Time-varying changes in median nerve deformation and position in response to quantified pinch and grip forces.

Abstract

The ability of the median nerve (MN) to adapt in response to altered carpal tunnel conditions is important to mitigate compressive stress on the nerve. We assessed changes in MN deformation and position throughout the entire time course of hand force exertions. Fourteen right-handed participants ramped up force from 0% to 50% of maximal voluntary force (MVF) before ramping force back down in three different hand force exertion tasks (pulp pinch, chuck pinch, power grip). Pinch and grip forces were measured with a digital dynamometer, which were time synchronized with transverse carpal tunnel images obtained via ultrasound. Ultrasound images were extracted in 10% increments between 0% and 50% MVF while ramping force up (loading phase) and down (unloading phase). MN deformation and position relative to the flexor digitorum superficialis tendon of the long finger were assessed in concert. During loading, the nerve became more circular while displacing dorsally and ulnarly. These changes primarily occurred at the beginning of the hand force exertions while ramping force up from 0% to 20%, with very little change between 20% and 50% MVF. Interestingly, deformation and position changes during loading were not completely reversed during unloading while ramping force down. These findings indicate an initial reorganization of carpal tunnel structures. Mirrored changes in nerve deformation and position may also reflect strain-related characteristics of adjoining subsynovial connective tissue. Regardless, time-varying changes in nerve deformation and position appear to be an important accommodative mechanism in the healthy carpal tunnel in response to gripping and pinching tasks.