Carpal tunnel mechanics and its relevance to carpal tunnel syndrome

Li, Zong-Ming; Jordan, David B.

doi:10.1016/j.humov.2022.103044

Cited by 7 publications

(7 citation statements)

References 124 publications

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“…2 ). Additionally, the thenar muscles originating at the palmar surface of the FLR have an impact on the biomechanics of the CT ( 30 ) as well as the lumbricals which slip into the CT during flexion of the finger ( 31 , 32 ) . The width of the CT is at its narrowest about two centimeters from its proximal margin, which is at the level of the hook of hamate.…”

Section: Normal Anatomy Of the Carpal Tunnelmentioning

confidence: 99%

“…Excessive pressure within the CT leads to local compression of the vasa nervorum of the MN, resulting in MN ischemia. Additionally, the MN itself can be mechanically compressed ( 30 , 33 , 37 , 38 ) . In CTS, both ischemia and long-lasting compression of the MN cause neuropathy, characterized by swelling of the nerve proximal to the FLR and flattening at the level of entrapment ( 30 , 39 , 40 ) .…”

Section: Normal Anatomy Of the Carpal Tunnelmentioning

confidence: 99%

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Anatomical considerations of US-guided carpal tunnel release in daily clinical practice

Honis,

Gruber,

Honold

et al. 2023

J Ultrason

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Carpal tunnel syndrome is the most frequent compression neuropathy with an incidence of one to three subjects per thousand. As specific anatomical variations might lead to unintended damage during surgical interventions, we present a review to elucidate the anatomical variability of the carpal tunnel region with important considerations for daily clinical practice: several variants of the median nerve branches in and around the transverse carpal ligament are typical and must – similarly to the variant courses of the median artery, which may be found eccentric ulnar to the median nerve – be taken into account in any interventional therapy at the carpal tunnel. Unintended interference in these structures might lead to heavy arterial bleeding and, in consequence, even underperfusion of segments of the median nerve or, if neural structures such as variant nerve branches are impaired or even cut, severe pain-syndromes with a profound impact on the quality of life. This knowledge is thus crucial for outcome- and safety-optimization of different surgical procedures at the volar aspect of the wrist and surgical therapy of the carpal tunnel syndrome e.g., USguided carpal tunnel release, as injury might result in dysfunction and/or pain on wrist motion or direct impact in the region concerned. For most variations, anatomical and surgical descriptions vary, as official classifications are still lacking.

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Section: Normal Anatomy Of the Carpal Tunnelmentioning

confidence: 99%

Section: Normal Anatomy Of the Carpal Tunnelmentioning

confidence: 99%

Anatomical considerations of US-guided carpal tunnel release in daily clinical practice

Honis,

Gruber,

Honold

et al. 2023

J Ultrason

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“…Although the precise pathophysiology of CTS remains unclear, it is believed that increased pressure within the carpal tunnel contributes to the interruption of nerve microcirculation, ischemia, impaired nerve conduction, increased vascular permeability, and disruption of axoplasmic flow, resulting in decreased function of the affected nerve [3]. This is attributed to the fixed volume of the carpal tunnel, an anatomical structure composed of bone and fibrous tissue [4].…”

Section: Introductionmentioning

confidence: 99%

“…disruption of axoplasmic flow, resulting in decreased function of the affected nerve [3]. This is attributed to the fixed volume of the carpal tunnel, an anatomical structure composed of bone and fibrous tissue [4].…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Ultrasound-Guided Perineural Hydrodissection as a Minimally Invasive Treatment in Carpal Tunnel Syndrome: A Systematic Review

Sveva,

Farì,

Fai

et al. 2024

JPM

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Ultrasound-guided perineural hydrodissection (HD) is a novel technique that has been found to be effective in providing mechanical release of perineural adhesions and decompression of the nerve, reducing inflammation and edema and restoring its physiological function. It has a significant impact on chronic neuropathic pain (20 ± 4 weeks with VAS < 5 or VAS diminished by 2 points after the procedure). Carpal tunnel syndrome (CTS) is a common entrapment mononeuropathy, and its distribution is typically innervated by the median nerve. Patients with mild or moderate CTS may benefit from nonsurgical treatments or conservative therapies. This review was conducted following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement guidelines. Four investigators assessed each title, abstract, and full-text article for eligibility, with disagreements being resolved by consensus with two experienced investigators. The qualitative assessment of the studies was carried out using the modified Oxford quality scoring system, also known as the modified Jadad score. Furthermore, risk of possible biases was assessed using the Cochrane collaboration tool. The results of this review suggest that US-guided HD is an innovative, effective, well-tolerated, and safe technique (11 out of 923 patients had collateral or side effects after the procedure). However, further studies comparing all drugs and with a larger sample population are required to determine the most effective substance.

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“…The carpal tunnel is a fibro-osseous canal at the wrist that accommodates the median nerve (MN) and the flexor tendons of the forearm. The structures running through the carpal tunnel are exposed to mechanical stress when finger or wrist movements are performed ( 1 – 2 ) . The feasibility of dynamic ultrasound examinations for the visualization and assessment of the median nerve has been well established ( 3 ) .…”

Section: Introductionmentioning

confidence: 99%

Median nerve versus flexor tendons: visualization of median nerve level changes in the proximal carpal tunnel during wrist movement with dynamic high-resolution ultrasound

Jengojan,

Lechner,

Kasprian

et al. 2023

J Ultrason

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Aim: The purpose of this prospective ultrasound study was to document dorso-palmar (vertical) displacement of the median nerve in relation to the superficial flexor tendons at the level of the carpal tunnel. Furthermore, the gliding patterns of the median nerve were characterized. The presence of vertical gliding was intended to serve as an additional bio-kinematic parameter of median nerve movement, and will be referred to as a ‘level change’. Material and methods: In this study, a total of 32 healthy young individuals underwent dynamic high-resolution ultrasound examinations of both wrists. The neutral position, and maximum flexion and extension of the wrist had to be reached in active and passive movement. The gliding patterns were determined in relation to the superficial flexor tendons. When no vertical nerve gliding was observed, it was characterized as ‘no level change’. Results: The presence of a level change prevailed in the healthy young cohort and was observed in 84% (27/32) of individuals during wrist flexion. The following gliding pattern was distinctively the most common: gliding of the entire nerve in between the flexor tendons in active but not in passive movement of the right and left wrists (13/27; 48%). The extent of vertical displacement was found to be associated with the gliding pattern (Kruskal–Wallis test). Conclusions: Movement in the carpal tunnel allows the median nerve to adapt to biomechanical stress. Dynamic ultrasound can demonstrate median nerve level changes in response to wrist movements. Furthermore, a typical gliding pattern was characterized. The presence of level change and gliding patterns were proposed as additional movement parameters during wrist flexion in healthy individuals.

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Carpal tunnel mechanics and its relevance to carpal tunnel syndrome

Cited by 7 publications

References 124 publications

Anatomical considerations of US-guided carpal tunnel release in daily clinical practice

Anatomical considerations of US-guided carpal tunnel release in daily clinical practice

Safety and Efficacy of Ultrasound-Guided Perineural Hydrodissection as a Minimally Invasive Treatment in Carpal Tunnel Syndrome: A Systematic Review

Median nerve versus flexor tendons: visualization of median nerve level changes in the proximal carpal tunnel during wrist movement with dynamic high-resolution ultrasound

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