Abstract

The carpal tunnel is geometrically irregular due to the complex composition of many carpal bones intercalated by numerous intercarpal ligaments. The purpose of the study was to investigate the relative contributions of the ligament and bone arches to carpal tunnel space at the proximal, middle, and distal tunnel regions. A catheter ultrasound probe acquired fan-like images inside cadaveric carpal tunnels for three-dimensional reconstruction of the tunnel. The total tunnel volume was 5367.6 ± 940.1 mm3 with contributions of 12.0%, 6.9%, and 4.1% by proximal, middle, and distal ligament arches, respectively, and 27.0%, 25.3%, and 24.7% by proximal, middle, and distal bone arches, respectively. The bone arch occupied more tunnel space than the ligament arch at all regions (p < 0.05). The ligament arch was largest at the proximal region of the tunnel and significantly decreased toward the distal region (p < 0.05). However, the bone arch significantly decreased only from the proximal to middle region (p < 0.05) but not from the middle to distal region (p = 0.311). Consequently, it was observed that the ligament arch was the key contributor to the unequal carpal tunnel space across regions. Partitional and regional tunnel morphometric information may provide a better understanding of tunnel abnormality associated with various wrist pathological conditions. The developed framework of ultrasonography and data processing can be applied to other areas of interest in the musculoskeletal system.

References

References
1.
Skie
,
M.
,
Zeiss
,
J.
,
Ebraheim
,
N. A.
, and
Thomas Jackson
,
W.
,
1990
, “
Carpal Tunnel Changes and Median Nerve Compression During Wrist Flexion and Extension Seen by Magnetic Resonance Imaging
,”
J. Hand Surg. Am.
,
15
(
6
), pp.
934
939
.10.1016/0363-5023(90)90019-N
2.
Bower
,
J. A.
,
Stanisz
,
G. J.
, and
Keir
,
P. J.
,
2006
, “
An MRI Evaluation of Carpal Tunnel Dimensions in Healthy Wrists: Implications for Carpal Tunnel Syndrome
,”
Clin. Biomech.
,
21
(
8
), pp.
816
825
.10.1016/j.clinbiomech.2006.04.008
3.
Sassi
,
S. A.
, and
Giddins
,
G.
,
2016
, “
Gender Differences in Carpal Tunnel Relative Cross-Sectional Area: A Possible Causative Factor in Idiopathic Carpal Tunnel Syndrome
,”
J. Hand Surg. (Eur.)
,
41
(
6
), pp.
638
642
.10.1177/1753193415625404
4.
Kim
,
H. S.
,
Joo
,
S. H.
,
Han
,
Z.-A.
, and
Kim
,
Y. W.
,
2012
, “
The Nerve/Tunnel Index: A New Diagnostic Standard for Carpal Tunnel Syndrome Using Sonography
,”
J. Ultrasound Med.
,
31
(
1
), pp.
23
29
.10.7863/jum.2012.31.1.23
5.
Cobb
,
T. K.
,
Dalley
,
B. K.
,
Posteraro
,
R. H.
, and
Lewis
,
R. C.
,
1993
, “
Anatomy of the Flexor Retinaculum
,”
J. Hand Surg. Am.
,
18
(
1
), pp.
91
99
.10.1016/0363-5023(93)90251-W
6.
Rotman
,
M. B.
, and
Donovan
,
J. P.
,
2002
, “
Practical Anatomy of the Carpal Tunnel
,”
Hand Clin.
,
18
(
2
), pp.
219
230
.10.1016/S0749-0712(01)00003-8
7.
Buchberger
,
W.
,
Schön
,
G.
,
Strasser
,
K.
, and
Jungwirth
,
W.
,
1991
, “
High-Resolution Ultrasonography of the Carpal Tunnel
,”
J. Ultrasound Med.
,
10
(
10
), pp.
531
537
.10.7863/jum.1991.10.10.531
8.
Nakamichi
,
K.-I.
, and
Tachibana
,
S.
,
2000
, “
Enlarged Median Nerve in Idiopathic Carpal Tunnel Syndrome
,”
Muscle Nerve
,
23
(
11
), pp.
1713
1718
.10.1002/1097-4598(200011)23:11<1713::AID-MUS7>3.0.CO;2-G
9.
Dekel
,
S.
,
Papaioannou
,
T.
,
Rushworth
,
G.
, and
Coates
,
R.
,
1980
, “
Idiopathic Carpal Tunnel Syndrome Caused by Carpal Stenosis
,”
Br. Med. J.
,
280
(
6227
), pp.
1297
1299
.10.1136/bmj.280.6227.1297
10.
Pacek
,
C. A.
,
Tang
,
J.
,
Goitz
,
R. J.
,
Kaufmann
,
R. A.
, and
Li
,
Z.-M.
,
2010
, “
Morphological Analysis of the Carpal Tunnel
,”
Hand
,
5
(
1
), pp.
77
81
.10.1007/s11552-009-9220-9
11.
Brett
,
A. W.
,
Oliver
,
M. L.
,
Agur
,
A. M. R.
,
Edwards
,
A. M.
, and
Gordon
,
K. D.
,
2014
, “
Quantification of the Transverse Carpal Ligament Elastic Properties by Sex and Region
,”
Clin. Biomech.
,
29
(
6
), pp.
601
606
.10.1016/j.clinbiomech.2014.05.003
12.
Pacek
,
C. A.
,
Chakan
,
M.
,
Goitz
,
R. J.
,
Kaufmann
,
R. A.
, and
Li
,
Z. M.
,
2010
, “
Morphological Analysis of the Transverse Carpal Ligament
,”
Hand
,
5
(
2
), pp.
135
140
.10.1007/s11552-009-9219-2
13.
Xiu
,
K.-H.
,
Kim
,
J.-H.
, and
Li
,
Z.-M.
,
2010
, “
Biomechanics of the Transverse Carpal Arch Under Carpal Bone Loading
,”
Clin. Biomech.
,
25
(
8
), pp.
776
780
.10.1016/j.clinbiomech.2010.05.011
14.
Richman
,
J. A.
,
Gelberman
,
R. H.
,
Rydevik
,
B. L.
,
Gylys-Morin
,
V. M.
,
Hajek
,
P. C.
, and
Sartoris
,
D. J.
,
1987
, “
Carpal Tunnel Volume Determination by Magnetic Resonance Imaging Three-Dimensional Reconstruction
,”
J. Hand Surg. Am.
,
12
(
5
), pp.
712
717
.10.1016/S0363-5023(87)80054-0
15.
Cobb
,
T. K.
,
Dalley
,
B. K.
,
Posteraro
,
R. H.
, and
Lewis
,
R. C.
,
1992
, “
Establishment of Carpal contents/canal Ratio by Means of Magnetic Resonance Imaging
,”
J. Hand Surg. Am.
,
17
(
5
), pp.
843
849
.10.1016/0363-5023(92)90454-W
16.
Mogk
,
J. P. M.
, and
Keir
,
P. J.
,
2007
, “
Evaluation of the Carpal Tunnel Based on 3-D Reconstruction From MRI
,”
J. Biomech.
,
40
(
10
), pp.
2222
2229
.10.1016/j.jbiomech.2006.10.033
17.
Gabra
,
J. N.
,
Kim
,
D. H.
, and
Li
,
Z. M.
,
2015
, “
Elliptical Morphology of the Carpal Tunnel Cross Section
,”
Eur. J. Anat.
,
19
(
1
), pp.
49
56
.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418467/
18.
Pavlidis
,
L.
,
Chalidis
,
B. E.
,
Demiri
,
E.
, and
Dimitriou
,
C. G.
,
2010
, “
The Effect of Transverse Carpal Ligament Lengthening on Carpal Tunnel Volumetry
,”
Ann. Plast. Surg.
,
65
(
5
), pp.
480
484
.10.1097/SAP.0b013e3181d9ab44
19.
Pierre-Jerome
,
C.
,
Bekkelund
,
S. I.
, and
Nordstrøm
,
R.
,
1997
, “
Quantitative MRI Analysis of Anatomic Dimensions of the Carpal Tunnel in Women
,”
Surg. Radiol. Anat.
,
19
(
1
), pp.
31
34
.10.1007/BF01627731
20.
Mogk
,
J. P. M.
, and
Keir
,
P. J.
,
2009
, “
The Effect of Landmarks and Bone Motion on Posture-Related Changes in Carpal Tunnel Volume
,”
Clin. Biomech.
,
24
(
9
), pp.
708
715
.10.1016/j.clinbiomech.2009.05.012
21.
Horch
,
R. E.
,
Allmann
,
K. H.
,
Laubenberger
,
J.
,
Langer
,
M.
, and
Björn Stark
,
G.
,
1997
, “
Median Nerve Compression Can Be Detected by Magnetic Resonance Imaging of the Carpal Tunnel
,”
Neurosurgery
,
41
(
1
), pp.
76
83
.10.1097/00006123-199707000-00016
22.
Monagle
,
K.
,
Dai
,
G.
,
Chu
,
A.
,
Burnham
,
R. S.
, and
Snyder
,
R. E.
,
1999
, “
Quantitative MR Imaging of Carpal Tunnel Syndrome
,”
Am. J. Roentgenol.
,
172
(
6
), pp.
1581
1586
.10.2214/ajr.172.6.10350293
23.
Uchiyama
,
S.
,
Itsubo
,
T.
,
Yasutomi
,
T.
,
Nakagawa
,
H.
,
Kamimura
,
M.
, and
Kato
,
H.
,
2005
, “
Quantitative MRI of the Wrist and Nerve Conduction Studies in Patients With Idiopathic Carpal Tunnel Syndrome
,”
J. Neurol. Neurosurg. Psychiatry
,
76
(
8
), pp.
1103
1108
.10.1136/jnnp.2004.051060
24.
Grasso
,
R. F.
,
Di Giacomo
,
V.
,
Sedati
,
P.
,
Sizzi
,
O.
,
Florio
,
G.
,
Faiella
,
E.
,
Rossetti
,
A.
,
Del Vescovo
,
R.
, and
Beomonte Zobel
,
B.
,
2010
, “
Diagnosis of Deep Infiltrating Endometriosis: Accuracy of Magnetic Resonance Imaging and Transvaginal 3D Ultrasonography
,”
Abdom. Imaging
,
35
(
6
), pp.
716
725
.10.1007/s00261-009-9587-7
25.
Marquardt
,
T. L.
,
Gabra
,
J. N.
, and
Li
,
Z.-M.
,
2015
, “
Morphological and Positional Changes of the Carpal Arch and Median Nerve During Wrist Compression
,”
Clin. Biomech.
,
30
(
3
), pp.
248
253
.10.1016/j.clinbiomech.2015.01.007
26.
Marquardt
,
T. L.
,
Evans
,
P. J.
,
Seitz
,
W. H.
, and
Li
,
Z.-M.
,
2016
, “
Carpal Arch and Median Nerve Changes During Radioulnar Wrist Compression in Carpal Tunnel Syndrome Patients
,”
J. Orthop. Res.
,
34
(
7
), pp.
1234
1240
.10.1002/jor.23126
27.
Yao
,
Y.
,
Grandy
,
E.
,
Evans
,
P. J.
,
Seitz
,
W. H.
, and
Li
,
Z.-M.
,
2018
, “
Enhancement in Median Nerve Mobility During Radioulnar Wrist Compression in Carpal Tunnel Syndrome Patients
,”
Clin. Biomech.
,
60
, pp.
83
88
.10.1016/j.clinbiomech.2018.10.017
28.
Manley
,
M.
,
Boardman
,
M.
, and
Goitz
,
R. J.
,
2013
, “
The Carpal Insertions of the Transverse Carpal Ligament
,”
J. Hand Surg. Am.
,
38
(
4
), pp.
729
732
.10.1016/j.jhsa.2013.01.015
29.
Nanno
,
M.
,
Sawaizumi
,
T.
,
Kodera
,
N.
,
Tomori
,
Y.
, and
Takai
,
S.
,
2015
, “
Three-Dimensional Analysis of the Attachment and Path of the Transverse Carpal Ligament
,”
J. Nippon Med. Sch.
,
82
(
3
), pp.
130
135
.10.1272/jnms.82.130
You do not currently have access to this content.