Kishor Lakshminarayanan1, Rakshit Shah2, Zong-Ming Li3. 1. Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA. 2. Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA; Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH, USA. 3. Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA; Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, USA; Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA; Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH, USA; Hand Research Laboratory, Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ, USA. Electronic address: lizongming@arizona.edu.
Abstract
BACKGROUND: Carpal tunnel and median nerve dynamically change with wrist motion. The purpose of this study was to investigate the morphological changes and positional migration of the carpal arch and median nerve, as well as nerve-arch positional relationship associated with wrist deviation in healthy volunteers. METHODS: Twenty asymptomatic male volunteers performed wrist motion from neutral to deviated positions combining flexion-extension and radioulnar deviation. Ultrasound images of the carpal arch and median nerve at the distal carpal tunnel were collected during wrist motion. Morphological and positional parameters of the carpal arch and median nerve were derived from the ultrasound images. FINDINGS: Carpal arch height, area, and palmar bowing of the transverse carpal ligament (TCL) increased with flexion related wrist motion and decreased with extension related motion (P < 0.05). Arch width increased with radial flexion and decreased with extension and ulnar extension (P < 0.05). Median nerve circularity increased with flexion and radial flexion but decreased with extension, ulnar extension, and ulnar deviation (P < 0.05). Nerve centroid displaced ulnarly with radial deviation, radial flexion, and radial extension and displaced radially with ulnar deviation, ulnar flexion, and ulnar extension (P < 0.05). Nerve centroid displaced in the dorsal direction with flexion and radial flexion, but in the palmar direction with extension (P < 0.05). Nerve-TCL distance increased with flexion related motion and decreased with extension relation motion (P < 0.05). INTERPRETATION: The current study advances our understanding the effect of wrist motion on the carpal tunnel and its contents, which has implications for pathomorphological and pathokinematic changes associated with wrist disorders.
BACKGROUND: Carpal tunnel and median nerve dynamically change with wrist motion. The purpose of this study was to investigate the morphological changes and positional migration of the carpal arch and median nerve, as well as nerve-arch positional relationship associated with wrist deviation in healthy volunteers. METHODS: Twenty asymptomatic male volunteers performed wrist motion from neutral to deviated positions combining flexion-extension and radioulnar deviation. Ultrasound images of the carpal arch and median nerve at the distal carpal tunnel were collected during wrist motion. Morphological and positional parameters of the carpal arch and median nerve were derived from the ultrasound images. FINDINGS: Carpal arch height, area, and palmar bowing of the transverse carpal ligament (TCL) increased with flexion related wrist motion and decreased with extension related motion (P < 0.05). Arch width increased with radial flexion and decreased with extension and ulnar extension (P < 0.05). Median nerve circularity increased with flexion and radial flexion but decreased with extension, ulnar extension, and ulnar deviation (P < 0.05). Nerve centroid displaced ulnarly with radial deviation, radial flexion, and radial extension and displaced radially with ulnar deviation, ulnar flexion, and ulnar extension (P < 0.05). Nerve centroid displaced in the dorsal direction with flexion and radial flexion, but in the palmar direction with extension (P < 0.05). Nerve-TCL distance increased with flexion related motion and decreased with extension relation motion (P < 0.05). INTERPRETATION: The current study advances our understanding the effect of wrist motion on the carpal tunnel and its contents, which has implications for pathomorphological and pathokinematic changes associated with wrist disorders.
Authors: Mohammad Hosseini-Farid; Verena J M M Schrier; Julia Starlinger; Peter C Amadio Journal: J Ultrasound Med Date: 2020-10-19 Impact factor: 2.153