Wrist and carpal tunnel size and shape measurements: Effects of posture

BACKGROUND: Wrist anthropometrics and posture have been implicated in the development of carpal tunnel syndrome, yet it remains unclear how external measurements relate to carpal tunnel parameters in neutral and non-neutral postures. The purposes of this study were (i) to evaluate the effect of slice orientation on several indices of carpal tunnel size and shape and (ii) to examine the relationship between carpal tunnel and external wrist dimensions. METHODS: Three-dimensional static models were generated to measure carpal tunnel and wrist parameters for six wrists in three wrist postures (30 degrees flexion, neutral and 30 degrees extension). A simulated imaging plane enabled measurement of four carpal tunnel dimensions and two shape indices throughout the tunnel length, using "axial" and "tunnel" slice orientations (perpendicular to forearm and tunnel, respectively). FINDINGS: Correction for tunnel orientation eliminated posture-related changes in tunnel size and shape noted at the distal end using "axial" alignment. "Tunnel" alignment reduced average carpal tunnel area and depth by nearly 15% in extension, but generally less than 5% in neutral and 2% in flexion. Subsequently, "tunnel" alignment also decreased carpal tunnel and non-circularity ratios to reveal a flatter, more elliptical shape throughout the tunnel in extension than neutral and flexion. Wrist dimensions correlated significantly with tunnel dimensions, but not tunnel shape, while wrist shape correlated significantly with tunnel shape, area and depth. INTERPRETATIONS: Slice alignment with the carpal tunnel may improve the consistency of findings within and between patient and control populations, and enhance the diagnostic utility of imaging in clinical settings.