Abstract
BackgroundThe median nerve and flexor tendons are known to translate transversely in the carpal tunnel. The purpose of this study was to investigate these motions in differential finger motion using ultrasound, and to compare them in healthy people and carpal tunnel syndrome patients.MethodsTransverse ultrasounds clips were taken during fist, index finger, middle finger and thumb flexion in 29 healthy normal subjects and 29 CTS patients. Displacement in palmar-dorsal and radial-ulnar direction was calculated using Analyze software. Additionally, the distance between the median nerve and the tendons was calculated.ResultsWe found a changed motion pattern of the median nerve in middle finger, index finger and thumb motion between normal subjects and CTS patients (p<0.05). Also, we found a changed motion direction in CTS patients of the FDS III tendon in fist and middle finger motion, and of the FDS II and flexor pollicis longus tendon in index finger and thumb motion, respectively (p<0.05). The distance between the median nerve and the FDS II or FPL tendon is significantly greater in patients than in healthy volunteers for index finger and thumb motion, respectively (p<0.05).ConclusionOur results suggest a changed motion pattern of the median nerve and several tendons in carpal tunnel syndrome patients compared to normal subjects. Such motion patterns may be useful in distinguishing affected from unaffected individuals, and in studies of the pathomechanics of carpal tunnel syndrome.
Highlights
Carpal tunnel syndrome is a peripheral compression neuropathy for which several potential pathophysiological explanations have been proposed
Some studies focus on fibrosis of the subsynovial connective tissue (SSCT) as a cause [1,2,3], while other studies focus on dynamic causes, such as a changed motion pattern of the median nerve [4,5]
A pilot study from our institution showed that in index finger and thumb flexion, the motion direction of the median nerve and flexor tendons differs between healthy normal subjects and carpal tunnel syndrome patients, and that it is possible to display these motions with high frequency ultrasound [8]
Summary
Carpal tunnel syndrome is a peripheral compression neuropathy for which several potential pathophysiological explanations have been proposed. Ettema et al showed that the gliding characteristics in CTS patients are altered, while Osamura et al showed that the material properties are changed in patients as well [6,7] They suggest that these changes may be due to fibrosis of the subsynovial connective tissue and that alterations in the gliding characteristics of the SSCT may affect tendon gliding motion [6]. A pilot study from our institution showed that in index finger and thumb flexion, the motion direction of the median nerve and flexor tendons differs between healthy normal subjects and carpal tunnel syndrome patients, and that it is possible to display these motions with high frequency ultrasound [8]. The purpose of this study was to investigate these motions in differential finger motion using ultrasound, and to compare them in healthy people and carpal tunnel syndrome patients
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