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Ultrasound Assessment of the Displacement and Deformation of the Median Nerve in the Human Carpal Tunnel with Active Finger Motion
Yuichi Yoshii, MD1; Hector R. Villarraga, MD1; Jacqueline Henderson, PhD1; Chunfeng Zhao, MD1; Kai-Nan An, PhD1; Peter C. Amadio, MD1
1 Orthopedic Biomechanics Laboratory and Division of Cardiovascular Diseases (H.R.V.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for P.C. Amadio: pamadio@mayo.edu
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases Grant AR49823. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.
Investigation performed at the Orthopedic Biomechanics Laboratory, Mayo Clinic, Rochester, Minnesota

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Dec 01;91(12):2922-2930. doi: 10.2106/JBJS.H.01653
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Background: Peripheral nerves are mobile structures, stretching and translating in response to changes in the position of adjuvant anatomic structures. The objective of this study was to develop a novel method to characterize the relative motion and deformation of the median nerve on cross-sectional ultrasound images of the carpal tunnel during active finger motion.

Methods: Fifteen volunteers without a history of carpal tunnel syndrome or wrist trauma were recruited. An ultrasound scanner and a linear array transducer were used to evaluate the motion of the median nerve and the flexor tendons within the carpal tunnel during motion from full extension to full flexion by the four fingers (fist motion) and by the long finger alone. The displacement of the median nerve relative to the long-finger flexor digitorum superficialis tendon as well as the perimeter, cross-sectional area, circularity, and aspect ratio of a minimum enclosing rectangle of the median nerve were measured. The data were compared between single-digit motion and fist motion and between extension and flexion positions.

Results: The distance between the long-finger flexor digitorum superficialis tendon and the median nerve with isolated long-finger flexion was decreased in the ulnar-radial direction and increased in the palmar-dorsal direction as compared with the distance with four-finger flexion (p < 0.01). Compared with the values with fist motion, the aspect ratio was decreased and the circularity was increased with long-finger motion (p < 0.01).

Conclusions: This report presents a method with which to assess displacement and deformation of the median nerve on a cross-sectional ultrasound image during different finger motions. This method may be useful to assess pathological changes within the carpal tunnel, and we plan to perform a similar study of patients with carpal tunnel syndrome on the basis of these preliminary data.

Level of Evidence: Diagnostic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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