carpal Tunnel Syndrome (CTS) is a pressure-induced neuropathy that causes sensorimotor disturbances of the median nerve, which impair functional ability. A clear history that elicits relevant personal and work exposures and the nature of symptoms can lead to a high probability of a correct diagnosis. Hand diagrams and diagnostic questionnaires are available to provide structure to this process. A variety of provocative tests have been described and have variable accuracy. The Phalen's wrist flexion and the carpal compression tests have the highest overall accuracy, while Tinel's nerve percussion test is more specific to axonal damage that may occur as a result of moderate to severe CTS. Sensory evaluation of light touch, vibration, or current perception thresholds can detect early sensory changes, whereas 2-point discrimination changes and thenar atrophy indicate loss of nerve fibers occurring with more severe disease. Electrodiagnosis can encompass a variety of tests and is commonly used to assess the presence/severity of neuropathic changes and to preclude alternative diagnoses that overlap with CTS in presentation. The pathophysiologic changes occurring with different stages of nerve compression must be considered when interpreting diagnostic test results and predicting response to physical therapy management.

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Practical anatomy of the carpal tunnel

Cited by 94 publications

References 43 publications

The significance of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome

The significance of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome

Are myofibroblasts activated in idiopathic carpal tunnel syndrome? An immunohistochemical study

Clinical and Electrodiagnostic Testing of Carpal Tunnel Syndrome: A Narrative Review

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