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. 2023 Sep 11;23(94):e114-e121.
doi: 10.15557/jou.2023.0020. eCollection 2023 Sep.

Median nerve versus flexor tendons: visualization of median nerve level changes in the proximal carpal tunnel during wrist movement with dynamic high-resolution ultrasound

Suren Armeni Jengojan  1 , Lisa Lechner  1 , Gregor Kasprian  1 , Elena Drakonaki  2 , Veith Moser  3 , Žiga Snoj  4 , Gerd Bodner  5
Affiliations

Median nerve versus flexor tendons: visualization of median nerve level changes in the proximal carpal tunnel during wrist movement with dynamic high-resolution ultrasound

Suren Armeni Jengojan et al. J Ultrason. .

Abstract

Aim: The purpose of this prospective ultrasound study was to document dorso-palmar (vertical) displacement of the median nerve in relation to the superficial flexor tendons at the level of the carpal tunnel. Furthermore, the gliding patterns of the median nerve were characterized. The presence of vertical gliding was intended to serve as an additional bio-kinematic parameter of median nerve movement, and will be referred to as a 'level change'.

Material and methods: In this study, a total of 32 healthy young individuals underwent dynamic high-resolution ultrasound examinations of both wrists. The neutral position, and maximum flexion and extension of the wrist had to be reached in active and passive movement. The gliding patterns were determined in relation to the superficial flexor tendons. When no vertical nerve gliding was observed, it was characterized as 'no level change'.

Results: The presence of a level change prevailed in the healthy young cohort and was observed in 84% (27/32) of individuals during wrist flexion. The following gliding pattern was distinctively the most common: gliding of the entire nerve in between the flexor tendons in active but not in passive movement of the right and left wrists (13/27; 48%). The extent of vertical displacement was found to be associated with the gliding pattern (Kruskal-Wallis test).

Conclusions: Movement in the carpal tunnel allows the median nerve to adapt to biomechanical stress. Dynamic ultrasound can demonstrate median nerve level changes in response to wrist movements. Furthermore, a typical gliding pattern was characterized. The presence of level change and gliding patterns were proposed as additional movement parameters during wrist flexion in healthy individuals.

Keywords: carpal tunnel; dynamic high-resolution ultrasound; median nerve gliding; nerve biomechanics.

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Conflict of interest statement

Conflict of interest All authors declare no conflicts of interest. No funding was received for this study.

Figures

Fig. 1.
Fig. 1.
Examination scheme: wrist alignments
Fig. 2.
Fig. 2.
Wrist in maximum flexion: no level change of MN (pattern A). MN – median nerve; FT – flexor tendons; TCL – transverse carpal ligament; SB – scaphoid bone; PB – pisiform bone
Fig. 3.
Fig. 3.
Wrist in maximum flexion: partial or mild gliding of MN parts (<1/3) onto the tendon level (pattern B). MN – median nerve; FT – flexor tendons; TCL – transverse carpal ligament; SB – scaphoid bone; PB – pisiform bone
Fig. 4.
Fig. 4.
Wrist in maximum flexion: significant or total gliding (>2/3) of the MN cross-section onto the tendon level (pattern C). MN – median nerve; FT –flexor tendons; TCL – transverse carpal ligament; SB – scaphoid bone; PB – pisiform bone
Fig. 5.
Fig. 5.
Wrist in maximum flexion: gliding of the MN below the flexor tendons (pattern D). MN – median nerve; FT -flexor tendons; TCL – transverse carpal ligament; SB – scaphoid bone; PB – pisiform bone
Fig. 6.
Fig. 6.
Median nerve: measurement of vertical displacement. A. neutral wrist position; B. maximum flexion
Fig. 7.
Fig. 7.
Median nerve: gliding patterns during movement from neutral wrist position to maximum flexion in individual subjects (n = 32)
Fig. 8.
Fig. 8.
Median nerve: presence of level change in individual subjects (n = 32)
Fig. 9.
Fig. 9.
Wrist in maximum flexion: MN in CTS patient. MN – median nerve; FT – flexor tendons; TCL – transverse carpal ligament. Note for comparability: an 18 MHz linear transducer was used here, whereas a 15 MHz linear transducer was used in the other cases
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