Median Nerve Mobility before and after Carpal Tun­nel Decompres­sion

Authors: A. Fibír 1,2;  R. Čáp 2,3;  L. Ungermann 4,5;  J. Vaněk 6
Authors‘ workplace: Oddělení plastické chirurgie a léčby popálenin, Chirurgická klinika LF UK a FN Hradec Králové 1;  Plastická a estetická chirurgie, První privátní chirurgické centrum s. r. o., Sanatorium SANUS, Hradec Králové 2;  Katedra válečné chirurgie, Fakulta vojenského zdravotnictví, UO v Hradci Králové 3;  Radiologická klinika LF UK a FN Hradec Králové 4;  Radiodiagnostické oddělení, Nemocnice Pardubického kraje, a. s. 5;  Katedra informatiky a kvantitativních metod, Fakulta informatiky a managementu, Univerzita Hradec Králové 6
Published in: Cesk Slov Neurol N 2015; 78/111(6): 675-679
Category: Original Paper


The main objective of the study was to describe transverse and longitudinal movement of the median nerve in patients with the carpal tunnel syndrome before and with delay after open decompression of the carpal tunnel.

Materials and Methods:
From March 2007 to July 2009, the study enrolled a total of 72 patients with the carpal tunnel syndrome. The examination of nerve movement was performed noninvasively by ultrasound before and several months after the surgery. Transverse nerve amplitude was measured at the level of the pisiform bone. Longitudinal movement was measured on the forearm at a distance of 8–11 cm proximal to the wrist. The standard open surgery was performed.

The mean of maximum transverse amplitude of the median nerve in our sample was 1.82 mm preoperatively and 1.76 mm postoperatively, and the difference was not statistically significant (p > 0.05). The average amplitude of the longitudinal movement of the median nerve was 3.74 mm preoperatively and 3.89 mm postoperatively, and the difference was not considered statistically significant (p > 0.05).

There were no statistically significant changes in transverse or longitudinal movement of the median nerve after open carpal tunnel decompression. Open decompression does not affect biomechanical parameters of the median nerve in carpal tunnel syndrome patients.

Key words:
carpal tunnel syndrome – median nerve – ultrasound – mobility – nerve movement – biomechanics

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


1. Latinovic R, Gul­liford MC, Hughes RA. Incidence of com­mon compres­sive neuropathies in primary care. J Neurol Neurosurg Psychiatry 2006; 77(2): 263– 265.

2. Papanicolaou GD, McCabe SJ, Fir­rell J. The prevalence and characteristics of nerve compres­sion symp­toms in the general population. J Hand Surg Am 2001; 26(3): 460– 466.

3. Fenclová Z, Urban P, Pelclová D, Navrátil T. Neurologická profesionální onemocnění v České republice v letech 1994– 2009. Cesk Slov Neurol N 2012; 75/ 108(1): 70– 74.

4. Akelman E. Carpal tun­nel syndrome. In: Berger PA, Weiss AP (eds). Hand surgery. Philadelphia: Lippincott Wil­liams & Wilkins 2004: 867– 885.

5. Yoshii Y, Ishii T, Sakai S. Median nerve deformation dur­ing finger motion in carpal tun­nel syndrome: cor­relation between nerve conduction and ultrasonographic indices. Hand Surg 2013; 18(2): 203– 208. doi: 10.1142/ S021881041350024X.

6. Korstanje JW, Scheltens‑ De Boer M, Blok JH, Amadio PC, Hovius SE, Stam HJ et al. Ultrasonographic as­ses­sment of longitudinal median nerve and hand flexor tendon dynamics in carpal tun­nel syndrome. Muscle Nerve 2012; 45(5): 721– 729. doi: 10.1002/ mus.23246.

7. Szabo RM, Bay BK, Sharkey NA, Gaut C. Median nerve displacement through the carpal canal. J Hand Surg Am 1994; 19(6): 901– 906.

8. Tuzuner S, Ozkaynak S, Acikbas C, Yildirim A. Median nerve excursion dur­ing endoscopic carpal tun­nel release. Neurosurgery 2004; 54(5): 1155– 1160.

9. Mil­lesi H, Zöch G, Rath T. The glid­ing apparatus of peripherial nerve and its clinical significance. Ann Chir Main Memb Super 1990; 9(2): 87– 97.

10. Ettema AM, Zhao C, Amadio PC, O‘Byrne M­, An KN. Glid­ing characteristics of flexor tendon and tenosynovium in carpal tun­nel syndrome: a pilot study. Clin Anat 2007; 20(3): 292– 299.

11. Zhao C, Ettema AM, Osamura N, Berglund LJ, An KN, Amadio PC. Glid­ing characteristics between flexor tendons and sur­round­ing tis­sues in the carpal tun­nel: a bio­mechanical cadaver study. J Orthop Res 2007; 25(2): 185– 190.

12. Wright TW, Glowczewskie F, Wheeler D, Mil­ler G, Cowin D. Excursion and strain of the median nerve. J Bone Joint Surg Am 1996; 78(12): 1897– 1903.

13. Wang Y, Filius A, Zhao C, Pas­se SM, Thoreson AR, An KN et al. Altered median nerve deformation and transverse displacement dur­ing wrist movement in patients with carpal tun­nel syndrome. Acad Radiol 2014; 21(4): 472– 480. doi: 10.1016/ j.acra.2013.12.012.

14. Dil­ley A, Lynn B, Green­ing J, DeLeon N. Quantitative in vivo studies of median nerve slid­ing in response to wrist, elbow, shoulder and neck movements. Clin Biomech 2003; 18(10): 899– 907.

15. Coppieters MW, Hough AD, Dil­ley A. Dif­ferent nerve‑ glid­ing exercises induce dif­ferent magnitudes of median nerve longitudinal excursion: an in vivo study us­ing dynamic ultrasound imaging. J Orthop Sports Phys Ther 2009; 39(3): 164– 171. doi: 10.2519/ jospt.2009.2913.

16. Kostopoulos D. Treatement of carpal tun­nel syndrome: a review of the non‑surgical approaches with emphasis in neural mobilisation. J Body Move Ther 2004; 8(1): 2– 8.

17. Dil­ley A, Green­ing J, Lynn B, Leary R, Mor­ris V. The use of cros­s‑ cor­relation analysis between high‑frequency ultrasound images to measure longitudinal median nerve movement. Ultrasound Med Biol 2001; 27(9): 1211– 1218.

18. Nakamichi K, Tachibana S. Restricted motion of the median nerve in carpal tun­nel syndrome. J Hand Surg Br 1995; 20(4): 460– 464.

19. Erel E, Dil­ley A, Green­ing J, Mor­ris V, Cohen B, Lynn B. Longitudinal slid­ing of the median nerve in patients with carpal tun­nel syndrome. J Hand Surg Br 2003; 28(5): 439– 443.

20. Ugbolue UC, Hsu WH, Goitz RJ, Li ZM. Tendon and nerve displacement at the wrist dur­ing finger movements. Clin Biomech 2005; 20(1): 50– 56.

21. Yamaguchi T, Osamura N, Zhao Ch, An KN, Amadio PC. Relative longitudinal motion of the finger flexors, subsynovial con­nective tis­sue and median nerve before and after carpal tun­nel release in a human cadaver model. J Hand Surg Am 2008; 33(6): 888– 892. doi: 10.1016/ j.jhsa.2008.02.017.

22. Tüzüner S, Inceoglu S, Bilen FE. Median nerve excursion in response to wrist movement after endoscopic and open carpal tun­nel release. J Hand Surg Am 2008; 33(7): 1063– 1068. doi: 10.1016/ j.jhsa.2008.03.007.

23. Erel E, Dil­ley A, Turner S, Kumar P, Bhatti WA, Lees VC. Sonographic measurements of longitudinal median nerve slid­ing in patients fol­low­ing nerve repair. Muscle Nerve 2010; 41(3): 350– 354. doi: 10.1002/ mus.21501.

Paediatric neurology Neurosurgery Neurology
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account