title: Mid-motion deformation of median nerve during finger flexion: a new insight into the dynamic aetiology of carpal tunnel syndrome.
abstract: Carpal tunnel syndrome (CTS) exists in a spectrum of severity and symptoms with a dynamic component. We aim to study dynamic nerve-tendon interrelationships in normal and mild CTS wrists during a fist motion, with dynamic ultrasound. We observed that in normal wrists, the nerve arcs in an ulnar-volar direction and changes from a circular shape to a flat oval during motion. In CTS candidates, however, the curvature and distance of the nerve's path are reduced, while nerve shape remains relatively constant. In all candidates, the nerve is compressed against the flexor retinaculum, with the nerve subject to less compression in normal candidates as it moves dorsally into a recess. These findings suggest that besides mechanical compression from increased carpal tunnel contents alone, a decrease in nerve gliding movement may lead to CTS symptomatology. Furthermore, we identified that maximum nerve deformation occurs mid-motion, supporting the use of wrist splints for symptom relief.
authors.affiliation: Department of Mechanical Engineering, National University of Singapore, 9 Engineering Drive 1, Block EA, 07-08, Singapore 117576, Singapore.
authors.forename: Kyrin
authors.initials: K
authors.lastname: Liong
authors.forename: Amitabha
authors.initials: A
authors.lastname: Lahiri
authors.forename: Shujin
authors.initials: S
authors.lastname: Lee
authors.forename: Dawn
authors.initials: D
authors.lastname: Chia
authors.forename: Arijit
authors.initials: A
authors.lastname: Biswas
authors.forename: Heow Pueh
authors.initials: HP
authors.lastname: Lee
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D002349:Carpal Tunnel Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D005385:Fingers / Q000294:innervation* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000000981:diagnostic imaging*; D009068:Movement; D012720:Severity of Illness Index; D014463:Ultrasonography