Transverse Movement of the Median Nerve in the Carpal Tunnel during Wrist and Finger Motion in Patients with Carpal Tunnel Syndrome

Nanno, Mitsuhiko; Sawaizumi, Takuya; Kodera, Norie; Tomori, Yuji; Takai, Shinro

doi:10.1620/tjem.236.233

Cited by 20 publications

(36 citation statements)

References 18 publications

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“…Currently, ultrasonography is used for diagnosing CTS, with a focus on detecting focal swelling of the median nerve in the carpal tunnel 17 . However, previous studies have suggested that a decrease in the transverse plane movement of the median nerve in ultrasonography is a characteristic feature of patients with CTS 18,19 .…”

Section: Discussionmentioning

confidence: 87%

Change to movement and morphology of the median nerve resulting from steroid injection in patients with mild carpal tunnel syndrome

Moon

Lee

Park

2020

Sci Rep

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There are conflicting hypotheses regarding the initial pathogenesis of carpal tunnel syndrome (CTS). One hypothesis characterizes it as inflammation of the median nerve caused by compression, while another hypothesis characterizes CTS as non-inflammatory fibrosis of the subsynovial connective tissue (SSCT). This study aimed to investigate the differences in the ultrasonography parameters before and after a steroid injection, which is effective for CTS, to elucidate the initial pathogenesis of CTS and the mechanisms of action of the injected steroid. Fourteen hands from 14 healthy participants and 24 hands from 24 participants with mild CTS were examined. Dynamic movement and morphology of the median nerve before and after steroid injection were measured. There was no significant difference in the normalized maximal distance of the median nerve, which reflects the degree of fibrosis in the SSCT indirectly, during finger and wrist movements before and after the injection among patients with CTS (p > 0.05). Among the parameters that indirectly reflects the degree of median nerve compression, such as normalized maximal change in the aspect ratio of the minimum-enclosing rectangle (MER), maximal change in the median nerve perimeter, and maximal value of the median nerve cross-sectional area (CSA), statistically significant differences were not observed between values of the normalized maximal change in the aspect ratio of the MER and maximal change in the median nerve perimeter, during finger and wrist movements recorded before and after the injection in patients with CTS (p > 0.05). However, multivariate logistic regression analysis revealed that the change in the normalized maximal value of the median nerve CSA, according to finger and wrist movement was correlated with the administration of the steroid injection (p < 0.05). In conclusion, compared to that noted before steroid injection, the median nerve CSA noted during finger and wrist movements changed significantly after injection in patients with mild CTS. Given the improvement in median nerve swelling after steroid injection, but no improvement in the movement of the median nerve during finger and wrist movements, median nerve swelling due to compression (rather than fibrosis of the SSCT may be the initial pathogenesis of early-stage (mild) CTS, and the fibrous changes around the median nerves (SSCT) may be indicative of secondary pathology after median nerve compression. Further studies are required to validate the findings of our study and confirm the pathogenesis of CTS.

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Section: Discussionmentioning

confidence: 87%

Change to movement and morphology of the median nerve resulting from steroid injection in patients with mild carpal tunnel syndrome

Moon

Lee

Park

2020

Sci Rep

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“…Dynamic ultrasound has been used to measure displacement differences in CTS patients versus healthy volunteers. In a transverse plane, movement of both the tendon and nerve within the carpal tunnel in CTS patients is inhibited (Filius et al, 2015; Nanno et al, 2015; van Doesburg et al, 2012; Wang et al, 2014). Normally, the median nerve moves dorsally between the superficial flexor tendons during flexing motions but this restriction in movement in CTS patients limits the ability of the nerve to translate while the tendons are loaded (Fig.…”

Section: Ssct and Carpal Tunnel Syndromementioning

confidence: 99%

The biomechanics of subsynovial connective tissue in health and its role in carpal tunnel syndrome

Festen-Schrier

Amadio

2018

Journal of Electromyography and Kinesiology

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Carpal Tunnel Syndrome (CTS) is the most common surgically treated problem in the hand. Aside from the neuropathy itself, the most common findings are fibrosis of the subsynovial connective tissue (SSCT) and increased intra carpal tunnel pressure. Normally, the SSCT is a multilayer tissue interspersed among the carpal tendons and nerve. As the tendons move, successive SSCT layers are recruited, forming a gliding unit and providing a limit to differential movement. Exceeding this limit, damages the SSCT as has been shown in both cadavers and animal models. This damage leads to a non-inflammatory response with progressive fibrosis and nerve ischemia leaving the SSCT more susceptible to injury. Although the direct consequences for patients are not fully understood, ultrasound research shows that this fibrosis restricts median nerve displacement during tendon loading. This article aims to provide insights into the mechanical properties of SSCT described so far and place it in the context of CTS pathophysiology. A theoretical damage model concerning the SSCT is proposed showing a chain of events and vicious cycles that could lead to the nerve compression as it is found in CTS. Although not complete, this model could explain the pathophysiological pathway of idiopathic CTS.

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“…Furthermore, in a previous study, we developed a technique to describe the detailed location of the median nerve as a coordinate within the carpal tunnel in healthy subjects and patients with CTS. 2,3 It is important to examine the location of the median nerve and its displacement amount as a coordinate to further comprehend the precise nerve position within the carpal tunnel during wrist and finger motions.…”

Section: Introductionmentioning

confidence: 99%

Median nerve movement in the carpal tunnel before and after carpal tunnel release using transverse ultrasound

Nanno

Kodera

Tomori

et al. 2017

Journal of Orthopaedic Surgery

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The current study demonstrated the movement patterns of the median nerve in the carpal tunnel during wrist and finger motions compared before and after CTR using transverse ultrasound in CTS patients. The findings suggested that as the median nerve shifted greatly palmarly away from the tendons after CTR, the nerve avoids compression or shearing stress from the tendons. This ultrasound information could offer further understanding of the pathomechanics of CTS and provide a more accurate diagnosis of CTS and better treatment by CTR.

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Transverse Movement of the Median Nerve in the Carpal Tunnel during Wrist and Finger Motion in Patients with Carpal Tunnel Syndrome

Cited by 20 publications

References 18 publications

Change to movement and morphology of the median nerve resulting from steroid injection in patients with mild carpal tunnel syndrome

Change to movement and morphology of the median nerve resulting from steroid injection in patients with mild carpal tunnel syndrome

The biomechanics of subsynovial connective tissue in health and its role in carpal tunnel syndrome

Median nerve movement in the carpal tunnel before and after carpal tunnel release using transverse ultrasound

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