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Peng L, Wu Y, Lakshminarayanan K, Zhang A, Gan Y, Li Y, Yao Y. The relationship between shear wave velocity in transverse carpal ligament and carpal tunnel pressure: A finite element analysis. Med Eng Phys 2023; 116:103995. [PMID: 37230698 DOI: 10.1016/j.medengphy.2023.103995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 05/12/2023] [Accepted: 05/14/2023] [Indexed: 05/27/2023]
Abstract
Elevated carpal tunnel pressure in carpal tunnel syndrome (CTS) patients is one of the major causes of nerve damage but cannot be measured non-invasively. This study proposed to use shear wave velocity (SWV) in the transverse carpal ligament (TCL) to measure the surrounding carpal tunnel pressure. The relationship between the carpal tunnel pressure and the SWV in the TCL was investigated through a subject-specific carpal tunnel finite element model reconstrued by MRI imaging. Parametric analysis was conducted to study the effect of TCL Young's modulus and carpal tunnel pressure on the TCL SWV. The SWV in TCL was found to be strongly dependent on the carpal tunnel pressure and TCL Young's modulus. The calculated SWV ranged from 8.0 m/s to 22.6 m/s under a combination of carpal tunnel pressure (0-200 mmHg) and TCL Young's modulus (1.1-11 MPa). An empirical equation was used to fit the relationship between the SWV in TCL and carpal tunnel pressure, with TCL Young's modulus as a confounding factor. The equation proposed in this study provided an approach to estimate carpal tunnel pressure by measuring the SWV in the TCL for a potential non-invasive diagnosis of CTS and may shed light on the mechanical nerve damage mechanism.
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Affiliation(s)
- Linjing Peng
- School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai, 200030, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai, 200030, China
| | - Yu Wu
- School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai, 200030, China; Olin College of Engineering, 1000 Olin Way, Needham, 02492, US
| | - Kishor Lakshminarayanan
- Department of Sensors and Biomedical Engineering, Vellore Institute of Technology, Ranipet Katpadi Road Vellore, 632 014, Tamil Nadu, India
| | - Aili Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai, 200030, China
| | - Yaokai Gan
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai, 200030, China; Department of Orthopedics, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, China, 200011
| | - Yiming Li
- Department of Orthopedics, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, China, 200011
| | - Yifei Yao
- School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai, 200030, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai, 200030, China.
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Elkima SEAA, Abdelaziz AA, Alsergany MA, Nagy HA. Diagnostic value of diffusion-weighted MRI using apparent diffusion coefficient (ADC) in evaluation of median nerve in carpal tunnel syndrome. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2023. [DOI: 10.1186/s43055-023-00996-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Abstract
Background
The diagnosis of carpal tunnel syndrome is based on a combination of clinical history, clinical examination and frequent use of electrodiagnostics as nerve conduction study and electromyography which often do not provide the spatial and anatomical localizing information, especially with small nerves of the extremities. Conventional magnetic resonance imaging can reveal morphological changes in carpal tunnel syndrome patients.
Aim
The purpose of our study was to assess the efficacy of diffusion magnetic resonance imaging as a functional imaging in evaluation of median nerve in carpal tunnel syndrome.
Patients and methods
This prospective study included a group of 33 patients with carpal tunnel syndrome diagnosed by both clinical examination and electromyography; 40 writs were examined. A control group of 20 subjects of matched age group were also included. All the participants were subjected to conventional and diffusion magnetic resonance imaging studies.
Results
Median nerve apparent diffusion coefficient values of patients are lower than those of controls. The sensitivity and diagnostic accuracy of diffusion conventional magnetic resonance imaging were 95% and 97.5%, respectively, versus 25% and 62.5% of conventional magnetic resonance imaging. A cut-off apparent diffusion coefficient value ≤ 0.99 obtained at distal radio-ulnar joint level and > 1.07 at pisiform level as well as apparent diffusion coefficient ratio at a cut-off ≤ 0.2 was significantly valid for diagnosing carpal tunnel syndrome.
Conclusions
Diffusion magnetic resonance imaging provides functional evaluation of median nerve in patients with carpal tunnel syndrome.
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Rezazadeh M, Aminianfar A, Pahlevan D. Short-term effects of dry needling of thenar muscles in manual laborers with carpal tunnel syndrome: a pilot, randomized controlled study. Physiother Theory Pract 2022; 39:927-937. [PMID: 35109752 DOI: 10.1080/09593985.2022.2033897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
STUDY DESIGN Pilot, randomized, single-blinded controlled clinical trial. BACKGROUND AND OBJECTIVE Trigger point (s) (TrPs) in thenar muscles could be a cause of narrowing of carpal tunnel in manual laborers with carpal tunnel syndrome (CTS). Effects of dry needling (DN) on the treatment of muscle tension have been reported, but no research has been done on the effect of DN on thenar tight muscles on reducing CTS symptoms. The aim of this study was to assess the effect of DN of thenar muscles TrPs in the treatment of mild-to-moderate carpal tunnel syndrome. METHODS Thirty manual laborers with mild-to-moderate CTS and the presence of TrP(s) in thenar muscles were randomized to DN group (n = 15) and control group (waiting list) (n = 15). The DN group received 2 sessions of DN of thenar muscles TrP(s), with a 48-h interval. The control group received no treatment. Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores were the primary outcome, while secondary outcomes included electrophysiological domains, pinch and grip strength. Outcome measures were obtained at baseline, 48 hours, and 2 weeks after treatment (follow-up). Two-way analysis of variance (2 groups × 3 times) was used to compare within- and between-group differences. Bonferroni post hoc test was used to find any significant differences in the main effect for group, time, or interaction (group time). RESULTS A baseline assessment revealed no intergroup differences in all evaluated parameters (P > .05). Compared to the control group, the DN group had a statistically significant improvement in pinch and grip strength, median SDL, and BCTQ score after 2 weeks (P < .05). There were no between-group differences in the assessment of motor electrophysiologic and SNCV findings (P > .05). CONCLUSION Dry needling of thenar TrP(s) is effective in short-term improvement of function in manual laborers with mild-to-moderate CTS.
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Affiliation(s)
- Maedeh Rezazadeh
- Rehabilitation Faculty, School of Physical Therapy, Semnan University of Medical Sciences, Semnan, Iran
| | - Atefeh Aminianfar
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Daryoush Pahlevan
- Occupational Medicine, Social Determinants of Health Research Center, Medical School, Semnan University of Medical Sciences, Semnan, Iran
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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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Niepel AL, Hellekes D, Sokullu F, Steinkellner L, Kömürcü F. Pre-operative grip force as clinical predictor for weakness after transversal carpal ligament release. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-018-1457-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lai S, Zhang K, Li J, Fu W. Carpal tunnel release with versus without flexor retinaculum reconstruction for carpal tunnel syndrome at short- and long-term follow up-A meta-analysis of randomized controlled trials. PLoS One 2019; 14:e0211369. [PMID: 30689656 PMCID: PMC6349326 DOI: 10.1371/journal.pone.0211369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/11/2019] [Indexed: 02/05/2023] Open
Abstract
Background Carpal tunnel syndrome is a common neuropathy disorder for which surgical treatment consists of release and reconstruction of the flexor retinaculum. Reports of postoperative clinical outcomes after carpal tunnel release with or without flexor retinaculum reconstruction in several studies are controversial. This meta-analysis aimed to compare the efficacy and safety of carpal tunnel release with or without flexor retinaculum reconstruction. Methods The PubMed, EMBASE, Web of Science, Ovid, Cochrane Library and Clinical Tri Org databases were searched for randomized controlled trials that compared carpal release with and without transverse carpal ligament reconstruction for carpal tunnel syndrome. Outcomes included postoperative Boston Carpal Tunnel Questionnaire Symptom Severity Scale (SSS), Functional Status Scale (FSS), grip strength and complications. The follow-up time was categorized into short-term (0-3mon) and long-term(>3mon). Results A total of 7 studies with 613 patients met the inclusion criteria and were analyzed in detail. Statistical analysis showed no significant difference between two groups on postoperative long-term grip strength (MD 5.85, 95% CI -1.05 to 12.76) long-term SSS (MD -0.31, 95% CI -0.75 to 0.13) and occurrence of complications (RR 1.14, 95% CI 0.84 to 1.54), whereas statistically significant difference was found between groups regarding short-term grip strength (MD 1.51, 95% CI 0.86 to 2.17) and long-term FSS (MD -0.34, 95% CI -0.47 to -0.21). Conclusion Carpal tunnel release with flexor retinaculum reconstruction for carpal tunnel syndrome may result in improved long-term functional status while there’s no advantage regarding grip strength, symptom severity and safety over individual carpal tunnel release in short- and long-term outcomes.
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Affiliation(s)
- Sike Lai
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Kaibo Zhang
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jian Li
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Weili Fu
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- * E-mail:
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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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Marquardt TL, Gabra JN, Evans PJ, Seitz WH, Li ZM. Thickness and Stiffness Adaptations of the Transverse Carpal Ligament Associated with Carpal Tunnel Syndrome. ACTA ACUST UNITED AC 2017; 19. [PMID: 28824216 DOI: 10.1142/s0218957716500196] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The purpose of this study was to investigate the morphological and mechanical properties of the transverse carpal ligament (TCL) in patients with carpal tunnel syndrome (CTS). Thickness and stiffness of the TCL in eight female CTS patients and eight female control subjects were examined using ultrasound imaging modalities. CTS patients had a 30.9% thicker TCL than control subjects. There was no overall difference in TCL stiffness between the two groups, but the radial TCL region was significantly stiffer than the ulnar region within the CTS group and such a regional difference was not found for the controls. The increased thickness and localized stiffness of the TCL for CTS patients may contribute to CTS symptoms due to reduction in carpal tunnel space and compliance. Advancements in ultrasound technology provide a means of understanding CTS mechanisms and quantifying the morphological and mechanical properties of the TCL in vivo.
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Affiliation(s)
- Tamara L Marquardt
- Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, United States
| | - Joseph N Gabra
- Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, United States
| | - Peter J Evans
- Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, United States
| | - William H Seitz
- Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, United States
| | - Zong-Ming Li
- Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, United States
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Ratnaparkhi R, Xiu K, Guo X, Li ZM. Changes in carpal tunnel compliance with incremental flexor retinaculum release. J Orthop Surg Res 2016; 11:43. [PMID: 27074707 PMCID: PMC4831089 DOI: 10.1186/s13018-016-0380-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background Flexor retinaculum transection is a routine surgical treatment for carpal tunnel syndrome, yet the biomechanical and clinical sequelae of the procedure remain unclear. We investigated the effects of flexor retinaculum release on carpal tunnel structural compliance using cadaveric hands. Methods The flexor retinaculum was incrementally and sequentially released with transections of 25, 50, 75, and 100 % of the transverse carpal ligament, followed by the distal aponeurosis and then the antebrachial fascia. Paired outward 10 N forces were applied to the insertion sites of the transverse carpal ligament at the distal (hamate-trapezium) and proximal (pisiform-scaphoid) levels of the carpal tunnel. Carpal tunnel compliance was defined as the change in carpal arch width normalized to the constant 10 N force. Results With the flexor retinaculum intact, carpal tunnel compliance at the proximal level, 0.696 ± 0.128 mm/N, was 13.6 times greater than that at the distal level, 0.056 ± 0.020 mm/N. Complete release of the transverse carpal ligament was required to achieve a significant gain in compliance at the distal level (p < 0.05). Subsequent release of the distal aponeurosis resulted in an appreciable additional increase in compliance (43.0 %, p = 0.052) at the distal level, but a minimal increase (1.7 %, p = 0.987) at the proximal level. Complete flexor retinaculum release provided a significant gain in compliance relative to transverse carpal ligament release alone at both proximal and distal levels (p < 0.05). Conclusions Overall, complete flexor retinaculum release increased proximal compliance by 52 % and distal compliance by 332 %. The increase in carpal tunnel compliance with complete flexor retinaculum release helps explain the benefit of carpal tunnel release surgery for patients with carpal tunnel syndrome.
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Affiliation(s)
- Rubina Ratnaparkhi
- Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, 44195, OH, USA
| | - Kaihua Xiu
- Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, 44195, OH, USA
| | - Xin Guo
- Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, 44195, OH, USA
| | - Zong-Ming Li
- Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, 44195, OH, USA.
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