Ultrasonographic assessment of carpal tunnel biomechanics

Abstract

In this thesis, we searched for a way to assess flexor tendon and median nerve biomechanics, as well as subsynovial connective tissue thickness (SSCT) in the carpal tunnel with ultrasound, and tried to see if these patterns would give a clue towards understanding the etiology of carpal tunnel syndrome (CTS). We made longitudinal and transverse ultrasound clips of the carpal tunnel during finger motion and measured the transformation of the median nerve and flexor tendons, as well as the motion direction. Additionally, we measured subsynovial connective tissue thickness and motion. We found that in carpal tunnel syndrome patients, the subsynovial connective tissue is thicker than in healthy controls. To measure its motion, we used a new technique called speckle tracking and found that this method has good accuracy for velocity measurements of SSCT and tendon motion. In the transverse plane, we found that there is more compression of the median nerve in CTS patients than in healthy controls during finger motion. Also, the flexor digitorum superficialis tensons and median nerve have a changed motion pattern compared to healthy persons. These findings can function as baseline data for further research towards understanding the etiology of carpal tunnel syndrome and the role of the subsynovial connective tissue in this disease. Also, these studies aid in the development of ultrasound as a tool for the investigation of tendon and subsynovial connective tissue biomechanics, both in healthy persons and in carpal tunnel syndrome