Effect of Wrist Dorsiflexion/Palmar Flexion on Median Nerve Deviation and Cross-Sectional Area in Patients with Carpal Tunnel Syndrome

Abstract

Objective. To evaluate the effect of wrist dorsiflexion/palmar flexion on median nerve excursion and cross-sectional area in patients with carpal tunnel syndrome. Methods. From November 2019 to December 2021, 85 patients (110 affected wrists) who presented to our department and were diagnosed with carpal tunnel syndrome were collected and classified by severity as mild to moderate. Twenty-five healthy controls were selected during the same period, with a total of 50 healthy wrists. All patients and healthy volunteers underwent high-frequency ultrasonography to measure the vertical deviation between the median nerve and the transverse carpal ligament during wrist dorsiflexion/palmar flexion and the changes in the cross-sectional area of the median nerve in the pisiform plane. All patients with carpal tunnel syndrome underwent neurophysiological testing to measure median nerve sensory conduction velocity, sensory latency time, and sensorimotor point fluctuation amplitude. Results. The mean age of the patients was$50\pm 8$years, the proportion of males was 18%, and the disease course was$2.3\pm 1.2$years. In terms of severity grading, 38 patients (34.5%) had mild carpal tunnel syndrome, 30 patients (27.3%) had moderate carpal tunnel syndrome, and 42 patients (38.2%) had severe carpal tunnel syndrome. Compared with the control group, the distance between the proximal median nerve and the transverse carpal ligament, the distance between the distal median nerve and the transverse carpal ligament, and the cross-sectional area were decreased in the carpal tunnel syndrome group compared with those during wrist dorsiflexion, and the differences were statistically significant ($P<0.05$). Compared with the control group, there were significant differences in the vertical distance and cross-sectional area between the median nerve and the transverse carpal ligament at the proximal and distal ends in the mild, moderate, and severe groups ($P<0.05$). The proximal vertical distance of the median nerve was positively correlated with sensory latency ($P<0.05$) and negatively correlated with sensory conduction velocity ($P<0.05$). The vertical distance of the distal end of the median nerve was also significantly positively correlated with sensory latency ($P<0.05$) and significantly negatively correlated with sensory conduction velocity ($P<0.05$). Conclusion. Wrist dorsiflexion/palmar flexion can affect median nerve deviation and cross-sectional area in patients with carpal tunnel syndrome. High-frequency ultrasound is helpful to detect such an effect and can also help determine the severity of carpal tunnel syndrome, which is worthy of clinical promotion.