Quantitative analysis of the variation in angles of the carpal arch after open and endoscopic carpal tunnel release

Flores, Leandro Pretto; Cavalcante, Thiago F P; Neto, Oswaldo Ribeiro Marquez; Alcântara, Fabiano S

doi:10.3171/2008.9.jns08457

Cited by 5 publications

(8 citation statements)

References 21 publications

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“…Our data agrees with the clinical observation of Flores et al [8] who reported a 6.2° angular change, in the axial plane, between the hook of hamate and the ridge of the trapezium. This is comparable to the summation of the angular rotations about the pronation/supination axis for the H-C, C-Td, and Td-Tm joints.…”

Section: Discussionsupporting

confidence: 93%

“…Carpal tunnel release leads to a widening of the CAW up to 3 mm [7] and also results in angular rotations of the distal carpal joints [8]. Our data agrees with the clinical observation of Flores et al [8] who reported a 6.2° angular change, in the axial plane, between the hook of hamate and the ridge of the trapezium.…”

Section: Discussionsupporting

confidence: 90%

“…As in-vivo studies have shown, CAW narrowing or widening occurs under different wrist conditions. For example, CAW narrowing occurred during flexion/extension of the wrist [6], but widening resulted from carpal tunnel release [6-8]. Hence, it is logical that CAW narrowing and widening would have different angular rotations for the distal carpal joints.…”

Section: Discussionmentioning

confidence: 99%

“…As previously stated, it has been shown that changes in the CAW occur under different wrist conditions [2, 6-8, 12]. However, the underlying kinematics of the joints within the distal carpal row during CAW widening and narrowing remained unclear.…”

Section: Introductionmentioning

confidence: 99%

“…For example, Garcia-Elias et al demonstrated that CAW narrowing occurs during flexion and extension of the wrist [6]. Transection of the transverse carpal ligament, also known as carpal tunnel release, results in a widening of the CAW up to 3 mm [7] or 11% [6], and it resulted in angular rotations within the distal carpal row [8, 10] such as slight external rotations of the trapezium and trapezoid [7]. Sucher et al showed that the CAW can be altered by manipulation and sustained load bearing [12].…”

Section: Introductionmentioning

confidence: 99%

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

Gabra

Domalain

2012

Journal of Biomechanical Engineering

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Change in carpal arch width (CAW) is associated with wrist movement, carpal tunnel release, or therapeutic tunnel manipulation. This study investigated the angular rotations of the distal carpal joints as the CAW was adjusted. The CAW was narrowed and widened by 2 and 4 mm in seven cadaveric specimens while the bone positions were tracked by a marker-based motion capture system. The joints mainly pronated during CAW narrowing and supinated during widening. Ranges of motion about the pronation axis for the hamate-capitate (H-C), capitate-trapezoid (C-Td), and trapezoid-trapezium (Td-Tm) joints were 8.1 ± 2.3°, 5.3 ± 1.3°, and 5.5 ± 3.5°, respectively. Differences between the angular rotations of the joints were found at ΔCAW = -4 mm about the pronation and ulnar-deviation axes. For the pronation axis, angular rotations of the H-C joint were larger than that of the C-Td and Td-Tm joints. Statistical interactions among the factors of joint, rotation axis, and ΔCAW indicated complex joint motion patterns. The complex three-dimensional motion of the bones can be attributed to several anatomical constraints such as bone arrangement, ligament attachments, and articular congruence. The results of this study provide insight into the mechanisms of carpal tunnel adaptations in response to biomechanical alterations of the structural components.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Gabra

Domalain

2012

Journal of Biomechanical Engineering

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Endoscopically assisted release of the ulnar nerve for cubital tunnel syndrome

Flores

2009

Acta Neurochir

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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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Quantitative analysis of the variation in angles of the carpal arch after open and endoscopic carpal tunnel release

Cited by 5 publications

References 21 publications

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

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

Endoscopically assisted release of the ulnar nerve for cubital tunnel syndrome

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

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