An MRI evaluation of carpal tunnel dimensions in healthy wrists: Implications for carpal tunnel syndrome

BACKGROUND: Deviated wrist postures and pinch grip use have been linked to the development of carpal tunnel syndrome and are likely related to the size and shape of the carpal tunnel. The purpose of this study was to quantify carpal tunnel dimensions with changes in wrist posture and pinch grip. METHODS: Eight healthy volunteers (4 male, 4 female) underwent magnetic resonance imaging of their dominant wrists under seven conditions which included: 30 degrees wrist extension, neutral and 30 degrees flexion (with and without a 10 N pinch force) and a fist with a neutral wrist. Cross-sectional area of the carpal tunnel and its contents were calculated at 3mm increments along the length of the tunnel and integrated to calculate volumes. Ratios were calculated between the contents of the tunnel to the tunnel itself for area and volume. FINDINGS: The use of a correction factor significantly reduced volume and distal carpal tunnel area in flexed and extended wrists. Carpal tunnel areas were largest in neutral and smallest at the distal end with wrist flexion. An extended wrist resulted in the smallest carpal tunnel and content volumes as well as the smallest carpal tunnel content volume to carpal tunnel volume ratios. While men had significantly larger areas and volumes than women for both the carpal tunnel and it contents, there were no differences in ratios between the contents and tunnel size. INTERPRETATION: A simple correction factor for non-perpendicular magnetic resonance images proved useful in relating volume changes to known pressure changes within the carpal tunnel. More inclusive and detailed evaluation of the carpal tunnel and its contents is required to fully understand mechanisms for median nerve compression in the carpal tunnel.