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. Author manuscript; available in PMC: 2022 Nov 26.
Published in final edited form as: Clin Biomech (Bristol). 2019 Oct 31;71:133–138. doi: 10.1016/j.clinbiomech.2019.10.024

Morphological and positional changes of the carpal arch and median nerve associated with wrist deviations

Kishor Lakshminarayanan a, Rakshit Shah a,d, Zong-Ming Li a,b,c,d
PMCID: PMC9701112  NIHMSID: NIHMS1544838  PMID: 31733628

Abstract

Background:

Carpal tunnel and median nerve dynamically change with wrist motion. The purpose of this study was to investigate the morphological changes and positional migration of the carpal arch and median nerve, as well as nerve-arch positional relationship associated with wrist deviation in healthy volunteers.

Methods:

Twenty asymptomatic male volunteers performed wrist motion from neutral to deviated positions combining flexion-extension and radioulnar deviation. Ultrasound images of the carpal arch and median nerve at the distal carpal tunnel were collected during wrist motion. Morphological and positional parameters of the carpal arch and median nerve were derived from the ultrasound images.

Findings:

Carpal arch height, area, and palmar bowing of the transverse carpal ligament (TCL) increased with flexion related wrist motion and decreased with extension related motion (P<0.05). Arch width increased with radial flexion and decreased with extension and ulnar extension (P<0.05). Median nerve circularity increased with flexion and radial flexion but decreased with extension, ulnar extension, and ulnar deviation (P<0.05). Nerve centroid displaced ulnarly with radial deviation, radial flexion, and radial extension and displaced radially with ulnar deviation, ulnar flexion, and ulnar extension (P<0.05). Nerve centroid displaced in the dorsal direction with flexion and radial flexion, but in the palmar direction with extension (P<0.05). Nerve-TCL distance increased with flexion related motion and decreased with extension relation motion (P<0.05).

Interpretation:

The current study advances our understanding the effect of wrist motion on the carpal tunnel and its contents, which has implications for pathomorphological and pathokinematic changes associated with wrist disorders.

Keywords: carpal arch, median nerve, wrist motion, ultrasonography

1. Introduction

The carpal tunnel is an anatomical compartment bounded on the medial, lateral, and dorsal sides by the carpal bones and the volar side by the transverse carpal ligament (TCL). The median nerve passes through the carpal tunnel together with the finger flexor tendons. Compression of the median nerve could result from a reduction in the tunnel size or increased volume of its contents leading to compression neuropathies. Wrist deviation from a neutral wrist posture has been shown to reduce the available space for the nerve, which is a contributing factor for median nerve entrapment (Armstrong & Chaffin 1979; DeKrom et al., 1990; Tanaka et al., 1995).

Carpal tunnel morphology has been shown to dynamically change with wrist motion (Skie et al., 1990; Yoshioka et al., 1993; Garcia-Elias et al., 1992). Flexion of the wrist, compared to the neutral position, reduced the available space for the carpal tunnel contents by decreasing tunnel cross-sectional area (Skie et al., 1990; Yoshioka et al., 1993; Horch et al., 1997; Bower et al., 2006). Wrist deviation from the neutral position has also been shown to increase carpal tunnel pressure with the highest pressure observed in extension (Keir et al., 1997; McGorry et al., 2014). Previous morphometric analysis have mainly investigated the entire carpal tunnel volume or cross-sectional area, but a focal examination of the TCL-formed carpal arch may be more revealing for median nerve compression mechanisms because of the close proximity of the nerve to TCL.

Wrist deviation implicates the carpal arch, median nerve deformation and displacement, and a change in nerve-arch relationship. Jessuran et al., (1987) qualitatively observed that wrist flexion caused palmar bowing of the TCL, which possibly enlarges the available space for the median nerve within the carpal tunnel. Wrist flexion also led to migration and decreased flattening of the median nerve (Skie et al., 1990), suggesting that the nerve be accommodated to the space made available. In addition, the nerve-arch geometric relationship could be altered due to simultaneous change in the carpal arch and median nerve (Marquardt et al., 2016; Colak et al., 2007). The wrist deviations examined in the above studies were largely restricted to flexion-extension, but functional wrist motion is coupled with flexion-extension and radioulnar deviation (e.g. dart-throwing motion). Studying the changes in the TCL-formed carpal arch with wrist deviations including flexion-extension, radioulnar deviations, and their coupled motions could offer a more comprehensive understanding of the effects of wrist motion on the carpal arch. Furthermore, information is scarce on the influence of wrist deviation on the relationship between the carpal arch and median nerve, examining which could shed light on the pathogenesis of compression neuropathy and its management.

Therefore, the purpose of this study was to investigate the morphological changes and migration of the TCL-formed carpal arch and median nerve, as well as nerve-arch positional relationship associated with wrist deviation. The carpal arch and median nerve were evaluated at the distal carpal tunnel with the wrist deviated in multiple directions combining flexion-extension and radioulnar deviations. It was hypothesized that wrist deviation would lead to changes in (1) carpal arch width, height, and area, as well as palmar bowing of the TCL, (2) median nerve circularity and centroid position, and (3) nerve-TCL distance.

2. Methods

2.1. Subjects

Twenty asymptomatic male volunteers were recruited for the study. The mean (SD) age, weight, height, and body mass index (BMI) of all the subjects were 27.8 (3.7) years, 73.1 (7.9) kg, and 1.8 (0.1) m, 23.1 (2.2) kg/m2 respectively. Individuals were excluded if they had a BMI greater than 30, history of upper limb injury, musculoskeletal or neurologic disorders. The study protocol was approved by the Cleveland Clinic’s Institutional Review Board. All participants signed a written consent form before participating in the study.

2.2. Experimental Procedures

An ultrasound system with a 18L6 HD linear array probe (Acuson S2000, Siemens Medical Solutions USA, Mountain View, CA, USA) was used to obtain axial images of the carpal tunnel. The system was configured for two-dimensional B-mode imaging with tissue harmonics at a frequency of 8–12 MHz, a gain of 0–10 dB, and image depth of 3 cm. A custom-made rig was used to allow the wrist movement in any position combining flexion-extension and radioulnar deviation (Fig 1). The amount of angular deviation in each direction was indicated by a protractor. The rig was equipped with a probe holder that allowed the probe to rotate together with the angular deviations.

Fig. 1.

Fig. 1.

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Experimental setup for wrist deviations and ultrasound imaging

Each subject was asked to sit with the right shoulder in an approximately neutral position, elbow at 90 degrees flexion, and the forearm supinated. The forearm of the subject was placed on the custom-made rig with the wrist in the neutral position (Fig 1). Velcro® straps were used to stabilize the four fingers in extension and the thumb in a natural abducted position. The probe was placed perpendicular to the palm with a 2–3 mm distance between the two surfaces to accommodate acoustic medium. The probe was then adjusted to target a cross section of the distal carpal tunnel containing the hook of hamate and the ridge of trapezium. The probe, together with its holder, was locked at the desired pose. The relative position between the probe and the palm was maintained to image the same cross section regardless of wrist postural changes. The carpal tunnel cross sectional images were collected as a video at a rate of 30 frames per second while the wrist moved from the initial neutral position to a final deviated position. Wrist deviations were performed in one of the following motion directions: flexion, extension, radial deviation, ulnar deviation, radial flexion, ulnar flexion, radial extension, and ulnar extension. The amount of flexion and extension were 30° in each direction, and deviations in radial and ulnar deviation were 10° and 15° respectively. The sequence of the wrist motion directions was randomized for each subject. A set of dynamic ultrasound videos corresponding to individual wrist deviations from a representative subject are provided as online supplement data.

2.3. Ultrasound Image Processing

Ultrasound images corresponding to the initial and final wrist positions were extracted from each video. Several anatomical features were manually traced in each image (Fig 2). The features included the volar boundary of the TCL, the two ligament insertion points (hook of hamate and ridge of trapezium), and the echogenic boundary of the median nerve. The tracing was facilitated by magnifying the image when needed. The traced feature points were exported as calibrated coordinates in mm for the calculation of outcome measures. The coordinates were transformed from image coordinate system to an anatomical coordinate system with the origin at the hamate-ligament insertion point. The arch width was calculated as the distance between the two ligament insertion points, and arch height was defined as the maximal perpendicular distance between the TCL boundary points and the line along the arch width. Furthermore, the arch height was normalized with respect to the arch width as a palmar bowing index (PBI). The arch area was obtained using the integral of the TCL boundary along the arch width. Median nerve roundness was quantified by circularity defined as (4π×areaperimeter2) ranging from 0 (most elliptical) to 1 (circular). The nerve location was represented by its centroid (x and y coordinates). Nerve displacement was calculated as a change of centroid coordinates for the final wrist position relative to that of the initial position. Nerve-TCL distance was calculated as the distance between the nerve centroid to the volar boundary of the TCL along the y-axis. A custom LabVIEW program was used to perform all ultrasound image processing.

Fig. 2.

Fig. 2.

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Anatomical features and local coordinate system on the ultrasound image. H = Hamate, T = Trapezium, TCL = Transverse Carpal Ligament, MN = Median Nerve

2.4. Statistical Analysis

Two-way repeated measures ANOVAs were used to investigate the effects of wrist position (initial and final) and motion direction (flexion, extension, radial deviation, ulnar deviation, radial flexion, ulnar flexion, radial extension, and ulnar extension) on the dependent variables of the carpal arch (arch width, arch height, PBI, arch area), nerve (centroid x-coordinate, centroid y-coordinate, circularity), and nerve-TCL distance. Post-hoc Bonferroni t-tests were performed for pairwise comparisons. Statistical analyses were performed using SigmaStat 4.0 (Systat Software Inc, San Jose, CA, USA). An α level of 0.05 was considered for statistical significance.

3. Results

Wrist deviation that had a flexion or extension component resulted in morphological changes in the carpal arch (Table 1). Arch height and PBI increased significantly with wrist motion associated with flexion (i.e. flexion, radial flexion, and ulnar flexion) (P<0.05) but decreased significantly with extension related motions (i.e. extension, radial extension, and ulnar extension) (P<0.05). Arch area changes in response to wrist deviation followed a similar trend to that for arch height and PBI, i.e. an increase for any flexion related motion (P<0.05) and a decrease for any extension related motion (P<0.05). Arch width showed a significant increase with radial flexion (P<0.05) and significant decreases with extension (P<0.05) and ulnar extension (P<0.05). Radial or ulnar deviation did not significantly change the arch width, height, PBI, and area (P>0.05).

Table 1.

Carpal arch parameters with different wrist deviations, Mean (SEM)

Arch Width (mm) Arch Height (mm) Palmar Bowing Index Arch Area (mm2)
Flexion
Initial 26.4 (0.6) 1.2 (0.1) 0.047 (0.005) 18.2 (2.7)
Final 26.6 (0.7) 2.0 (0.2)* 0.076 (0.006)* 35.3 (3.6)*
Radial Flexion
Initial 26.8 (0.6) 1.2 (0.1) 0.046 (0.004) 17.8 (2.5)
Final 25.9 (0.6)* 1.9 (0.1)* 0.072 (0.005)* 31.8 (3.0)*
Ulnar Flexion
Initial 26.8 (0.7) 1.2 (0.1) 0.046 (0.004) 18.1 (2.5)
Final 26.7 (0.7) 1.9 (0.1)* 0.070 (0.005)* 30.1 (3.0)*
Extension
Initial 25.9 (0.6) 1.3 (0.1) 0.051 (0.006) 17.8 (2.5)
Final 26.9 (0.5)* 0.6 (0.1)* 0.024 (0.004)* 0.5 (3.1)*
Radial Extension
Initial 26.5 (0.6) 1.2 (0.1) 0.048 (0.005) 18.3 (2.5)
Final 27.1 (0.6) 0.6 (0.1)* 0.022 (0.003)* 3.0 (2.2)*
Ulnar Extension
Initial 26.7 (0.6) 1.2 (0.1) 0.047 (0.005) 18.1 (2.6)
Final 27.7 (0.5)* 0.6 (0.1)* 0.023 (0.004)* 3.3 (2.8)*
Radial Deviation
Initial 26.3 (0.7) 1.3 (0.1) 0.050 (0.004) 18.9 (2.5)
Final 26.2 (0.7) 1.2 (0.1) 0.048 (0.005) 18.1 (2.6)
Ulnar Deviation
Initial 26.4 (0.6) 1.2 (0.1) 0.046 (0.004) 17.3 (2.4)
Final 26.3 (0.6) 1.2 (0.1) 0.045 (0.005) 15.9 (2.6)
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*

p<0.05 compared with initial

The median nerve also displaced with wrist deviation (Fig 3). The x-coordinate of the nerve centroid exhibited a contralateral change in location with radioulnar deviations. Nerve centroid significantly displaced ulnarly with radial deviation, radial flexion, and radial extension (P<0.05, Table 2). The centroid significantly displaced radially with ulnar deviation, ulnar flexion, and ulnar extension (P<0.05, Table 2). The x-coordinate of the nerve centroid did not change significantly with flexion (P>0.05) and extension (P>0.05). The y-coordinate of the nerve centroid changed significantly in the dorsal direction with flexion (P<0.05) and radial flexion (P<0.05), but in the palmar direction with extension (P<0.05). The nerve centroid did not display significant displacement in the palmar-dorsal direction with the remaining wrist motions (radioulnar deviations, ulnar flexion, radial extension, and ulnar extension; P>0.05).

Fig. 3.

Fig. 3.

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Nerve centroid position at neutral (N), flexion (F), radial flexion (RF), ulnar flexion (UF), extension (E), radial extension (RE), ulnar extension (UE), radial deviation (R), and ulnar deviation (U). Mean (SEM)

Table 2.

Median nerve centroid (X, Y), circularity, and nerve-TCL distance with different wrist deviations, Mean (SEM)

X (mm) Y (mm) Circularity Nerve-TCL distance (mm)
Flexion
Initial 11.5 (0.4) −1.8 (0.2) 0.019 (0.001) 2.6 (0.1)
Final 11.6 (0.6) −2.3 (0.2)* 0.025 (0.002)* 4.0 (0.1)*
Radial Flexion
Initial 11.3 (0.5) −1.8 (0.2) 0.017 (0.001) 2.6 (0.1)
Final 10.0 (0.6)* −2.4 (0.2)* 0.023 (0.002)* 4.0 (0.2)*
Ulnar Flexion
Initial 11.3 (0.6) −1.9 (0.2) 0.019 (0.001) 2.7 (0.1)
Final 13.7 (0.6)* −2.0 (0.2) 0.022 (0.001) 3.5 (0.2)*
Extension
Initial 11.7 (0.5) −2.0 (0.2) 0.018 (0.002) 3.0 (0.1)
Final 11.6 (0.5) −1.6 (0.2)* 0.014 (0.001)* 1.6 (0.1)*
Radial Extension
Initial 11.1 (0.6) −2.0 (0.2) 0.018 (0.001) 2.8 (0.1)
Final 10.3 (0.5)* −1.5 (0.2) 0.017 (0.001) 1.7 (0.1)*
Ulnar Extension
Initial 12.0 (0.7) −1.9 (0.2) 0.017 (0.001) 2.8 (0.1)
Final 14.2 (0.5)* −1.8 (0.2) 0.014 (0.001)* 1.8 (0.1)*
Radial Deviation
Initial 11.9 (0.4) −2.1 (0.2) 0.018 (0.002) 2.9 (0.1)
Final 9.8 (0.6)* −1.9 (0.2) 0.020 (0.001) 2.8 (0.1)
Ulnar Deviation
Initial 11.4 (0.4) −1.7 (0.2) 0.020 (0.002) 2.6 (0.1)
Final 13.3 (0.5)* −2.1 (0.2) 0.016 (0.001)* 2.8 (0.1)
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*

p<0.05 compared with initial

The median nerve deformed when the wrist deviated from a neutral position (Fig 4). Median nerve circularity significantly increased with flexion (P<0.05) and radial flexion (P<0.05) but decreased with extension (P<0.05), ulnar extension (P<0.05), and ulnar deviation (P<0.05). The remaining wrist motions (ulnar flexion, radial extension, and radial deviation) did not significantly affect circularity (P>0.05, Table 2).

Fig. 4.

Fig. 4.

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Changes in nerve circularity and nerve-TCL distance with flexion (F), radial flexion (RF), ulnar flexion (UF), extension (E), radial extension (RE), ulnar extension (UE), radial deviation (R), and ulnar deviation (U). Mean (SEM)

Nerve-TCL distance (Fig 4) increased significantly with flexion related motions (flexion, radial flexion, and ulnar flexion; P<0.05, Table 2). Extension related motions (extension, radial extension, and ulnar extension) led to a significant decrease in the nerve-TCL distance (P<0.05). Wrist motion in the radioulnar directions did not show any significant change in the nerve-TCL distance (P>0.05).

4. Discussion

The evaluation of the carpal arch and median nerve associated with wrist deviations revealed that wrist flexion resulted in increased palmar bowing and arch area. The results were consistent with the findings from a previous study (Jessuran et al., 1987) reporting an increase in palmar bowing of the TCL with wrist flexion. Concurrently, wrist flexion also led to an increase in circularity and dorsal displacement of the median nerve, consistent with the observations reported by Wang et al., (2013). The palmar bowing of the TCL and dorsal displacement of the median nerve associated with wrist flexion explain the increase in the distance between the ligament and nerve. Conversely, wrist extension decreased the palmar bowing, arch area, and nerve circularity while displacing the nerve palmarly, accounting for the reduction of TCL-nerve distance. The decrease in nerve circularity and TCL-nerve distance with extension agree with the observations by Greening et al., (1999), suggesting increased physical contact between the ligament and nerve. However, previous studies reported that carpal tunnel area (including both palmar ligament and dorsal bone arches) decreased with wrist flexion and increased with wrist extension (Yoshioka et al., 1993; Skie et al., 1990). The different trend of tunnel vs. arch area associated with wrist flexion-extension may be explained by the relatively large bone arch increasing/decreasing in an opposite way to the ligament arch during wrist motion.

Wrist deviations investigated in the current study included flexion-extension, radioulnar deviation, and coupled motions. Among the wrist deviations, we found minimal changes in arch width, nerve displacement, and nerve circularity associated with radial extension or ulnar flexion. The arc of motion extending from radial extension to ulnar flexion is termed as the dart throwing motion, which has been shown to involve less motion of the carpal bones than during uniplanar flexion-extension or radioulnar deviation (Werner et al., 2004; Crisco et al., 2005; Wolfe et al., 2006). The dart throwing motion is facilitated by the individual intercarpal joints with obliquely oriented surfaces (Moritomo et al., 2000a; Moritomo et al., 2000b), main constraint of the scaphocapitate and scaphotrapezio-trapezoidal ligaments (Moritomo et al., 2003), and strong flexor carpi ulnaris and extensor carpi radialis brevis and longus (Brand et al., 1999). The minimal carpal bone motion associated with dart throwing motion would result in unchanged arch width and bone arch space which helps explain the observed minimal effect on the median nerve with radial extension or ulnar flexion in the current study.

The normative data obtained from healthy controls in the current study will serve as a reference to identify pathomorphological and pathokinematic patterns associated with wrist disorders. For example, a reduced palmar bowing may indicate the thickening and stiffening of the TCL which has been shown to be associated with CTS (Schuind et al., 1990). In addition, motion of the median nerve has been observed to be diminished in CTS patients (Wang et al., 2014) which could be a result of fibrotic and hypertrophic changes of the carpal tunnel content (Ettema et al., 2004; Mackinnon 2002). The altered TCL-formed carpal arch and nerve morphology and nerve motion patterns during wrist deviation could help identify CTS mechanisms and manage rehabilitation and treatment. For example, the minimal carpal bone and nerve changes associated with radial extension and ulnar flexion (i.e. dart-throwing motion) points to a permissible wrist motion to minimize compression of the vulnerable median nerve and avoid exacerbation of symptoms in CTS patients.

The participants in the current study were male, healthy, and young adults, which limits the generalization of the findings to females, diseased wrist, and other age groups. Future studies can be designed to investigate sex, age and pathological factors affecting the morphological and positional changes in the carpal arch and median nerve in the wrist.

Supplementary Material

1

Highlights.

  • Carpal arch and median nerve morphology and position changed with wrist deviations.

  • Arch-nerve positioning relationship changed with wrist deviation.

  • Morphological and positional changes were dependent on wrist deviation directions.

  • Minimal changes were observed in deviations associated with dart-throwing motion.

  • Findings has implications for pathomorphological and pathokinematic changes.

Acknowledgements

The study described in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number R01AR068278. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

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References

  1. Armstrong TJ, & Chaffin DB (1979). Some biomechanical aspects of the carpal tunnel. Journal of biomechanics, 12(7), 567–570. [DOI] [PubMed] [Google Scholar]
  2. Bower JA, Stanisz GJ, & Keir PJ (2006). An MRI evaluation of carpal tunnel dimensions in healthy wrists: implications for carpal tunnel syndrome. Clinical Biomechanics, 21(8), 816–825. [DOI] [PubMed] [Google Scholar]
  3. Brand PW, & Hollister A (1999). Clinical mechanics of the hand. Mosby Incorporated. [Google Scholar]
  4. Colak A, Kutlay M, Pekkafali Z, Saracoglu M, Demircan N, ŞİMŞEK H, Akin ON, & Kibici K (2007). Use of sonography in carpal tunnel syndrome surgery. Neurologia medico-chirurgica, 47(3), 109–115. [DOI] [PubMed] [Google Scholar]
  5. Crisco JJ, Coburn JC, Moore DC, Akelman E, Weiss APC, & Wolfe SW (2005). In vivo radiocarpal kinematics and the dart thrower’s motion. JBJS, 87(12), 2729–2740. [DOI] [PubMed] [Google Scholar]
  6. De Krom MCTFM, Kester ADM, Knipschild PG, & Spaans F (1990). Risk factors for carpal tunnel syndrome. American journal of epidemiology, 132(6), 1102–1110. [DOI] [PubMed] [Google Scholar]
  7. Ettema AM, Amadio PC, Zhao C, Wold LE, & An KN (2004). A histological and immunohistochemical study of the subsynovial connective tissue in idiopathic carpal tunnel syndrome. JBJS, 86(7), 1458–1466. [DOI] [PubMed] [Google Scholar]
  8. Garcia-Elias M, Sanchez-Freijo JM, Salo JM, & Lluch AL (1992). Dynamic changes of the transverse carpal arch during flexion-extension of the wrist: effects of sectioning the transverse carpal ligament. The Journal of hand surgery, 17(6), 1017–1019. [DOI] [PubMed] [Google Scholar]
  9. Greening J, Smart S, Leary R, Hall-Craggs M, O’Hggins P, & Lynn B (1999). Reduced movement of median nerve in carpal tunnel during wrist flexion in patients with non-specific arm pain. The Lancet, 354(9174), 217–218. [DOI] [PubMed] [Google Scholar]
  10. Horch RE, Allmann KH, Laubenberger J, Langer M, & Stark GB (1997). Median nerve compression can be detected by magnetic resonance imaging of the carpal tunnel. Neurosurgery, 41(1), 76–83. [DOI] [PubMed] [Google Scholar]
  11. Jessurun W, Hillen B, Zonneveld F, Huffstadt AJC, Beks JWF, & Overbeek W (1987). Anatomical relations in the carpal tunnel: a computed tomographic study. Journal of Hand Surgery, 12(1), 1–4. [DOI] [PubMed] [Google Scholar]
  12. Keir PJ, Wells RP, Ranney DA, & Lavery W (1997). The effects of tendon load and posture on carpal tunnel pressure. The Journal of hand surgery, 22(4), 628–634. [DOI] [PubMed] [Google Scholar]
  13. Mackinnon SE (2002). Pathophysiology of nerve compression. Hand clinics, 18(2), 231–241. [DOI] [PubMed] [Google Scholar]
  14. Marquardt TL, Evans PJ, Seitz WH Jr, & Li ZM (2016). Carpal arch and median nerve changes during radioulnar wrist compression in carpal tunnel syndrome patients. Journal of Orthopaedic Research, 34(7), 1234–1240. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. McGorry RW, Fallentin N, Andersen JH, Keir PJ, Hansen TB, Pransky G, & Lin JH (2014). Effect of grip type, wrist motion, and resistance level on pressures within the carpal tunnel of normal wrists. Journal of Orthopaedic Research, 32(4), 524–530. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Moritomo H, Goto A, Sato Y, Sugamoto K, Murase T, & Yoshikawa H (2003). The triquetrum-hamate joint: an anatomic and in vivo three-dimensional kinematic study. The Journal of hand surgery, 28(5), 797–805. [DOI] [PubMed] [Google Scholar]
  17. Moritomo H, Viegas SF, Elder K, Nakamura K, DaSilva MF, & Patterson RM (2000). The scaphotrapezio-trapezoidal joint. Part 2: a kinematic study. The Journal of hand surgery, 25(5), 911–920. [DOI] [PubMed] [Google Scholar]
  18. Moritomo H, Viegas SF, Nakamura K, DaSilva MF, & Patterson RM (2000). The scaphotrapezio-trapezoidal joint. Part 1: An antomic and radiographic study. The Journal of hand surgery, 25(5), 899–910. [DOI] [PubMed] [Google Scholar]
  19. Schuind F, Ventura M, & Pasteels JL (1990). Idiopathic carpal tunnel syndrome: histologic study of flexor tendon synovium. The Journal of hand surgery, 15(3), 497–503. [DOI] [PubMed] [Google Scholar]
  20. Skie M, Zeiss J, Ebraheim NA, & Jackson WT (1990). Carpal tunnel changes and median nerve compression during wrist flexion and extension seen by magnetic resonance imaging. The Journal of hand surgery, 15(6), 934–939. [DOI] [PubMed] [Google Scholar]
  21. Tanaka S, Wild DK, Seligman PJ, Halperin WE, Behrens VJ, & Putz- Anderson V (1995). Prevalence and work- relatedness of self- reported carpal tunnel syndrome among US workers: Analysis of the Occupational Health Supplement data of 1988 National Health Interview Survey. American journal of industrial medicine, 27(4), 451–470. [DOI] [PubMed] [Google Scholar]
  22. Wang Y, Filius A, Zhao C, Passe SM, Thoreson AR, An KN, & Amadio PC (2014). Altered median nerve deformation and transverse displacement during wrist movement in patients with carpal tunnel syndrome. Academic radiology, 21(4), 472–480. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Wang Y, Zhao C, Passe SM, Filius A, Thoreson AR, An KN, & Amadio PC (2014). Transverse ultrasound assessment of median nerve deformation and displacement in the human carpal tunnel during wrist movements. Ultrasound in medicine & biology, 40(1), 53–61. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Werner FW, Green JK, Short WH, & Masaoka S (2004). Scaphoid and lunate motion during a wrist dart throw motion. The Journal of hand surgery, 29(3), 418–422. [DOI] [PubMed] [Google Scholar]
  25. Wolfe SW, Crisco JJ, Orr CM, & Marzke MW (2006). The dart-throwing motion of the wrist: is it unique to humans?. The Journal of hand surgery, 31(9), 1429–1437. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Yoshioka S, Okuda Y, Tamai K, Hirasawa Y, & Koda Y (1993). Changes in carpal tunnel shape during wrist joint motion MRI evaluation of normal volunteers. The Journal of Hand Surgery: British & European Volume, 18(5), 620–623. [DOI] [PubMed] [Google Scholar]

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Supplementary Materials

1
NIHMS1544838-supplement-1.zip (353.1MB, zip)

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