1
|
Jengojan SA, Lechner L, Kasprian G, Drakonaki E, Moser V, Snoj Ž, Bodner G. Median nerve versus flexor tendons: visualization of median nerve level changes in the proximal carpal tunnel during wrist movement with dynamic high-resolution ultrasound. J Ultrason 2023; 23:e114-e121. [PMID: 37732110 PMCID: PMC10508267 DOI: 10.15557/jou.2023.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/20/2023] [Indexed: 09/22/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Suren Armeni Jengojan
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Lisa Lechner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Elena Drakonaki
- Anatomy Department, Medical School, University of Crete, Crete, Greece
| | - Veith Moser
- Department of Trauma Surgery, Lorenz Boehler Hospital, Vienna, Austria
| | - Žiga Snoj
- Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gerd Bodner
- Neuromuscular Imaging Center Döbling, Döbling Doctors’ Center, Vienna, Austria
| |
Collapse
|
2
|
Impaired median nerve mobility in patients with carpal tunnel syndrome: a systematic review and meta-analysis. Eur Radiol 2023; 33:2378-2385. [PMID: 36394604 DOI: 10.1007/s00330-022-09262-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This systematic review and meta-analysis investigated the mobility of the median nerve (MN) in carpal tunnel syndrome (CTS) patients compared to healthy people. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed and the electronic databases including PubMed, Scopus, EMBASE, and Cochrane Library were searched up to April 2022. All published observational studies comparing the excursion of MN between participants with and without CTS were included. The quality of research was assessed by the Newcastle-Ottawa Scale tool. The primary outcome was the excursion of the MN under dynamic examination, representing nerve mobility quantified by the standardized mean difference (SMD) for random effect meta-analysis. RESULTS Fourteen studies were included in the qualitative review, and twelve entered the meta-analysis involving a total of 375 CTS patients and 296 healthy controls. The forest plot revealed that the mobility of the MN significantly decreased in the CTS group compared to the non-CTS control (SMD = -1.47, 95% CI: -1.91, -1.03, p < 0.001, heterogeneity 82%). In subgroup analysis, both transverse and longitudinal methods for nerve excursion showed less nerve mobility in CTS than in non-CTS. CONCLUSIONS This meta-analysis showed that the patients with CTS exhibited less mobility of the MN than those without CTS, suggesting MN mobility as a potential CTS marker. KEY POINTS • The patients with CTS revealed less mobility of the median nerve than those without CTS. • The mobility of the median nerve could be regarded as a potential CTS marker.
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
Abstract
Diagnostic ultrasound in the diagnosis of carpal tunnel syndrome is firmly established. Preoperative evaluation is based on quantitative parameters such as measurement of the pathologically enlarged cross-sectional area of the nerve. The value of postoperative ultrasound lies in the visualization of the anatomy and the conclusions that can be drawn from it. It focuses on the semiquantitative sonographic parameters of nerve compression. Nerve lesions and persistent strictures can be visualized and clearly localized. In recurrent disease, the primary focus is to dynamically exclude postoperative scarring, which results in a reduction of nerve gliding.
Collapse
Affiliation(s)
- Sebastian Kluge
- Handchirurgie Seefeld, Seefeldstrasse 27, Zurich 8008, Switzerland; Department of Hand Surgery, Klinik Impuls, Bahnhofstraße 137, Wetzikon 8620, Switzerland.
| | - Martin Langer
- Department of Trauma, Hand and Reconstructive Surgery, University of Munster, Waldeyerstraße 1, Munster 48149, Germany
| | - Thomas Schelle
- Department of Neurology, Klinikum Dessau-Rosslau, Auenweg 38, Dessau-Rosslau 06847, Germany
| |
Collapse
|
5
|
Yao B, Roll SC. An ultrasound study of the mobility of the median nerve during composite finger movement in the healthy young wrist. Muscle Nerve 2022; 65:82-88. [PMID: 34648193 PMCID: PMC8671362 DOI: 10.1002/mus.27437] [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: 01/13/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION/AIMS There is a lack of consensus regarding median nerve movement in the carpal tunnel during composite finger flexion in healthy individuals. In this study we examined the amount and direction of median nerve movement and differentiate nerve mobility between dominant and nondominant sides in a large, healthy, young adult cohort. METHODS Sonographic videos of the median nerve during composite finger motion from extension to full flexion were analyzed in 197 participants without median nerve pathology. Displacement of the nerve's centroid was calculated based on a change in the relative location of the nerve. Longitudinal nerve sliding was categorized as none, independently from the tendons, or with the tendons. RESULTS In short axis, median nerves moved within 1 mm vertically and 3 mm horizontally; no direction was predominant. About half of the nerves (52.5%) slid independently while 26.9% slid with the tendons; 21.3% did not slide at all. On the nondominant side, median nerves that slid with the tendons had a larger absolute vertical displacement than nerves that slid independently or did not slide at all (P < .01). Nerves on the dominant side moved in a radial direction more frequently than on the nondominant side (P = .02). DISCUSSION Transverse nerve movement during composite finger flexion in healthy individuals varies widely with no clear pattern in the direction of transverse movement or amount of longitudinal sliding. These data provide a foundation for future research to better understand the biomechanical contribution of nerve movement to median nerve pathologies.
Collapse
Affiliation(s)
- Buwen Yao
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Shawn C Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
6
|
Hosseini-Farid M, Schrier VJMM, Starlinger J, Zhao C, Amadio PC. Carpal tunnel syndrome treatment and the subsequent alterations in tendon and connective tissue dynamics. Clin Biomech (Bristol, Avon) 2021; 88:105440. [PMID: 34329857 PMCID: PMC8490321 DOI: 10.1016/j.clinbiomech.2021.105440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Carpal tunnel syndrome patients demonstrate diminished motion of the median nerve and fibrotic changes in the subsynovial connective tissue within the carpal tunnel. Currently, there are few prognostic factors to help predict the outcome of commonly performed treatments including surgical carpal tunnel release and corticosteroid injections. This study aimed to non-invasively assess the changes in the dynamic response of the subsynovial tissue relative to tendon motion after the intervention and to correlate this with disease severity. METHODS A total of 145 patients with carpal tunnel syndrome were recruited into this study. Clinical and demographic data, electrophysiological severity and dynamic ultrasound images were collected before and after treatment, either by injection or surgery. The relative motion of the subsynovial tissue with the underlying middle finger flexor digitorum superficialis tendon was measured using a speckle tracking algorithm and was expressed as a shear index (SI). Baseline and follow-up data, the association between change in SI and severity, and the role of treatment modality were analyzed and statistically compared. FINDINGS Overall, there was a significant increase (more relative motion) after treatment in the mean shear index from 79.9% (±15.4% SD) to 82.9% (±14.8% SD) (p = 0.03). Secondary analyses showed that this change was mostly present in those with mild disease severity undergoing surgery (p = 0.01). INTERPRETATION This study shows that the relative subsynovial tissue movement increases in patients after intervention. The present study lays a foundation for future studies to non-invasively assess the role of carpal tunnel dynamics in response to treatment.
Collapse
Affiliation(s)
- Mohammad Hosseini-Farid
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States; College of Computing and Engineering, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Verena J M M Schrier
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States; Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Julia Starlinger
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States; Medical University Vienna, Department of Orthopedics and Trauma Surgery, Vienna, Austria
| | - Chunfeng Zhao
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Peter C Amadio
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| |
Collapse
|
7
|
Schrier VJMM, Evers S, Geske JR, Kremers WK, Villarraga HR, Selles RW, Hovius SER, Gelfman R, Amadio PC. Relative Motion of the Connective Tissue in Carpal Tunnel Syndrome: The Relation with Disease Severity and Clinical Outcome. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2236-2244. [PMID: 32600671 PMCID: PMC7429249 DOI: 10.1016/j.ultrasmedbio.2020.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 05/07/2023]
Abstract
Excursion of the median nerve and the surrounding subsynovial connective tissue (SSCT) is diminished in patients with carpal tunnel syndrome (CTS). This study sought to determine if SSCT excursion could be utilized to predict surgical outcome. Idiopathic CTS patients were reviewed with ultrasound and electrodiagnostic tests at baseline. A speckle tracking algorithm was used to determine SSCT relative to tendon motion (shear index). Analysis of variance tests were used to compare SSCT motion with disease severity at baseline. Adjusted linear regressions were used to test the association with patient-reported outcome. A total of 90 CTS patients were analyzed and found to have an average shear index of 79% (95% confidence interval: 76.3%-81.6%). SSCT motion was lower in CTS patients with increasing electrophysiological severity (p = 0.0475). There was no significant association of pre-operative SSCT motion with symptomatic improvement (p = 0.268). Overall, SSCT motion is decreased in CTS patients, but exhibits limited correlation with clinical severity.
Collapse
Affiliation(s)
- Verena J M M Schrier
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stefanie Evers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jennifer R Geske
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Walter K Kremers
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Hector R Villarraga
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Steven E R Hovius
- Department of Plastic and Reconstructive Surgery, Radboudumc University Hospital, Nijmegen, The Netherlands
| | - Russell Gelfman
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter C Amadio
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Woo EHC, White P, Lai CWK. Morphological Changes of the Median Nerve Within the Carpal Tunnel During Various Finger and Wrist Positions: An Analysis of Intensive and Nonintensive Electronic Device Users. J Hand Surg Am 2019; 44:610.e1-610.e15. [PMID: 30301644 DOI: 10.1016/j.jhsa.2018.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/07/2018] [Accepted: 08/08/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effects of static hand postures during various finger and wrist positions on morphological changes of the median nerve within the carpal tunnel in intensive and nonintensive electronic device users. METHODS Forty-eight university students, equally divided into intensive and nonintensive users (≥5 h/d and <5 h/d of electronic device usage, respectively), were randomly selected after questionnaire responses and evaluated clinically and by ultrasonography. RESULTS Intensive users reported more wrist/hand pain with a high severity score than nonintensive users. They also had larger median nerve cross-sectional areas, flattening ratios, and perimeters than nonintensive users, and showed less median nerve deformation under various finger and wrist positions. Compared with the neutral wrist position with all fingers extended for both intensive and nonintensive users, the cross-sectional areas decreased under finger flexion and grip, as well as wrist extension-flexion and radial-ulnar deviation. Overall, the average median nerve size of the dominant hand was much larger than that of the nondominant hand, especially for intensive users. CONCLUSIONS Wrist deviation from neutral can lead to more pronounced deformation of the median nerve than finger flexion for both intensive and nonintensive users. To minimize compression on the median nerve, it is important to keep the wrist as near to the neutral position as possible during computer-related work and avoid keeping the thumb and fingers in a static flexed position when using mobile devices, especially for single-hand use. CLINICAL RELEVANCE On the basis of this observational study, intensive users had enlarged and flattened median nerves as well as decreased nerve deformation during hand motions compared with nonintensive users. As overuse of electronic devices may adversely affect the median nerve, caution may be warranted.
Collapse
Affiliation(s)
- Eugenia Hoi Chi Woo
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region, China
| | - Peter White
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region, China.
| | - Christopher Wai Keung Lai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region, China
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
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.
Collapse
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.
| |
Collapse
|
12
|
Ellis R, Rohan M, Fox J, Hitt J, Langevin H, Henry S. Ultrasound Elastographic Measurement of Sciatic Nerve Displacement and Shear Strain During Active and Passive Knee Extension. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2091-2103. [PMID: 29430675 DOI: 10.1002/jum.14560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/22/2017] [Accepted: 11/24/2017] [Indexed: 06/08/2023]
Abstract
There is current need for objective measures of sciatic nerve mobility in patients with sciatic-type pain. The objective of the study was to assess the feasibility and reliability of ultrasound elastography to quantify sciatic nerve displacement and shear strain at the sciatic nerve-hamstring muscle interface during active and passive knee extension-flexion exercises performed while sitting in healthy people. Ultrasound elastography showed excellent intrarater within-session reliability for assessing sciatic nerve displacement and sciatic nerve-hamstring muscle interface shear strain during active knee extension-flexion exercises. These findings will inform similar future work conducted in patients with sciatic-type pain.
Collapse
Affiliation(s)
- Richard Ellis
- Department of Physiotherapy, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland, New Zealand
- Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland, New Zealand
| | - Maheswaran Rohan
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences , Auckland University of Technology, Auckland, New Zealand
| | - James Fox
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Juvena Hitt
- Department of Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Helene Langevin
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, Vermont, USA
- Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sharon Henry
- Department of Rehabilitation Science, University of Vermont College of Nursing and Health Science, Burlington, Vermont, USA
| |
Collapse
|
13
|
Is there a relationship between impaired median nerve excursion and carpal tunnel syndrome? A systematic review. J Hand Ther 2017; 30:3-12. [PMID: 27692791 DOI: 10.1016/j.jht.2016.09.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/31/2016] [Accepted: 09/01/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review. INTRODUCTION It is accepted that the etiology of carpal tunnel syndrome (CTS) is multifactorial. One of the most commonly accepted etiologic factors for CTS is compromise of the kinematic behavior and excursion of the median nerve. PURPOSE OF THE STUDY The objective of this systematic review was to establish if there is a relationship between impaired median nerve excursion and CTS. METHODS A systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, was conducted. Studies were sought where in vivo median nerve excursion was compared between people with CTS to an appropriate control group. Quality appraisal for each study was conducted using the Newcastle-Ottawa Scale by 2 independent evaluators. RESULTS Ten case-control studies using ultrasound imaging to quantify median nerve excursion were included. All studies were rated as of "moderate" methodologic quality having scored 6 or 7 (of 9 stars) for the Newcastle-Ottawa Scale. Seven of the 10 studies concluded that median nerve excursion was reduced in a CTS population when compared with controls. CONCLUSION The literature suggests that median nerve excursion is reduced in people with CTS when compared with healthy controls. LEVEL OF EVIDENCE 3a.
Collapse
|
14
|
Kang HJ, Yoon JS. Effect of finger motion on transverse median nerve movement in the carpal tunnel. Muscle Nerve 2016; 54:738-42. [DOI: 10.1002/mus.25101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 03/01/2016] [Accepted: 03/07/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Hyo Jung Kang
- Department of Physical Medicine and Rehabilitation; Veterans Health Service Medical Center; Seoul South Korea
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation; Korea University Guro Hospital; Korea University College of Medicine, 148 Gurodong-ro Guro-gu, Seoul South Korea
| |
Collapse
|
15
|
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.
Collapse
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,
| |
Collapse
|
16
|
Kasehagen B, Ellis R, Mawston G, Allen S, Hing W. Assessing the Reliability of Ultrasound Imaging to Examine Radial Nerve Excursion. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1651-1659. [PMID: 27087692 DOI: 10.1016/j.ultrasmedbio.2016.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 02/17/2016] [Accepted: 02/21/2016] [Indexed: 06/05/2023]
Abstract
Ultrasound imaging allows cost effective in vivo analysis for quantifying peripheral nerve excursion. This study used ultrasound imaging to quantify longitudinal radial nerve excursion during various active and passive wrist movements in healthy participants. Frame-by-frame cross-correlation software allowed calculation of nerve excursion from video sequences. The reliability of ultrasound measurement of longitudinal radial nerve excursion was moderate to high (intraclass correlation coefficient range = 0.63-0.86, standard error of measurement 0.19-0.48). Radial nerve excursion ranged from 0.41 to 4.03 mm induced by wrist flexion and 0.28 to 2.91 mm induced by wrist ulnar deviation. No significant difference was seen in radial nerve excursion during either wrist movement (p > 0.05). Wrist movements performed in forearm supination produced larger overall nerve excursion (1.41 ± 0.32 mm) compared with those performed in forearm pronation (1.06 ± 0.31 mm) (p < 0.01). Real-time ultrasound is a reliable, cost-effective, in vivo method for analysis of radial nerve excursion.
Collapse
Affiliation(s)
- Ben Kasehagen
- Faculty of Health Sciences and Medicine, Bond University Institute of Health and Sport, Gold Coast, Robina, Queensland, Australia
| | - Richard Ellis
- Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Grant Mawston
- Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Scott Allen
- Sound Experience, Mt. Albert, Auckland, New Zealand
| | - Wayne Hing
- Faculty of Health Sciences and Medicine, Bond University Institute of Health and Sport, Gold Coast, Robina, Queensland, Australia
| |
Collapse
|
17
|
|
18
|
Nanno M, Sawaizumi T, Kodera N, Tomori Y, Takai S. Transverse Movement of the Median Nerve in the Carpal Tunnel during Wrist and Finger Motion in Patients with Carpal Tunnel Syndrome. TOHOKU J EXP MED 2015; 236:233-40. [DOI: 10.1620/tjem.236.233] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Norie Kodera
- Department of Orthopaedic Surgery, Nippon Medical School
| | - Yuji Tomori
- Department of Orthopaedic Surgery, Nippon Medical School
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School
| |
Collapse
|