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Lee HH, Lynch KJ, Kohls MR, Fowler JR. Localization of the Median Nerve and Flexor Pollicis Longus at the Carpal Tunnel Inlet in Patients With and Without Carpal Tunnel Syndrome Using Ultrasound. Hand (N Y) 2024; 19:387-391. [PMID: 36050935 PMCID: PMC11067854 DOI: 10.1177/15589447221120841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Current illustrations of the carpal tunnel vary greatly. The relative positions of the components such as the median nerve and flexor pollicis longus (FPL) tendon seem often arbitrarily chosen. The purpose of this study was to determine the locations of the median nerve and FPL in the carpal tunnel using ultrasound (US) and to determine whether the position of the median nerve changes in carpal tunnel syndrome (CTS). METHOD Patients with and without CTS underwent US examination of the wrist. A 4 × 10 grid was fitted to each saved cross-sectional image. The center points of the median nerve and FPL were identified, and their horizontal and vertical coordinates were recorded. RESULTS The median nerve was identified in 115 wrists (average x = 0.70, y = 0.82), and FPL was identified in 90 wrists (average x = 0.86, y = 0.59). A scatter plot was created by stacking all US images to demonstrate the average positions of the median nerve and FPL. There were 97 wrists without CTS (No CTS) and 17 wrists with CTS. There was a significant difference in the vertical position of the median nerve between No CTS and CTS wrists (P = .0006). CONCLUSIONS The locations of the median nerve and FPL within the carpal tunnel were determined using US of 115 wrists, and a heat map was created to illustrate these locations. The median nerve was found to be more superficial in the setting of CTS.
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Li ZM. Non-Surgical Carpal Arch Space Augmentation for Median Nerve Decompression. J Biomech Eng 2023; 145:080801. [PMID: 36628998 PMCID: PMC10259465 DOI: 10.1115/1.4056651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 01/12/2023]
Abstract
The carpal tunnel is a tightly bounded space, making the median nerve prone to compression and eventually leading to carpal tunnel syndrome. Carpal tunnel release surgery transects the transverse carpal ligament to expand the tunnel arch space, decompress the median nerve, and relieve the associated symptoms. However, the surgical procedure unavoidably disrupts essential anatomical, biomechanical and physiological functions of the wrist, potentially causing reduced grip strength, pillar pain, carpal bone instability, scar tissue formation, and perineural fibrosis. It is desirable to decompress the median nerve without surgically transecting the transverse carpal ligament. This paper is to review several approaches we have developed for nonsurgical carpal arch space augmentation (CASA), namely, radio ulnar wrist compression, muscle-ligament interaction, palmar pulling, and collagenolysis of the transverse carpal ligament. Briefly summarized is the research work on the CASA topic about theoretical considerations, in vitro and in situ experiment, computational modeling, and human subject studies with asymptomatic and carpal tunnel syndrome hands.
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Affiliation(s)
- Zong-Ming Li
- Departments of Orthopaedic Surgery and Biomedical Engineering, Hand Research Laboratory, University of Arizona, Tucson, AZ 85724
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Zhang H, Jordan D, Li ZM. Carpal arch space increased by volar force applied to the skin surface above the carpal tunnel. Clin Biomech (Bristol, Avon) 2023; 102:105888. [PMID: 36640747 PMCID: PMC9975036 DOI: 10.1016/j.clinbiomech.2023.105888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/23/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND Carpal arch space augmentation can help decompress the median nerve. The augmentation can be achieved by mechanical manipulations utilizing the biomechanics of the tunnel structure. The purpose of this study was to expand the carpal arch in vitro by applying volar forces on the surface of the wrist. METHODS The mechanism was implemented in eight cadaver hands by attaching a volar force transmitter to the palmar surface of the wrist and pulling the transmitter volarly at six force levels (0, 3, 6, 9, 12, and 15 N). Ultrasound images of the cross section at the distal carpal tunnel were collected for morphological analysis. FINDINGS The carpal arch height, width, and area were significantly altered by the volarly applied force (P < 0.001). The arch height and area were increased but the arch width was decreased by the force. Pearson's correlation coefficient showed that there was a positive correlation between the arch height and force magnitude; and between the arch area and force magnitude. A negative correlation existed between the arch width and force magnitude (P < 0.001). The magnitude of change of the arch height, width, and area was increased as the force magnitude increased. INTERPRETATION This study demonstrated that applying external forces on the wrist skin to increase the carpal arch space was feasible. The magnitude of the force influenced its effect on altering the carpal arch. Study limitations include small sample size and inclusion of male specimens. Future in vivo work is needed for clinical translation feasibility.
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Affiliation(s)
- Hui Zhang
- Hand Research Laboratory, Department of Orthopaedic Surgery and Arthritis Center, University of Arizona College of Medicine, Tucson, USA
| | - David Jordan
- Hand Research Laboratory, Department of Orthopaedic Surgery and Arthritis Center, University of Arizona College of Medicine, Tucson, USA
| | - Zong-Ming Li
- Hand Research Laboratory, Department of Orthopaedic Surgery and Arthritis Center, University of Arizona College of Medicine, Tucson, USA; Department of Biomedical Engineering, University of Arizona, Tucson, USA.
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Li ZM, Jordan DB. Carpal tunnel mechanics and its relevance to carpal tunnel syndrome. Hum Mov Sci 2023; 87:103044. [PMID: 36442295 PMCID: PMC9839559 DOI: 10.1016/j.humov.2022.103044] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
The carpal tunnel is an elaborate biomechanical structure whose pathomechanics plays an essential role in the development of carpal tunnel syndrome. The purpose of this article is to review the movement related biomechanics of the carpal tunnel together with its anatomical and morphological features, and to describe the pathomechanics and pathophysiology associated with carpal tunnel syndrome. Topics of discussion include biomechanics of the median nerve, flexor tendons, subsynovial tissue, transverse carpal ligament, carpal tunnel pressure, and morphological properties, as well as mechanisms for biomechanical improvement and physiological restoration. It is our hope that the biomechanical knowledge of the carpal tunnel will improve the understanding and management of carpal tunnel syndrome.
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Affiliation(s)
- Zong-Ming Li
- Hand Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, University of Arizona, Tucson, AZ, United States of America.
| | - David B Jordan
- Hand Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, University of Arizona, Tucson, AZ, United States of America
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Li ZM, Grandy EL, Jenkins L, Norman C, Bena J, Hou J, Evans PJ, Seitz WH, Kwoh CK. A preliminary study of radioulnar wrist compression in improving patient-reported outcomes of carpal tunnel syndrome. BMC Musculoskelet Disord 2022; 23:971. [DOI: 10.1186/s12891-022-05943-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/02/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractPrevious studies have shown radioulnar wrist compression augments carpal arch space. This study investigated the effects of radioulnar wrist compression on patient-reported outcomes associated with carpal tunnel syndrome. Subjects underwent thrice-daily (15 min each time 45 min daily) wrist compression over 4 weeks with an additional four weeks of follow-up without treatment. Primary outcomes included Boston Carpal Tunnel Questionnaire symptom and functional severity scales (SSS and FSS) and symptoms of numbness/tingling based on Visual Analog Scales. Our results showed that radioulnar wrist compression improved SSS by 0.55 points after 2 weeks (p < 0.001) and 0.51 points at 4 weeks (p < 0.006) compared to the baseline scale. At the four-week follow-up, SSS remined improved at 0.47 points (p < 0.05). Symptoms of numbness/tingling improved at two and 4 weeks, as well as the follow-up (p < 0.05). Hand motor impairment such as weakness had a lower frequency across carpal tunnel syndrome sufferers and does not significantly improve (p > 0.05). Radioulnar wrist compression might be an effective alternative treatment in improving sensory related symptoms in patients with mild to moderate carpal tunnel syndrome.
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Jordan D, Li ZM. Cross-sectional changes of the distal carpal tunnel with simulated carpal bone rotation. Comput Methods Biomech Biomed Engin 2022; 25:1599-1607. [PMID: 35062851 PMCID: PMC9701111 DOI: 10.1080/10255842.2022.2028143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/31/2021] [Accepted: 01/08/2022] [Indexed: 11/03/2022]
Abstract
This study simulated the cross-sectional changes in the distal carpal tunnel resulting from inward rotations of the hamate and trapezium. Rotations which decreased the carpal arch width, increased the carpal arch area. For example, simultaneous rotation of 5 degrees around the hamate and trapezium centroids decreased the carpal arch width by 1.69 ± 0.17 mm and increased the carpal arch area by 6.83 ± 0.68 mm2. Although the bone arch area decreased, decompression of the median nerve would likely occur due to the adjacent location of the nerve near the transverse carpal ligament.
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Affiliation(s)
- David Jordan
- Hand Research Laboratory, Department of Orthopaedic Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Zong-Ming Li
- Hand Research Laboratory, Department of Orthopaedic Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
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Song K, Wang Y, Yi R, Lakshminarayanan K, Zhang G, Yao Y. The effects of wrist position and radioulnar wrist compression on median nerve longitudinal mobility. Clin Biomech (Bristol, Avon) 2022; 99:105754. [PMID: 36057239 DOI: 10.1016/j.clinbiomech.2022.105754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/06/2022] [Accepted: 08/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Carpal tunnel syndrome is an entrapment neuropathy at the wrist characterized by compromised median nerve mobility. The purpose of this study was to investigate the effect of wrist position on median nerve longitudinal mobility in healthy subjects and the effect of radioulnar wrist compression on the median nerve mobility under non-neutral wrist positions. METHODS Dynamic B mode ultrasound images captured longitudinal median nerve motion in the carpal tunnel in 10 healthy subjects at wrist neutral position, 30-degree flexion, and 30-degree extension. In each position, RWC of 0, 5, 10, and 15 N were applied. One-way repeated measure analysis of variance (ANOVA), Post-hoc Tukey's tests, and the Friedman Test were used to show the significant differences of median nerve longitudinal mobility at different wrist positions and force conditions. FINDINGS Median nerve longitudinal mobility was found to be significantly influenced by wrist position (P < 0.05). The mobility under wrist neutral position was 3.02 mm/s, 38% higher than under wrist flexion (2.18 ± 0.60 mm/s), and 32% higher than under wrist extension (2.29 ± 0.43 mm/s). The impaired median nerve mobility was significantly restored under 10 N radioulnar wrist compression (P < 0.05), by 34.4% under wrist flexion (3.03 ± 0.85 mm/s), and 38.9% under wrist extension (3.07 ± 0.79 mm/s). INTERPRETATION Non-neutral wrist positions compromise median nerve longitudinal mobility, but moderate radioulnar compressive forces are beneficial in the recovery of median nerve longitudinal mobility, and may help to prevent symptoms associated with carpal tunnel syndrome.
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Affiliation(s)
- Kewei Song
- Soft Tissue Biomechanics Laboratory, Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, IL, USA
| | - Yu Wang
- Soft Tissue Biomechanics Laboratory, Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; University of Michigan - Shanghai Jiao Tong University Joint Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Rongxi Yi
- Soft Tissue Biomechanics Laboratory, Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Kishor Lakshminarayanan
- Department of Sensors and Biomedical Engineering, School of Electronics Engineering, Vellore Institute of Technology, Tamil Nadu, India
| | - Guoning Zhang
- Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yifei Yao
- Soft Tissue Biomechanics Laboratory, Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
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Shah R, Li ZM. Three-Dimensional Carpal Arch Morphology Using Robot-Assisted Ultrasonography. IEEE Trans Biomed Eng 2022; 69:894-898. [PMID: 34460363 PMCID: PMC9190071 DOI: 10.1109/tbme.2021.3108720] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The morphology of the carpal arch implicates the available space for the median nerve within the carpal tunnel. The purposes of this study were to 1) reconstruct the three-dimensional (3D) carpal arch by robot-assisted ultrasonography with a linear array transducer using cadaveric hands, and 2) investigate the 3D morphological properties of the carpal arch. METHODS An ultrasound probe with two-dimensional (2D) linear array was integrated on a robotic arm and maneuvered over the cadaveric carpal tunnels to scan the entire transverse carpal ligament and its osseous attachments to carpal bones. The acquired series of 2D ultrasound images together with robot positioning were utilized to reconstruct the 3D carpal arch for morphometric analyses. RESULTS Total carpal arch volume was 1099.4 ± 163.2 mm3 with the distal, middle, and proximal regions contributing 18.2 ± 1.5%, 32.7 ± 1.2%, and 49.1 ± 2.3%, respectively. The ligament surface area was 420.1 ± 63.9 mm2. The carpal arch width, height, curvature, length, area, and palmar bowing index progressively increased from the distal to proximal locations within the tunnel (p < 0.01). CONCLUSION The incorporation of the robot technology with the ultrasound system advanced the applications of traditional 2D ultrasound imaging for a 3D carpal arch reconstruction, allowing for comprehensive morphological assessment of the carpal arch. SIGNIFICANCE The developed workflow can be used for the reconstruction and analysis of other anatomical features in vivo.
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Affiliation(s)
- Rakshit Shah
- Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ 85724, USA
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Turcotte KE, Kociolek AM. Median nerve travel and deformation in the transverse carpal tunnel increases with chuck grip force and deviated wrist position. PeerJ 2021; 9:e11038. [PMID: 33777528 PMCID: PMC7983861 DOI: 10.7717/peerj.11038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/09/2021] [Indexed: 12/31/2022] Open
Abstract
Background We assessed median nerve travel and deformation concurrently to better understand the influence of occupational risk factors on carpal tunnel dynamics, including forceful chuck gripping and deviated wrist positions. Methods Fourteen healthy right-hand dominant participants performed a chuck grip in 6 experimental conditions: two relative force levels (10% and 40% of maximum voluntary effort); three wrist positions (15° radial deviation, 0° neutral, 30° ulnar deviation). Chuck grip forces were measured with a load cell while the transverse cross-section of the carpal tunnel was imaged via ultrasound at the distal wrist crease. Images of the median nerve were analyzed in ImageJ to assess cross-sectional area, circularity, width, and height as well as travel in the anterior-posterior and medial-lateral axes. Results We found a main effect of deviated wrist position on both anterior-posterior and medial-lateral travel, with the greatest nerve travel occurring in 30° ulnar deviation. There was also a significant interaction between chuck grip force and deviated wrist position on cross-sectional area. Specifically, the area decreased with 40% vs. 10% chuck grip force when the wrist was in 30° ulnar deviation; however, there were no changes in 0° neutral and 15° radial deviation. Discussion Overall, we demonstrated that forceful chuck gripping in deviated wrist positions influenced carpal tunnel dynamics, resulting in both migratory and morphological changes to the median nerve. These changes may, in turn, increase local strain and stress with adjacent structures in the carpal tunnel. Future studies mapping contact stress between structures may further elucidate injury development of work-related carpal tunnel syndrome.
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Affiliation(s)
- Kaylyn E Turcotte
- School of Physical and Health Education, Nipissing University, North Bay, Ontario, Canada
| | - Aaron M Kociolek
- School of Physical and Health Education, Nipissing University, North Bay, Ontario, Canada
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Fong SW, Liu BWF, Sin CL, Lee KS, Wong TM, Choi KS, Yang YP, Lin YY, Chien Y, Tarng YW, Chen CF, Lin LT. A systematic review of the methodology of sonographic assessment of upper limb activities-associated carpal tunnel syndrome. J Chin Med Assoc 2021; 84:212-220. [PMID: 32858552 DOI: 10.1097/jcma.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Various upper limb activities were speculated to be associated with the development of carpal tunnel syndrome (CTS). Nonetheless, there are currently no standardization on the uses of parameters in CTS assessments, nor are there any conclusive findings regarding the usefulness of various sonographic measurements in studies of different upper limb activities. In this review, we intend to evaluate the methodology of assessing CTS induced by upper limb activities with ultrasonographic technique and provide corresponding suggestions. METHODS Clinical studies on the association between upper limb activities and prevalence of CTS using ultrasonography were recruited in a database research on the basis of a procedural selection criteria and reviewed. The following qualitative items were extracted: characteristics of studies, scanning methods, selection of sonographic parameters, and related article findings. RESULTS Eleven studies were qualified for this review. Three studies were computer keyboard typing related, five studies were electronic device related, and three studies were wheelchair-related. All sampled articles included cross-sectional area (CSA) at the pisiform level. The swelling ratio (SR) and flattening ratio (FR) at the hamate level are also used in most studies in addition to the CSA at the pisiform level. The effectiveness of such parameters is subjected to various confounding factors such as age, weight, body mass index, and wrist anthropometrics, suggesting CSA and SR with sufficient levels had significant values as sonographic parameters. Values of parameters were found affecting symptomatic signs and hand dominance. CONCLUSION Ultrasound scan is a suitable tool to assess the relationship between upper limb activity and CTS. CSA at the pisiform level and SR and the FR at the hamate levels are generally suitable in upper limb-associated CTS investigations. Specific study designs are required to eliminate different confounding factors accordingly.
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Affiliation(s)
- Sze Wah Fong
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Bosco Wang Fung Liu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Chun Lok Sin
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - King Sang Lee
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Tsun Ming Wong
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Ka Sin Choi
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Yi-Ping Yang
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yi-Ying Lin
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yueh Chien
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yih-Wen Tarng
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Cheng-Fong Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Orthopedics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Liang-Ting Lin
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
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Keir PJ, Farias Zuniga A, Mulla DM, Somasundram KG. Relationships and Mechanisms Between Occupational Risk Factors and Distal Upper Extremity Disorders. HUMAN FACTORS 2021; 63:5-31. [PMID: 31314601 DOI: 10.1177/0018720819860683] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The relationships between workplace risk factors and upper extremity injuries from epidemiological and laboratory studies were examined. BACKGROUND Epidemiological studies are associated with several limitations, affecting the strength of association between risk factors and the development of injuries. METHOD In this narrative review, we identified epidemiological and laboratory studies (published primarily since 1997) investigating exposure to workplace risk factors (force, repetition, posture, vibration) and risk of hand/wrist tendon-related disorders, epicondylitis, and carpal tunnel syndrome (CTS). RESULTS Forceful exertions are strongly associated with hand/wrist tendon-related disorders, epicondylitis, and CTS. Dose-response relationships were found for epicondylitis (repetition) and CTS (posture). Interactions demonstrate multiplicative effects of risk factors for injury risk. Laboratory studies display clear associations between task demands and biomechanical measures linked to mechanisms for upper extremity injuries with animal models providing further evidence of a dose-response between risk factors and injury. CONCLUSION Forceful, repetitive work requiring non-neutral postures are associated with increasing risk of hand/wrist tendon-related disorders, epicondylitis, and CTS as evidenced by epidemiology studies and laboratory-based investigations of humans and animals. APPLICATION Understanding the relationship between exposure levels of workplace risk factors and upper extremity disorders can improve injury prevention and rehabilitation strategies.
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Shah R, Li ZM. Ligament and Bone Arch Partition of the Carpal Tunnel by Three-Dimensional Ultrasonography. J Biomech Eng 2020; 142:091008. [PMID: 32110808 PMCID: PMC7247533 DOI: 10.1115/1.4046502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 01/30/2020] [Indexed: 11/08/2022]
Abstract
The carpal tunnel is geometrically irregular due to the complex composition of many carpal bones intercalated by numerous intercarpal ligaments. The purpose of the study was to investigate the relative contributions of the ligament and bone arches to carpal tunnel space at the proximal, middle, and distal tunnel regions. A catheter ultrasound probe acquired fan-like images inside cadaveric carpal tunnels for three-dimensional reconstruction of the tunnel. The total tunnel volume was 5367.6 ± 940.1 mm3 with contributions of 12.0%, 6.9%, and 4.1% by proximal, middle, and distal ligament arches, respectively, and 27.0%, 25.3%, and 24.7% by proximal, middle, and distal bone arches, respectively. The bone arch occupied more tunnel space than the ligament arch at all regions (p < 0.05). The ligament arch was largest at the proximal region of the tunnel and significantly decreased toward the distal region (p < 0.05). However, the bone arch significantly decreased only from the proximal to middle region (p < 0.05) but not from the middle to distal region (p = 0.311). Consequently, it was observed that the ligament arch was the key contributor to the unequal carpal tunnel space across regions. Partitional and regional tunnel morphometric information may provide a better understanding of tunnel abnormality associated with various wrist pathological conditions. The developed framework of ultrasonography and data processing can be applied to other areas of interest in the musculoskeletal system.
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Affiliation(s)
- Rakshit Shah
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195; Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH 44115
| | - Zong-Ming Li
- Department of Biomedical Engineering, Orthopaedic Surgery, and Physical, Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH 44195; Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ 85724
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13
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Yao Y, Grandy E, Evans PJ, Seitz WH, Li ZM. Location-dependent change of median nerve mobility in the carpal tunnel of patients with carpal tunnel syndrome. Muscle Nerve 2020; 62:522-527. [PMID: 32644200 DOI: 10.1002/mus.27017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The purpose of this study was to investigate in vivo median nerve longitudinal mobility in different segments of the carpal tunnel associated with active finger motion in carpal tunnel syndrome (CTS) patients in a comparison with healthy controls. METHODS Eleven healthy volunteers and 11 CTS patients participated in this study. Dynamic ultrasound images captured location-dependent longitudinal median nerve mobility within the carpal tunnel during finger flexion at the metacarpophalangeal joints using a speckle cross-correlation algorithm. RESULTS Median nerve longitudinal mobility in the carpal tunnel was significantly smaller in CTS patients (0.0037 ± 0.0011 mm/degree) compared with controls (0.0082 ± 0.0026 mm/degree) (P < .05), especially in the proximal (0.0064 vs 0.0132 mm/degree on average) and middle (0.0033 vs 0.0074 mm/degree on average) carpal tunnel sections. DISCUSSION Median nerve mobility can potentially serve as a biomechanical marker when diagnosing CTS, or when assessing the effectiveness of surgical and conservative treatments.
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Affiliation(s)
- Yifei Yao
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Emily Grandy
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Peter J Evans
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - William H Seitz
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zong-Ming Li
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona, USA
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14
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Yao B, Gan K, Lee A, Roll SC. Comparing Shape Categorization to Circularity Measurement in the Evaluation of Median Nerve Compression Using Sonography. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020; 2020. [PMID: 32064465 DOI: 10.1177/8756479319898471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose This study aimed to develop a subjective categorization of nerve shape and to examine the relationship of shape categorizations to measurement of nerve circularity. Methods Wrists were evaluated with sonography in healthy participants. Images of the median nerve were obtained in the transverse plane at the level of pisiform with the fingers resting, gripping, and pinching. Nerves were categorized as ovoid, angular, or irregular, and the cross-sectional area and perimeter were measured to calculate nerve circularity. Results Across 167 participants, the median nerve shifted from being primarily ovoid at rest to angular shaped when the fingers were in a full fist or pinching. Approximately three-quarters of subjects exhibited a shape change during dynamic movement. Irregular nerves had the lowest circularity values; however, the majority of nerves had similar circularity measures despite having different shapes. Conclusions Subjective categorization of shape has the potential to be a valid technique for evaluation of the median nerve using sonography, and this evaluation may provide additional information regarding nerve compression that is not fully captured by a circularity measure. Further investigation is needed to determine how these two techniques may be best used individually or together to advance clinical diagnosis, prevention, and rehabilitative interventions.
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Affiliation(s)
- Buwen Yao
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Kayla Gan
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Annie Lee
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Shawn C Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
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Bueno-Gracia E, Salcedo-Gadea J, López-de-Celis C, Salcedo-Gadea E, Pérez-Bellmunt A, Estébanez-de-Miguel E. Dimensional Changes of the Tibial Nerve and Tarsal Tunnel in Different Ankle Joint Positions in Asymptomatic Subjects. J Foot Ankle Surg 2019; 58:1129-1133. [PMID: 31679666 DOI: 10.1053/j.jfas.2019.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 12/19/2018] [Accepted: 03/12/2019] [Indexed: 02/03/2023]
Abstract
The tarsal tunnel is a clinically important fibrous osseous conduit for the tibial nerve and associated tendons. It is mechanically dynamic, and normal ankle movements appear to change the tunnel shape, potentially having an impact on the tibial nerve. The objective of this study was to measure changes in the tibial nerve and tarsal tunnel dimensions in plantarflexion and dorsiflexion of the ankle joint in healthy subjects. A cross-sectional study with 13 volunteer subjects and a total of 18 records was designed. The cross-sectional area, anterior-posterior distance, transverse distance, and flattening ratio of the tibial nerve were measured by using ultrasound in plantarflexion and dorsiflexion of the ankle joint. The anterior-posterior distance of the tarsal tunnel was also measured. The tunnel anterior-posterior distance significantly increased during plantarflexion (p < .001) and decreased during dorsiflexion (p = .027) of the ankle. From plantarflexion to dorsiflexion of the ankle, the tibial nerve cross-sectional area significantly decreased (p = .035). The anterior-posterior distance also decreased significantly (p < .001), whereas the transverse distance increased (p < .001), thus decreasing the flattening ratio of the tibial nerve (p < .001). Ankle joint position determined significant changes in the shape and dimensions of the tibial nerve at the tarsal tunnel.
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Affiliation(s)
- Elena Bueno-Gracia
- Physiotherapist, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | | | - Carlos López-de-Celis
- Physiotherapist, Faculty of Medicine and Health Sciences, International University of Catalonia, Barcelona, Spain
| | | | - Albert Pérez-Bellmunt
- Physiotherapist, Faculty of Medicine and Health Sciences, International University of Catalonia, Barcelona, Spain
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Yao Y, Grandy E, Jenkins L, Hou J, Evans PJ, Seitz WH, Li ZM. Changes of median nerve conduction, cross-sectional area and mobility by radioulnar wrist compression intervention in patients with carpal tunnel syndrome. J Orthop Translat 2019; 18:13-19. [PMID: 31508303 PMCID: PMC6718919 DOI: 10.1016/j.jot.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/16/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Owing to the compressive nature of the neuropathy, patients with carpal tunnel syndrome (CTS) have prolonged distal motor latency (DML), sensory nerve latency (SNL), median nerve swelling and restricted median nerve mobility. The purpose of this study was to noninvasively augment carpal tunnel space using radioulnar wrist compression (RWC) and evaluate its effects on median nerve pathological properties in patients with CTS. It was hypothesized that the RWC intervention would reduce the median nerve DML, SNL and cross-sectional area (CSA) and enhance longitudinal median nerve mobility in patients. with CTS. METHODS Eleven patients diagnosed with CTS participated in this study. A portable RWC intervention splint was developed to apply 10 N of compressive force across the wrist. Three daily sessions of RWC were performed over 4 weeks of intervention (15 min per session, 45 min per day, 7 days per week). Each 15-min session consisted of three 5-min blocks of RWC, with a 1-min rest in between consecutive blocks. Patients were evaluated at Week 0 (baseline), Week 2 (mid-intervention) and Week 4 (end of intervention). DML and SNL of the median nerve were evaluated using established nerve conduction study techniques. Median nerve CSA at the distal wrist crease was obtained by ultrasound imaging. Median nerve motion associated with finger flexion/extension was captured by dynamic ultrasound imaging and quantified using a speckle cross-correlation algorithm. Finger flexion/extension was recorded using an electrogoniometer. The slope of the regressed linear equation of median nerve displacement as a function of finger flexion angle was used to quantify nerve mobility. RESULTS Patients with CTS showed significantly decreased DML (p = 0.048) and median nerve CSA (p < 0.001) and increased nerve mobility (p < 0.001) at mid-intervention compared to baseline. However, DML, CSA and mobility of the median nerve did not differ significantly between Weeks 2 and 4 (p = 0.574, 1.00 and 0.139, respectively). Median nerve SNL was not significantly affected throughout the 4-week intervention (p = 0.330 for Week 0 vs. 2; p = 1.00 for Week 2 vs. 4). CONCLUSION This study revealed that RWC intervention with 10-N force applied to the wrist in the radioulnar direction could restore impaired neurophysiological and biomechanical functions of the median nerve. The beneficial effects of RWC intervention for the median nerve were in evidence after a relatively short period of two weeks. These functional improvements could be explained by intermittent decompression of the median nerve via RWC-induced augmentation of the carpal arch. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE Biomechanically manipulating the carpal tunnel by RWC decompresses the median nerve and has the potential to become an alternative treatment for CTS.
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Affiliation(s)
- Yifei Yao
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Emily Grandy
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Lenicia Jenkins
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Juliet Hou
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Peter J. Evans
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - William H. Seitz
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Zong-Ming Li
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA
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Yao Y, Grandy E, Evans PJ, Seitz WH, Li ZM. Enhancement in median nerve mobility during radioulnar wrist compression in carpal tunnel syndrome patients. Clin Biomech (Bristol, Avon) 2018; 60:83-88. [PMID: 30336369 PMCID: PMC6252106 DOI: 10.1016/j.clinbiomech.2018.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/10/2018] [Accepted: 10/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Carpal tunnel syndrome is a compression neuropathy at the wrist associated with compromised median nerve mobility. The purpose of this study was to investigate the effects of radioulnar wrist compression on median nerve longitudinal mobility within the carpal tunnel in carpal tunnel syndrome patients as well as healthy subjects. METHODS Dynamic ultrasound images captured longitudinal median nerve motion in the carpal tunnel during radioulnar wrist compression force application in 11 healthy subjects and 11 carpal tunnel syndrome patients. FINDINGS We found that median nerve mobility was not significantly affected by radioulnar wrist compression in healthy subjects (P = 0.34), but improved by 10 N radioulnar wrist compression in carpal tunnel syndrome patients (P < 0.05). Analysis of segmental median nerve mobility in carpal tunnel syndrome patients showed significantly improved mobility in the proximal tunnel section under 10 N radioulnar wrist compression force condition compared to the no compression condition (P < 0.05). INTERPRETATION Moderate radioulnar wrist compression force application helps restore impaired median nerve mobility and may be effective in improve nerve function and symptoms associated with carpal tunnel syndrome.
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Affiliation(s)
- Yifei Yao
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Emily Grandy
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Peter J Evans
- Department of Orthopaedic Surgery, and Cleveland Clinic, Cleveland, OH, USA
| | - William H Seitz
- Department of Orthopaedic Surgery, and Cleveland Clinic, Cleveland, OH, USA
| | - Zong-Ming Li
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA; Department of Orthopaedic Surgery, and Cleveland Clinic, Cleveland, OH, USA; Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA.
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Dimensional changes of the carpal tunnel and median nerve during manual mobilization of the carpal bones - Anatomical study. Clin Biomech (Bristol, Avon) 2018; 59:56-61. [PMID: 30195102 DOI: 10.1016/j.clinbiomech.2018.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/01/2018] [Accepted: 09/01/2018] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Cross-sectional study. BACKGROUND The carpal tunnel is a clinically important fibro-osseous conduit for the median nerve and associated tendons. It is mechanically dynamic and therapeutic manual techniques that appear to move and change tunnel shape is part of clinical practice. OBJECTIVES To measure changes in dimensions of the carpal tunnel and median nerve with manual mobilization of the carpal bones in cadavers. METHODS A total of 20 cryopreserved upper extremities from cadaveric specimens were used in the study. The wrist was cut using an anatomical saw at the level of the pisiform. Measurements of the cross-sectional area (CSA), anteroposterior diameter (APD), transverse diameter (TD), perimeter, flattening ratio and circularity of the carpal tunnel and of the median nerve, were taken, both in the anatomical position of the wrist and during the mobilization technique of the carpal bones. RESULTS During the mobilization technique, the tunnel CSA (p < 0.011), APD (p < 0.001) and circularity (p < 0.001) significantly increased, while TD (p < 0.001), perimeter (p < 0.004) and flattening ratio (p < 0.001), decreased. The median nerve showed similar behavioral tendencies to the tunnel but only the CSA (p < 0.005), APD (p < 0.005) and flattening ratio (p < 0.004) of the nerve showed significant differences. CONCLUSION Application of external manually applied compressive force across the wrist can increase the CSA of the carpal tunnel and the median nerve in cadavers. These results are consistent with other studies in which similar results were found non-invasively using ultrasound.
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Bueno-Gracia E, Ruiz-de-Escudero-Zapico A, Malo-Urriés M, Shacklock M, Estébanez-de-Miguel E, Fanlo-Mazas P, Caudevilla-Polo S, Jiménez-Del-Barrio S. Dimensional changes of the carpal tunnel and the median nerve during manual mobilization of the carpal bones. Musculoskelet Sci Pract 2018; 36:12-16. [PMID: 29635191 DOI: 10.1016/j.msksp.2018.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 03/26/2018] [Accepted: 04/03/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The carpal tunnel is a clinically important fibro-osseous conduit for the median nerve and associated tendons. It is mechanically dynamic, such that the dimensions of the tunnel and median nerve change with position, movement and application of externally applied force with mechanical devices. Therapeutic manual techniques that appear to move and change tunnel shape are part of clinical practice. The aim of this study was therefore to measure changes in dimensions of the carpal tunnel and median nerve with manual mobilization of the carpal bones. MATERIAL AND METHODS An analytical descriptive study with 18 volunteer subjects and a total of 33 records was designed. Ultrasound measurements of the cross-sectional area (CSA), anteroposterior diameter (APD), transverse diameter (TD), perimeter, flattening ratio and circularity of the carpal tunnel and of the median nerve, were measured, both in the anatomical position of the wrist and during mobilization techniques of the carpal bones. RESULTS During the mobilization technique, the tunnel (p = 0.003) CSA significantly increased. APD also increased significantly for the tunnel (<0.001) while TD decreased. The median nerve showed similar and significant (p < 0.001) changes than the tunnel. However, because several of the obtained differences where smaller than the SDD obtained in a previous study, these differences were considered as irrelevant. CONCLUSIONS Manual mobilization of the carpal bones produced significant changes in the dimensions of the carpal tunnel.
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Affiliation(s)
- Elena Bueno-Gracia
- Department of Physiatry and Nursery, Faculty of Heath Sciences, University of Zaragoza, C/Domingo Miral s/n, CP: 50009. Zaragoza, Spain.
| | - Alazne Ruiz-de-Escudero-Zapico
- Department of Physiatry and Nursery, Faculty of Heath Sciences, University of Zaragoza, C/Domingo Miral s/n, CP: 50009. Zaragoza, Spain
| | - Miguel Malo-Urriés
- Department of Physiatry and Nursery, Faculty of Heath Sciences, University of Zaragoza, C/Domingo Miral s/n, CP: 50009. Zaragoza, Spain
| | | | - Elena Estébanez-de-Miguel
- Department of Physiatry and Nursery, Faculty of Heath Sciences, University of Zaragoza, C/Domingo Miral s/n, CP: 50009. Zaragoza, Spain
| | - Pablo Fanlo-Mazas
- Department of Physiatry and Nursery, Faculty of Heath Sciences, University of Zaragoza, C/Domingo Miral s/n, CP: 50009. Zaragoza, Spain
| | - Santos Caudevilla-Polo
- Department of Physiatry and Nursery, Faculty of Heath Sciences, University of Zaragoza, C/Domingo Miral s/n, CP: 50009. Zaragoza, Spain
| | - Sandra Jiménez-Del-Barrio
- Department of Physiatry and Nursery, Faculty of Heath Sciences, University of Zaragoza, C/Domingo Miral s/n, CP: 50009. Zaragoza, Spain
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Yao Y, Erdemir A, Li ZM. Finite element analysis for transverse carpal ligament tensile strain and carpal arch area. J Biomech 2018; 73:210-216. [PMID: 29678419 DOI: 10.1016/j.jbiomech.2018.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 03/21/2018] [Accepted: 04/02/2018] [Indexed: 11/18/2022]
Abstract
Mechanics of carpal tunnel soft tissue, such as fat, muscle and transverse carpal ligament (TCL), around the median nerve may render the median nerve vulnerable to compression neuropathy. The purpose of this study was to understand the roles of carpal tunnel soft tissue mechanical properties and intratunnel pressure on the TCL tensile strain and carpal arch area (CAA) using finite element analysis (FEA). Manual segmentation of the thenar muscles, skin, fat, TCL, hamate bone, and trapezium bone in the transverse plane at distal carpal tunnel were obtained from B-mode ultrasound images of one cadaveric hand. Sensitivity analyses were conducted to examine the dependence of TCL tensile strain and CAA on TCL elastic modulus (0.125-10 MPa volar-dorsally; 1.375-110 MPa transversely), skin-fat and thenar muscle initial shear modulus (1.6-160 kPa for skin-fat; 0.425-42.5 kPa for muscle), and intratunnel pressure (60-480 mmHg). Predictions of TCL tensile strain under different intratunnel pressures were validated with the experimental data obtained on the same cadaveric hand. Results showed that skin, fat and muscles had little effect on the TCL tensile strain and CAA changes. However, TCL tensile strain and CAA increased with decreased elastic modulus of TCL and increased intratunnel pressure. The TCL tensile strain and CAA increased linearly with increased pressure while increased exponentially with decreased elastic modulus of TCL. Softening the TCL by decreasing the elastic modulus may be an alternative clinical approach to carpal tunnel expansion to accommodate elevated intratunnel pressure and alleviate median nerve compression neuropathy.
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Affiliation(s)
- Yifei Yao
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Ahmet Erdemir
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Zong-Ming Li
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, United States; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, United States; Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH 44195, United States.
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21
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Bueno-Gracia E, Malo-Urriés M, Ruiz-de-Escudero-Zapico A, Rodríguez-Marco S, Jiménez-Del-Barrio S, Shacklock M, Estébanez-de-Miguel E, Tricás-Moreno JM. Reliability of measurement of the carpal tunnel and median nerve in asymptomatic subjects with ultrasound. Musculoskelet Sci Pract 2017; 32:17-22. [PMID: 28800435 DOI: 10.1016/j.msksp.2017.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/29/2017] [Accepted: 08/04/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Morphology of the carpal tunnel changes with varying wrist postures and compressive forces applied to the wrist. These changes may affect the morphology and pressure on the median nerve and could be used as part of the treatment of the carpal tunnel syndrome patients. Reliability of the ultrasonographic measurements of the median nerve has been widely studied. However, there is a lack of investigation regarding reliability of ultrasonographic measurements of the carpal tunnel. OBJECTIVE The purpose of this study was to assess intra-tester and inter-tester reliability of measurement of dimensions of the carpal tunnel and median nerve with ultrasound in asymptomatic volunteers. DESIGN A cross-sectional methodological study. METHODS Aspects measured were mediolateral and anteroposterior diameters, flattening ratio, circularity, perimeter and cross-section area of the carpal tunnel and median nerve. RESULTS Intra-tester reliability was excellent for the carpal tunnel (ICCs from 0.91 to 0.97) and for the median nerve (ICCs from 0.79 to 0.94) measurements. The flattening ratio of the median nerve showed good agreement (ICC = 0.68). Inter-tester reliability was excellent for the carpal tunnel measurements (ICCs from 0.76 to 0.95) and, for the cross sectional area, the perimeter and mediolateral diameter of the median nerve, the ICC values were 0.89, 0.84 and 0.81, respectively. CONCLUSION In the context of this study, ultrasound was a reliable instrument for measuring carpal tunnel and median nerve dimensions in asymptomatic subjects. LEVEL OF EVIDENCE 1b.
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Affiliation(s)
- Elena Bueno-Gracia
- Department of Physiatry and Nursery, Faculty of Heath Sciences, University of Zaragoza, C/Domingo Miral s/n, CP: 50009, Zaragoza, Spain.
| | - Miguel Malo-Urriés
- Department of Physiatry and Nursery, Faculty of Heath Sciences, University of Zaragoza, C/Domingo Miral s/n, CP: 50009, Zaragoza, Spain
| | - Alazne Ruiz-de-Escudero-Zapico
- Department of Physiatry and Nursery, Faculty of Heath Sciences, University of Zaragoza, C/Domingo Miral s/n, CP: 50009, Zaragoza, Spain
| | - Sonia Rodríguez-Marco
- Department of Physiatry and Nursery, Faculty of Heath Sciences, University of Zaragoza, C/Domingo Miral s/n, CP: 50009, Zaragoza, Spain
| | | | | | - Elena Estébanez-de-Miguel
- Department of Physiatry and Nursery, Faculty of Heath Sciences, University of Zaragoza, C/Domingo Miral s/n, CP: 50009, Zaragoza, Spain
| | - José Miguel Tricás-Moreno
- Department of Physiatry and Nursery, Faculty of Heath Sciences, University of Zaragoza, C/Domingo Miral s/n, CP: 50009, Zaragoza, Spain
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Walia P, Erdemir A, Li ZM. Subject-specific finite element analysis of the carpal tunnel cross-sectional to examine tunnel area changes in response to carpal arch loading. Clin Biomech (Bristol, Avon) 2017; 42:25-30. [PMID: 28073093 PMCID: PMC5319899 DOI: 10.1016/j.clinbiomech.2017.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Manipulating the carpal arch width (i.e. distance between hamate and trapezium bones) has been suggested as a means to increase carpal tunnel cross-sectional area and alleviate median nerve compression. The purpose of this study was to develop a finite element model of the carpal tunnel and to determine an optimal force direction to maximize area. METHODS A planar geometric model of carpal bones at hamate level was reconstructed from MRI with inter-carpal joint spaces filled with a linear elastic surrogate tissue. Experimental data with discrete carpal tunnel pressures (50, 100, 150, and 200mmHg) and corresponding carpal bone movements were used to obtain material property of surrogate tissue by inverse finite element analysis. The resulting model was used to simulate changes of carpal arch widths and areas with directional variations of a unit force applied at the hook of hamate. FINDINGS Inverse finite element model predicted the experimental area data within 1.5% error. Simulation of force applications showed that carpal arch width and area were dependent on the direction of force application, and minimal arch width and maximal area occurred at 138° (i.e. volar-radial direction) with respect to the hamate-to-trapezium axis. At this force direction, the width changed to 24.4mm from its initial 25.1mm (3% decrease), and the area changed to 301.6mm2 from 290.3mm2 (4% increase). INTERPRETATION The findings of the current study guide biomechanical manipulation to gain tunnel area increase, potentially helping reduce carpal tunnel pressure and relieve symptoms of compression median neuropathy.
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Affiliation(s)
- Piyush Walia
- Hand Research Laboratory, Cleveland Clinic, Cleveland, OH, United States,Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States
| | - Ahmet Erdemir
- Computational Biomodeling (CoBi) Core, Cleveland Clinic, Cleveland, OH, United States,Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States
| | - Zong-Ming Li
- Hand Research Laboratory, Cleveland Clinic, Cleveland, OH, United States,Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States,Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, United States,Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, United States
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Marquardt TL, Evans PJ, Seitz WH, Li ZM. Carpal arch and median nerve changes during radioulnar wrist compression in carpal tunnel syndrome patients. J Orthop Res 2016; 34:1234-40. [PMID: 26662276 PMCID: PMC4903096 DOI: 10.1002/jor.23126] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/08/2015] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to investigate the morphological changes of the carpal arch and median nerve during the application of radiounlarly directed compressive force across the wrist in patients with carpal tunnel syndrome. Radioulnar compressive forces of 10 N and 20 N were applied at the distal level of the carpal tunnel in 10 female patients diagnosed with carpal tunnel syndrome. Immediately prior to force application and after 3 min of application, ultrasound images of the distal carpal tunnel were obtained. It was found that applying force across the wrist decreased the carpal arch width (p < 0.001) and resulted in increased carpal arch height (p < 0.01), increased carpal arch curvature (p < 0.001), and increased radial distribution of the carpal arch area (p < 0.05). It was also shown that wrist compression reduced the flattening of the median nerve, as indicated by changes in the nerve's circularity and flattening ratio (p < 0.001). This study demonstrated that the carpal arch can be non-invasively augmented by applying compressive force across the wrist, and that this strategy may decompress the median nerve providing symptom relief to patients with carpal tunnel syndrome. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1234-1240, 2016.
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Affiliation(s)
| | | | | | - Zong-Ming Li
- Correspondence: Zong-Ming Li, PhD, Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH 44195, USA, Phone: 216-444-1211, Fax: 216-444-9198,
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