Intraoperative dynamic pressure measurements in carpal tunnel syndrome: Correlations with clinical signs

Lee, Ho Jin; Kim, Il Sup; Sung, Jae Hoon; Lee, Sang Won; Hong, Jae Taek

doi:10.1016/j.clineuro.2015.11.006

Cited by 18 publications

(15 citation statements)

References 22 publications

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“…On the other hand, CTS patients potentially have higher pressure in the carpal tunnel as a base condition. The sustained high pressure in the carpal tunnel would cause functional damage to the median nerve (Lee et al, 2016; Luchetti et al, 1998; Murata et al, 2007; Okutsu et al, 1989; Silverstein et al, 1987; Viikari-Juntura and Silverstein, 1999). Thus, the higher the CTP, the more compressed the median nerve becomes.…”

Section: Discussionmentioning

confidence: 99%

“…Many risk factors are involved in CTS initiation or progression, such as aging, gender, forceful and repetitive hand use, wrist joint deformity after trauma injury and endogenous diseases represented by metabolic disease including diabetes (English et al, 1995; Mackinnon and Novak, 1997; Masear et al, 1986; Silverstein et al, 1987; Zhou et al, 2016). Furthermore, carpal tunnel pressure (CTP) in patients with CTS is usually significantly higher than that in healthy people both at rest and during activities (Goss and Agee, 2010; Hamanaka et al, 1995; Ikeda et al, 2006; Lee et al, 2016). If CTP exceeds a certain level, usually 30 mmHg, symptoms such as discomfort, tingling and paresthesia would appear suggesting median nerve disorder (Coppieters et al, 2012; Goss and Agee, 2010; Prim et al, 2016; Seradge et al, 1995).…”

Section: Introductionmentioning

confidence: 99%

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The quantitative evaluation of the relationship between the forces applied to the palm and carpal tunnel pressure

Kubo

Cheng

Zhou

et al. 2018

Journal of Biomechanics

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Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy occurring in upper limbs. The etiology, however, has not been fully understood yet. Median nerve could be compressed by either increase of carpal tunnel pressure (CTP) or direct impingement when it is forced toward to carpal ligament especially in wrist flexion leading to CTS development. Thus, the increase of carpal tunnel pressure is considered an important role in CTS development. It has been identified that forces applied to the palm would affect the CTP. However, the quantitative relationship between palmar contact force and CTP is not known. The purpose of this study was to quantitatively evaluate the relationship between palmar contact force and CTP. Eight human cadaveric hands were used. The CTP was measured with a diagnostic catheter-based pressure transducer inserted into the carpal tunnel. A custom made device was used to apply forces to the palm for the desired CTP. Palmar contact forces corresponding to the determined CTP level were recorded respectively. The testing was repeated with different ranges of tension applied to the flexor digitorum superficialis tendon of the third finger. The tensions were constant at 50 g for the other flexor tendons and median nerve. The results showed that CTP increased linearly with the force applied to the palm. When CTP was 30 mmHg, mean values of the contact force to the palm was 293 g (SD: 15.2) including all tensions. These results would help to understand the effect of daily activities with hands on CTP.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The quantitative evaluation of the relationship between the forces applied to the palm and carpal tunnel pressure

Kubo

Cheng

Zhou

et al. 2018

Journal of Biomechanics

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“…20 Numerous approaches have been tried to measure carpal tunnel pressure in both a clinical and a laboratory setting. 5,[13][14][15][16]18,21,[43][44][45] So far, all these methods have been invasive to some extent. A noninvasive assessment of carpal tunnel pressure would be ideal to reduce the burden and anxiety of patients, and to allow for both office based assessment and field evaluations.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12] Carpal tunnel pressure in patients with CTS is significantly higher than that in healthy people both at rest and during activities. [13][14][15][16] An earlier identification of elevation in carpal tunnel pressure may allow for better treatment and prevention of CTS.…”

mentioning

confidence: 99%

Ultrasound elastography for carpal tunnel pressure measurement: A cadaveric validation study

Kubo

Zhou

Cheng

et al. 2017

Journal Orthopaedic Research

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Carpal tunnel pressure is a key factor in the etiology of carpal tunnel syndrome. Numerous approaches have been conducted to measure carpal tunnel pressure. However, most techniques are invasive and take time and effort. We have developed an innovative approach to noninvasively assess the tunnel pressure by using the ultrasound surface wave elastography (USWE) technique. In a previous study it was shown that the shear wave speed in a tendon increased linearly with increasing tunnel pressure enclosed the tendon in a simple tendon model. This study aimed to examine the relationship between the carpal tunnel pressure and the shear wave speeds inside and outside the carpal tunnel in a human cadaveric model. The result showed that the shear wave speed inside the carpal tunnel increased linearly with created carpal tunnel pressure, while the shear wave speed outside the carpal tunnel remained constant. These findings suggest that noninvasive measurement of carpal tunnel pressure is possible by measuring the shear wave speed in the tendon. After fully establishing this technology and being applicable in clinic, it would be useful in the diagnosis of carpal tunnel syndrome. For that reason, further validation with this technique in both healthy controls and patients with carpal tunnel syndrome is required. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:477-483, 2018.

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“…Carpal tunnel syndrome (CTS) is a common peripheral compression neuropathy 5 and a frequent topic of investigation. Regardless of cause, a characteristic finding of CTS is increased pressure 6–11 in the carpal tunnel, typically associated with fibrosis of the connective tissue located around the nerve and flexor tendons 12–17 . As a result of the increase in pressure, the nerve is not only prone to ischemia, but the mechanical properties of the nerve are also altered over time 17 .…”

Section: Introductionmentioning

confidence: 99%

Shear wave elastography of the median nerve: A mechanical study

et al. 2020

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Background: Shear wave elastography (SWE) shows promise in peripheral neuropathy evaluation but has potential limitations due to tissue size and heterogeneity. We tested SWE sensitivity to elasticity change and the effect of probe position in a median nerve cadaver model. Methods: Ten specimens were used to measure median nerve elasticity under increasing loads using SWE and indentation. Measurements were compared using repeated-measures analysis of variance. Results: Indentation and SWE-based longitudinal nerve elasticity increased with tensile loading (P < .01), showing a similar relationship. Acquisition in a transverse plane showed lower values compared with longitudinal measurements, mostly under higher loads (P = .03), as did postdissection elasticity (P = .02). Elasticity did not change when measured proximal to the carpal tunnel. Conclusions: Longitudinal SWE is sensitive to changes in median nerve elasticity. Measuring elasticity of peripheral nerves noninvasively could elucidate intra-neural pathology related to compression neuropathies, and proof to be of added value as a diagnostic or prognostic tool. K E Y W O R D S carpal tunnel syndrome, elastography, nerve elasticity, neurodynamics, peripheral neuropathy

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Intraoperative dynamic pressure measurements in carpal tunnel syndrome: Correlations with clinical signs

Cited by 18 publications

References 22 publications

The quantitative evaluation of the relationship between the forces applied to the palm and carpal tunnel pressure

The quantitative evaluation of the relationship between the forces applied to the palm and carpal tunnel pressure

Ultrasound elastography for carpal tunnel pressure measurement: A cadaveric validation study

Shear wave elastography of the median nerve: A mechanical study

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