Effect of Wrist Deviation on Median Nerve Cross-Sectional Area at Proximal Carpal Tunnel Level
Effect of Wrist Deviation on Median Nerve Cross-Sectional Area at Proximal Carpal Tunnel Level
复制标题
手腕偏差对近端腕管水平正中神经横截面积的影响
DOI：
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
S. Muraki
中科院分区：
文献类型：
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作者：
P. Loh;S. Muraki
计算机在日常工作中被广泛使用。它们已成为工作场所必不可少的工具。重复和笨拙的姿势与电脑使用者的上肢肌肉骨骼疾病有关(1)。日常生活中长时间使用计算机增加了颈部、肩部、肘部、手腕和手部的疾患程度。研究表明，大约20%的计算机用户患有上肢肌肉骨骼疾病(2，3)。大量使用电脑键盘和鼠标可能会增加患腕管综合征(CTS)的风险，CTS是上肢最常见的肌肉骨骼疾病之一，由于神经压迫，正中神经在腕管受到影响[1]。腕管位于腕掌侧，以腕骨为底，腕横韧带为顶，近端腕管由腕横韧带的边缘在豌豆状水平形成。中间神经和9条肌腱通过腕管进入腕管，分别为指长屈肌(FPL)、指浅屈肌(FDS)和指前屈肌(FDP)。正中神经位于屈肌支持带附近，易受压迫。腕关节运动包括屈曲、伸展、偏向和尺骨偏斜。以往的研究表明，手指的动态运动可通过FDS、FDP和FPL的滑动运动对内侧神经施加压应力。腕骨的动态运动也可能在腕屈伸运动中影响腕管的体积(6)。因此，不同的手腕角度可能会对正中神经造成不同程度的压应力。一个舒适的工作空间，让计算机用户以良好的姿势进行日常工作，对于减少重复的劳损是必要的。然而，身体姿势和关节角度会随着时间的推移而变化。例如，在计算机工作过程中，手腕的运动是动态的，因为手腕同时在屈曲和伸展之间变化，并伴有尺-尺偏斜。在之前的一项研究中，大多数电脑用户在使用电脑时，腕关节伸展20°，尺骨偏斜20°的比例较高(7)。因此，工作时不同的手腕角度可能会对正中神经造成不同程度的压迫应力。超声检查已广泛应用于包括医学以外的不同领域。特别是，在动态腕关节运动过程中，可以观察到腕管区结构的机械压缩。与其他成像技术相比，US相对便宜，检查腕部所需时间较短(1)。因此，本研究的目的是利用高分辨率的超声图像，研究腕屈伸并尺-尺偏斜对正中神经横截面积(MNCSA)的影响。材料与方法8名右利手健康男性成人(表1)。根据筛查测试，所有的裤子都没有CTS的迹象和症状。所有患者均行Phalen‘s试验、CTS Tinel试验和BCTQ检查，以排除CTS(8-10)。超声检查采用GE Healthcare超声系统(LOGIQ e型)，探头频率为5~13 MHz(12L-RS型)，胶垫(厚度7.0 mm，Sonar Pad，日本BXI公司)作为超声检查的耦合介质。检查时，受试者坐直，前臂支撑在桌子上。共检查了9个腕位，包括WN、WF30°和WE30°，以及3种腕部偏斜情况，即无尺偏(UD)和无尺偏(RD)、最大RD和最大UD(图2)。…
IntroductionComputers are widely used in daily work. They have become essential tools in the workplace. Re- petitive and awkward positions are associated with musculoskeletal disorders of the upper extremities among computer users (1). Long hours of com- puter use in daily life have increased the discom- fort levels of the neck, shoulder, elbow, and wrist and hand regions. Studies have shown that ap- proximately 20% of computer users experience musculoskeletal disorders of the upper extremities (2, 3). Intensive use of a computer keyboard and a mouse may increase the risk of carpal tunnel syndrome (CTS), which is one of the most com- monly reported musculoskeletal disorders of the upper extremities, in which the median nerve is affected at the carpal tunnel as a result of nerve compression (1). CTS has a multifactorial etiology and mechanical compression stress on the median nerve is one of the relevant factors.The carpal tunnel is located at the volar wrist and formed by carpal bones as the floor, transverse carpal ligament as the roof and the proximal car- pal tunnel defined by the edge of the transverse carpal ligament at the pisiform level (4). The me- dian nerve and a total of nine tendons enter through the carpal tunnel, which are the flexor policies longus (FPL), four flexor digitorum su- perficialis (FDS) and four flexor digitorum pro- fundus (FDP). The median nerve is located near the flexor retinaculum and is vulnerable to com- pression stress. Wrist movements comprise flex- ion, extension, radial deviation and ulnar devia- tion. Finger dynamic movements were previously shown to impose compression stress on the medi- an nerve from FDS, FDP and FPL gliding motion (5). Dynamic kinematic movements of carpal bones may also influence the carpal tunnel volume during wrist flexion-extension motion (6). There- fore, different wrist angles may cause different levels of compression stress on the median nerve. A comfortable workspace that allows computer users to perform daily work in a good posture is necessary to reduce repetitive strain injuries. How- ever, body posture and joint angles change over time. For example, wrist motions during computer work are dynamic as the wrist changes between flexion and extension simultaneously with radial- ulnar deviation. In a previous study, most com- puter users showed a higher percentage of wrist extension at 20° with 20° ulnar deviation during computer use (7). Therefore, different wrist angles while working may cause different levels of com- pression stress on the median nerve.Ultrasound (US) examination has been widely used in different fields, including outside of medi- cine. In particular, the mechanical compression of carpal tunnel region structures during dynamic wrist motion can be observed by US. Compared with other imaging techniques, US is relatively inexpensive and requires a shorter time to exam- ine the wrist region (1).The objective of this study was thus to investigate the effect of wrist flexion-extension with radial-ulnar deviation on median nerve cross-sectional area (MNCSA) by using high-resolution US images.Materials and MethodsEight right-handed healthy male adults were re- cruited for this study (Table 1). All the partici- pants were free from signs and symptoms of CTS, as indicated by a screening test. Phalen's Test, CTS Tinel test and Boston Carpal Tunnel Ques- tionnaire (BCTQ) were conducted for all partici- pants to rule out CTS (8-10). In total, sixteen wrists were included for median nerve ultrasound (US) examination.US examination was performed with the GE Healthcare Ultrasound System (Model LOGIQ e) with a 5-13 mHz transducer (Model 12L-RS), and a gel pad (thickness 7.0 mm; Sonar Pad, Nippon BXI Inc., Japan) was used as the coupling medium for the US examination.Participants sat upright with the forearm resting on a forearm support on a table during the US examination. A total of nine wrist positions were examined, including WN, WF30°, and WE30°, together with three wrist deviation conditions, namely, without radial deviation (RD) and ulnar deviation (UD), with maximal RD and with maxi- mal UD (Fig. …