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Carpal Tunnel Pressure and Flexor Tendon Kinematics: A Biomechanical Study
Olivia Wang, MD; Livia Banninger, MD; Jean Tuffier, MD; Giovanni F. Solitro, PhD; Kyle J. MacGillis, MD; Leslie Schwindel, MD; Alfonso Mejia, MD, MPH; Farid Amirouche, PhD; Mark H. Gonzalez, MD, PhD
University of Illinois at Chicago, Chicago, IL

Manual dexterity may be profoundly affected in patients suffering from carpal tunnel syndrome. This study investigates the possible effect of increased carpal tunnel pressures on finger joint kinematics. Three cadaver hands were analyzed and intracarpal pressure was increased artificially by inserting a balloon into the carpal tunnel and measuring MCP and DIP joint flexion by computational motion tracking analysis.
Pressure increases of 0 mmHg, 40 mmHg, 80 mmHg, and 140 mmHg were applied. The angular displacement of the MCP, PIP, and DIP joints was tracked for an intact, partially, and fully released flexor retinaculum.
This study found that higher carpal tunnel pressures had no statistically significant effect on the angular displacement of the MCP, PIP, and DIP joints at an excursion of 35 mm and with pressure values up to 140 mmHg (P<0.05). However a tendency towards reduced ROM overall with increasing pressure was identified for the MCP joint. This trend was demonstrated for an intact and partially released ligament. No drift could be detected for neither the PIP nor the DIP joints. DIP joint displacement during finger movement differed from hand to hand. For all conditions of the flexor retinaculum, two specimens did not exhibit any change in rotation of the DIP joint when pulling the FDS tendon separately. A small DIP displacement was noted to occur for the remaining specimen. Data analysis of all conditions showed a statistical significance only for the MCP joint when pulling the FDS tendon separately (p<0.04). No other experimental set reached statistical significance.
When combining the values from the FDP and FDS tendon separately and together, a statistically significant difference in excursion between an intact and a partially released ligament for the MCP (p<0.03) as well as PIP joint (p<0.009) was observed.
This study showed that an increased intracarpal pressure did not have a significant impact on finger joint kinematics. However, a trend towards a reduction in angular displacement for the MCP joint was observed. Augmentation of pressure also had a significant effect on the required force to pull the FDP and FDS tendons. Additionally, this study determined that the integrity of the flexor retinaculum had an influence on the range of motion of the index finger. A partially and fully released ligament exhibited an increased range of motion for the MCP and PIP joints.

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