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Mechanics of carpal tunnel soft tissue, such as fat, muscle and transverse carpal ligament (TCL), around the median nerve may render the median nerve vulnerable to compression neuropathy. The purpose of this study was to understand the roles of carpal tunnel soft tissue mechanical properties and intratunnel pressure on the TCL tensile strain and carpal arch area (CAA) using finite element analysis (FEA). Manual segmentation of the thenar muscles, skin, fat, TCL, hamate bone, and trapezium bone in the transverse plane at distal carpal tunnel were obtained from B-mode ultrasound images of one cadaveric hand. Sensitivity analyses were conducted to examine the dependence of TCL tensile strain and CAA on TCL elastic modulus (0.125-10 MPa volar-dorsally; 1.375-110 MPa transversely), skin-fat and thenar muscle initial shear modulus (1.6-160 kPa for skin-fat; 0.425-42.5 kPa for muscle), and intratunnel pressure (60-480 mmHg). Predictions of TCL tensile strain under different intratunnel pressures were validated with the experimental data obtained on the same cadaveric hand. Results showed that skin, fat and muscles had little effect on the TCL tensile strain and CAA changes. However, TCL tensile strain and CAA increased with decreased elastic modulus of TCL and increased intratunnel pressure. The TCL tensile strain and CAA increased linearly with increased pressure while increased exponentially with decreased elastic modulus of TCL. Softening the TCL by decreasing the elastic modulus may be an alternative clinical approach to carpal tunnel expansion to accommodate elevated intratunnel pressure and alleviate median nerve compression neuropathy., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The transverse carpal ligament (TCL) plays a critical role in carpal tunnel biomechanics through interactions with its surrounding tissues. The purpose of this study was to investigate the in vivo adaptations of the TCL's mechanical properties in response to repetitive hand use in pianists using acoustic radiation force impulse (ARFI) imaging. It was hypothesized that pianists, in comparison to non-pianists, would have a stiffer TCL as indicated by an increased acoustic shear wave velocity (SWV). ARFI imagining was performed for 10 female pianists and 10 female non-pianists. The median SWV values of the TCL were determined for the entire TCL, as well as for its radial and ulnar portions, rTCL and uTCL, respectively. The TCL SWV was significantly increased in pianists relative to non-pianists (p < 0.05). Additionally, the increased SWV was location dependent for both pianist and non-pianist groups (p < 0.05), with the rTCL having a significantly greater SWV than the uTCL. Between groups, the rTCL SWV of pianists was 22.2% greater than that of the non-pianists (p < 0.001). This localized increase of TCL SWV, i.e. stiffening, may be primarily attributable to focal biomechanical interactions that occur at the radial TCL aspect where the thenar muscles are anchored. Progressive stiffening of the TCL may become constraining to the carpal tunnel, leading to median nerve compression in the tunnel. TCL maladaptation helps explain why populations who repeatedly use their hands are at an increased risk of developing musculoskeletal pathologies, e.g. carpal tunnel syndrome.

This study presents methodology to determine joint moments of the digits of the hand during pinch function. This methodology incorporates steps to identify marker-based kinematic data defining aligned coordinate systems for individual digit segments and joint centre locations. The kinematic data are then transformed to a common reference frame along with the force data collected at pinch contact of a customised apparatus in three dimensions. These methods were demonstrated with a pilot investigation to examine the static joint moments occurring during two-digit oppositional precision pinch at a particular end point force level applied at the digit pads. Notable abduction joint moments at the proximal joints of both digits were observed, which implicate the role of respective intrinsic and extrinsic muscles in maintaining pinch grasp. Examining differences in joint moment results when substituting selected steps of this methodological approach suggested greater relative importance for joint centre identification and segment coordinate system alignment.

Purpose: This study investigated novel kinematic performance parameters to understand regulation by visual feedback (VF) of the reaching hand on the grasp and transport components during the reach-to-pinch maneuver. Conventional metrics often signify discrete movement features to postulate sensory-based control effects (e.g., time for maximum velocity to signify feedback delay). The presented metrics of this study were devised to characterize relative vision-based control of the sub-movements across the entire maneuver., Methods: Movement performance was assessed according to reduced variability and increased efficiency of kinematic trajectories. Variability was calculated as the standard deviation about the observed mean trajectory for a given subject and VF condition across kinematic derivatives for sub-movements of inter-pad grasp (distance between thumb and index finger-pads; relative orientation of finger-pads) and transport (distance traversed by wrist). A Markov analysis then examined the probabilistic effect of VF on which movement component exhibited higher variability over phases of the complete maneuver. Jerk-based metrics of smoothness (minimal jerk) and energy (integrated jerk-squared) were applied to indicate total movement efficiency with VF., Results/discussion: The reductions in grasp variability metrics with VF were significantly greater (p<.05) compared to transport for velocity, acceleration, and jerk, suggesting separate control pathways for each component. The Markov analysis indicated that VF preferentially regulates grasp over transport when continuous control is modeled probabilistically during the movement. Efficiency measures demonstrated VF to be more integral for early motor planning of grasp than transport in producing greater increases in smoothness and trajectory adjustments (i.e., jerk-energy) early compared to late in the movement cycle., Conclusions: These findings demonstrate the greater regulation by VF on kinematic performance of grasp compared to transport and how particular features of this relativistic control occur continually over the maneuver. Utilizing the advanced performance metrics presented in this study facilitated characterization of VF effects continuously across the entire movement in corroborating the notion of separate control pathways for each component., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Carpal tunnel syndrome (CTS) can adversely affect fine motor control of the hand. Precision pinch between the thumb and index finger requires coordinated movements of these digits for reliable task performance. We examined the impairment upon precision pinch function affected by CTS during digit movement and digit contact. Eleven CTS subjects and 11 able-bodied (ABL) controls donned markers for motion capture of the thumb and index finger during precision pinch movement (PPM). Subjects were instructed to repetitively execute the PPM task, and performance was assessed by range of movement, variability of the movement trajectory, and precision of digit contact. The CTS group demonstrated shorter path-length of digit endpoints and greater variability in inter-pad distance and most joint angles across the PPM movement. Subjects with CTS also showed lack of precision in contact points on the digit-pads and relative orientation of the digits at contact. Carpal tunnel syndrome impairs the ability to perform precision pinch across the movement and at digit-contact. The findings may serve to identify deficits in manual dexterity for functional evaluation of CTS., (© 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.)

Intermuscular coupling has been investigated to understand neural inputs to coordinate muscles in a motor performance. However, little is known on the role of nerve innervation on intermuscular coupling. The purpose of this study was to investigate how the anatomy of nerve distribution affected intermuscular coupling in the hand during static grip. Electromyographic (EMG) signals were recorded from intrinsic and extrinsic muscles while subjects performed a static grip. Coherence was computed for muscle pairs innervated by either the same or different nerves. The results did not support the hypothesis that muscles sharing the same nerve exhibit greater coupling than muscles innervated by different nerves. In general, extrinsic muscle pairs displayed higher coherence than intrinsic pairs. The results suggest that intermuscular coupling in a voluntary motor task is likely modulated in a functional manner and that different nerves might transport common neural inputs to functionally coupled muscles., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

The transverse carpal ligament (TCL) serves as the origin of the thenar muscles and is integral to thenar muscle contraction anatomically and biomechanically. TCL hypertrophy has been observed in patients with carpal tunnel syndrome and is potentially caused by repetitive hand use. The purpose of this study was to investigate the biomechanical interaction between the TCL and the thenar muscles. Specifically, the morphological changes of the carpal arch, formed by the TCL, in response to thenar muscle contractions were examined during isometric tip pinch between the thumb and index finger. Ultrasound videos of the carpal tunnel were recorded from 13 healthy subjects and were synchronized with the forces measured by a pinch dynamometer. The thenar muscles' ulnar point, trapezium, and hamate were tracked by a pattern-matching program. The pinch force significantly affected the carpal arch height, width, and area (P < 0.005). As the pinch force increased from 0 to 100% maximum voluntary contraction force, the carpal arch height increased from 1.8 ± 1.0 to 2.3 ± 1.3 mm, the carpal arch width decreased from 23.9 ± 2.4 to 23.1 ± 2.4 mm, and the carpal arch area increased from 22.2 ± 13.6 to 27.3 ± 16.3 mm(2). The TCL was pulled volarly during thenar muscle contractions, providing evidence for the biomechanical interaction between the ligament and muscles. Repetitive biomechanical stimulation on the TCL from thenar muscle contractions could lead to tissue remodeling and then TCL hypertrophy. This study sheds light on the potential cause of TCL hypertrophy, which may be an etiological factor for carpal tunnel syndrome.

This study investigated the expansion of the carpal tunnel resulting from the application of palmarly directed forces to the transverse carpal ligament (TCL) from inside the carpal tunnel. Ten fresh-frozen cadaveric hands were dissected to evacuate the carpal tunnel, and thus to expose the TCL. A custom lever device was built to apply forces, ranging from 10 N to 200 N, to the TCL. Without force application, the carpal tunnel area was 148.4+/-36.8 mm2. The force application caused the TCL to form arches with an increase in cross-sectional areas of 33.3+/-5.6 mm2 at 10 N and 48.7+/-11.4 mm2 at 200 N, representing respective increases of 22.4% and 32.8% relative to the initial carpal tunnel area. The TCL length remained constant under the applied forces. It was found that the TCL arch formation was due to the narrowing of the arch width, which resulted from the migration of the bony insertion sites of the TCL. A geometrical model of the carpal tunnel was then developed to elucidate the relationships among the arch width, TCL length, arch height, and arch area. The model illustrated the effectiveness of carpal tunnel expansion by TCL elongation or arch width narrowing.

The tightness of intrinsic hand muscles is a common cause of finger joint stiffness. The purposes of this study were to develop a robot-assisted methodology to obtain torque-angle data of a finger joint, and to investigate the regulation of the intrinsic muscles on finger joint stiffness. Our robot system features the integration of a low payload robot arm, a controller, and a force/torque transducer. The system provided highly reproducible torque-angle curves. Torque-angle data of the proximal interphalangeal joint with the metacarpophalangeal joint at 0 and 60 degrees were obtained from eight asymptomatic hands. The torque-angle curve shifted with the position of the metacarpophalangeal joint. As the metacarpophalangeal joint flexion angle changed from 60 to 0 degrees, the equilibrium of the proximal interphalangeal joint increased more than 20 degrees, and joint stiffness increased more than 50%. The dependence of the stiffness of the proximal interphalangeal joint on metacarpophalangeal joint position supports the regulatory role of the intrinsic muscles on finger joint mechanics. This regulatory mechanics is likely amplified in hands with intrinsic muscle tightness, justifying the commonly used Bunnell Intrinsic Tightness Test., (Copyright 2005 Orthopaedic Research Society.)

Abstract Purpose The purpose of this study was to characterize thumb motor dysfunction resulting from simulated lower median nerve lesions at the wrist. Methods Bupivacaine hydrochloride was injected into the carpal tunnel of six healthy subjects to locally anesthetize the median nerve. Motor function was subsequently evaluated by measuring maximal force production in all directions within the transverse plane perpendicular to the longitudinal axis of the thumb. Force envelopes were constructed using these measured multidirectional forces. Results Blockage of the median nerve resulted in decreased force magnitudes and thus smaller force envelopes. The average force decrease around the force envelope was 27.9%. A maximum decrease of 42.4% occurred in a direction combining abduction and slight flexion, while a minimum decrease of 10.5% occurred in a direction combining adduction and slight flexion. Relative decreases in adduction, extension, abduction, and flexion were 17.3%, 21.2%, 41.2% and 33.5%, respectively. Areas enclosed by pre- and post-block force envelopes were 20628 ± 7747 N.N, and 10700 ± 4474 N.N, respectively, representing an average decrease of 48.1%. Relative decreases in the adduction, extension, abduction, and flexion quadrant areas were 31.5%, 42.3%, 60.9%, and 52.3%, respectively. Conclusion Lower median nerve lesion, simulated by a nerve block at the wrist, compromise normal motor function of the thumb. A median nerve block results in force deficits in all directions, with the most severe impairment in abduction and flexion. From our results, such a means of motor function assessment can potentially be applied to functionally evaluate peripheral neuropathies.

The purpose of the current study was to examine motion enslaving characteristics of multiple fingers during isolated flexion of the distal interphalangeal joints. Because the distal interphalangeal joints are flexed by multiple tendons of the single flexor digitorum profundus, the current experimental design provided a unique advantage to understand inter-finger enslaving effects due to the flexor digitorum profundus. Eight subjects were instructed to flex the distal interphalangeal joint of each individual finger from the fully extended position to the fully flexed position as quickly as possible. Maximal angular displacements, velocities, or accelerations of individual fingers were used to calculate the enslaving effects. An independence index, defined as the ratio of the maximal displacement of a master finger to the sum of the maximal displacements of the master and slave fingers, was used to quantify relative independence of each finger. The angular displacements of the index, middle, ring, and little fingers were 68.6° (±7.7), 68.1° (±10.1), 68.1° (±9.7), and 74.7°(±13.3), respectively. The motion of a master finger was invariably accompanied by motion of 1 or 2 slave fingers. Angular displacements of master and slave fingers increased to maximum values with time monotonically. Velocity curves demonstrated bell-shaped profile, and the acceleration curves were sinusoidal. Enslaving effects were generated mainly on the neighboring fingers. The amount of enslaving on the middle and ring fingers exceeded more than 60% of their own maximum angular displacements when a single adjacent finger moved. The index finger had the highest level of independence as indicated by the lowest enslaving effects on other fingers or by other fingers. The independence indices of the index, middle, ring, and little fingers were 0.812 (±0.070), 0.530 (±0.051), 0.479 (±0.099), and 0.606 (±0.148), respectively. In all tasks, motion of slave fingers always lagged with respect to the master finger. Time delays, on average, ranged from 7.8 (±5.0) to 35.9 (±22.1) ms. Our results suggest that there exist relatively large enslaving effects among the compartments of the flexor digitorum profundus, and functional independence of fingers in daily activities is likely enhanced through synergistic activities of multiple muscles, including flexors and extensors. [ABSTRACT FROM AUTHOR]

Background: Precision grip by the thumb and index finger is vulnerable to sensorimotor deficits. Traditional biomechanical parameters offer limited insight into the dynamical coordination between digits during precision grip. In this study, the thumb and index finger were viewed as "coupled systems", and a cross recurrence quantification analysis (CRQA) was used to examine the changes of interdigit dynamics and synchronization caused by peripheral median nerve block Methods: Seven subjects performed a precision grip by holding an instrumented handle before and after median nerve block at the wrist. The forces and the torques at each digit-handle interface were recorded with two sixcomponent transducers. For CRQA, the percentage of recurrence rate (%RR), percentage of determinism (%DET), longest diagonal line (Lmax) and percentage of laminarity (%LAM) were computed for the force, torque and center of pressure (COP) signals. Phase synchronization of the thumb and index finger was examined based on the t- recurrence rate. Paired t-tests and Wilcoxon signed-rank tests were used for statistical comparisons. The twinsurrogate hypothesis test was used to examine phase synchronization. Results: Nerve block led to significant increases (p < 0.05) for %DET, Lmax and %LAM in all components of force, torque, and COP. Only the normal force met the conditions of phase synchronization for all successfully completed pre- and post-block grasping trials. The probability of synchronization with larger time lags (t > 0.1 s) increased after nerve block. The percentage of trials that the thumb led the index finger increased from 52% (pre-block) to 86% (post-block). Conclusions: Nerve block caused more deterministic structures in force, torque and COP when the thumb interacted with the index finger. A compensatory mechanism may be responsible for this change. Phase synchronization between the opposite normal forces exerted by the thumb and index finger would be an essential dynamical principle for a precision grip. The nerve block resulted in an increased interdigit phase delay and increased probability that the thumb leads the index finger. The CRQA provides an effective tool to examine interdigit coordination during precision grip and has the potential for clinical evaluation of hand dysfunction. [ABSTRACT FROM AUTHOR]

Purpose: Assessment of wrist motion is important in diagnosing and treating motion impairment after injuries to the wrist. Little is known of how finger posture influences the movement of the wrist. The aim of this study was to investigate the effect of finger constraints on the maximum circumduction movement of the wrist. Methods: Fifteen male right-handed subjects performed maximal circumferential wrist movements under 4 finger conditions: unconstrained fingers, holding a large cylinder (50 mm diameter), holding a small cylinder (25 mm diameter), and closed fist position. The wrist motion was captured by a surface marker-based motion analysis system. To quantify wrist motion capability, we constructed the maximal boundaries of wrist motion (circumduction envelope) from angular plots in flexion–extension (FE) and radial–ulnar deviation (RUD). The ranges of motion in FE and RUD and the envelope area were calculated. Results: Finger constraints significantly reduced motion ranges in flexion and ulnar deviation, but not in extension and radial deviation. In comparison to the unconstrained finger condition, the motion ranges in flexion decreased by 13%, 16%, and 27% for the large cylinder, small cylinder, and fist conditions, respectively. The range of ulnar deviation was reduced by 10% for the large and small cylinder conditions and by 11% for the fist condition. The overall mobility in FE and RUD, as quantified by the area of circumduction envelope, decreased by 15%, 15%, and 23% for the large cylinder, small cylinder, and fist conditions, respectively. Conclusions: Wrist mobility is facilitated by the synergistic motion of finger joints. Constraining fingers in static flexion posture reduces wrist flexion and ulnar deviation without decreasing extension and radial deviation. A clinical implication is that wrist motion should be assessed under standardized finger joint configuration. [Copyright &y& Elsevier]

The objective of this study was to investigate three-dimensional thumb joint movements produced by individual extrinsic thumb muscles. Ten cadaveric arms were dissected to expose the musculotendinous junctions of the flexor pollicis longus (FPL), abductor pollicis longus (APL), extensor pollicis brevis (EPB), and extensor pollicis longus (EPL). Each muscle/tendon was loaded to 10% of its maximal force capability whereas three-dimensional angular movements of the carpometacarpal (CMC), metacarpophalangeal (MCP), and interphalangeal (IP) joints were obtained simultaneously. We found that each extrinsic muscle produced unique joint angular trajectories in multiple directions. The FPL, APL, EBP, and EPL generated two, two, three, and six movements, respectively. The extrinsic muscles all together generated eight movements among the multiple thumb joints. High interjoint coordination was shown between the MCP joint flexion and IP joint flexion by FPL loading, as well as between the MCP joint extension and IP joint extension by EPL loading. High intrajoint coordination was observed between extension and supination at the CMC joint by the APL, EPL, and EPB. We concluded that each muscle produces movements in multiple joints and/or in multiple anatomical directions. The findings provide a novel insight into the biomechanical roles of the extrinsic muscles of the thumb. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:1289-1295, 2008 [ABSTRACT FROM AUTHOR]

Purpose: Carpal tunnel syndrome (CTS) impairs the performance of fine motor tasks of the hand, leading to clumsiness. Precision pinch by the thumb and index finger is a frequent task that requires the fine control of each digit as well as the coordination of the 2 digits. The purpose of this study was to examine the performance of precision pinch movements impaired by CTS. Methods: Sixteen CTS subjects and 16 gender- and age-matched control subjects were instructed to repetitively perform the precision pinch movement with the thumb and index finger. A marker-based motion analysis method was used to obtain the kinematic data of the thumb and index finger during the precision pinch movements. Pinch performance was quantified by the variability of tip positions, joint angles, and tip distance at the pinch closures in the repeated movements. Results: The CTS subjects performed the precision pinch movements less consistently compared with performance of the control subjects. The inconsistency was demonstrated by the increased variability of the tip positions of the 2 digits and the joint angles of the index finger. However, the variability of thumb joint angles was not significantly different between the 2 groups. The tip-to-tip distance, an indicator of thumb and index finger coordination, was relatively reproducible for both groups. Still, the CTS subjects showed a 50% greater variability of the tip distance compared with that of the control subjects. Conclusions: Carpal tunnel syndrome impairs the performance of precision pinch movement as indicated by the increased variability. The results correlate with the observed clumsiness or lack of dexterity for patients with CTS. [Copyright &y& Elsevier]

The purposes were to examine the workspace of the thumb during its operational (submaximal and random) movement and to compare the operational workspace with its maximal workspace. Fifteen female subjects with asymptomatic hands performed the thumb circumduction and operational motion. Linear and angular measurements of the thumb were obtained by a marker-based motion analysis system. During the circumduction, the linear ranges of motion of the thumb tip were 102.8 ± 9.9 mm and 130.7 ± 14.1 mm in abduction/adduction and flexion/extension directions, respectively, and the corresponding values for the operational motion were 67.3 ± 16.1 mm and 73.1 ± 18.0 mm, respectively. The angular ranges of motion of the carpometacarpal (CMC) and metacarpophalangeal joints during the operational motion were less than 65% of their maximal motion ranges. In addition, the CMC joint tended to move in directions oblique to its anatomical defined axes. The results of operational motion may provide guidelines for ergonomic design of thumb-operated tools and hand-held electronics devices. [ABSTRACT FROM AUTHOR]

Abstract: Thumb opposition plays a vital role in hand function. Kinematically, thumb opposition results from composite movements from multiple joints moving in multiple directions. The purpose of this study was to examine the coordination of thumb joints during opposition tasks. A total of 15 female subjects with asymptomatic hands were studied. Three-dimensional angular kinematics of the carpometacarpal (CMC), metacarpophalangeal (MCP) and interphalangeal (IP) joints were obtained by a marker-based motion analysis system. Thumb opposition revealed coordination among joints in a specific direction (inter-joint coordination) and among different directions within a joint (intra-joint coordination). In particular, linear couplings existed between the flexion and pronation at the CMC joint, and between the flexion of the CMC joint and flexion of the MCP joint. Principal component analysis showed that only two principal components adequately represented the thumb opposition data of seven movement directions. A term functional degrees of freedom by virtue of principal component analysis was proposed to uncover the extent of movement coordination in functional tasks. [Copyright &y& Elsevier]

Abstract: Objective: The objective of this study was to investigate the effects of a simulated peripheral median nerve lesion on precision pinch movement by the thumb and index finger. Methods: A median neuropathy was created by blocking the median nerve at the wrist using an anesthetic. The subjects (n =5) were asked to perform pulp-to-pulp precision pinch movements before and after the nerve block. Digit motion data was obtained with a marker-based motion analysis system. Results: The radial offset of the thumb tip, as defined by the minimum distance of the thumb tip to the flexion-extension plane of the index finger, showed an increase of 11.2mm after the nerve block. For the thumb, the nerve block caused a decrease in the range of motion at the metacarpophalangeal (MCP) joint, and a compensatory increase in the range of motion at the interphalangeal (IP) joint. The range of motion ratio (MCP:IP) changed from 1:4.8 (pre-block) to 1:1.0 (post-block). The maximum flexion angle at the MCP joint increased from 18.8° (pre-block) to 33.7° (post-block), and maximum flexion angle at the IP joint decreased from 42.6° (pre-block) to 18.8° (post-block). For the index finger, the nerve block caused a decrease in the range of motion at the MCP joint, and compensatory increases in the ranges of motion at the proximal and distal interphalangeal (PIP and DIP) joints. The range of motion ratio (MCP:PIP:DIP) changed from 1:1.1:0.7 (pre-block) to 1:2.4:1.8 (post-block). The maximum flexion angle at the MCP joint decreased from 56.8° (pre-block) to 34.6° (post-block), and the maximum flexion angle at the PIP joint increased from 51.2° (pre-block) to 76.0° (post-block), but the change at the DIP joint was insignificant. Conclusions: The median nerve block caused remarkable degradation of the pinch performance as quantified by an inaccurate pulp-to-pulp contact of the thumb to the index finger and an alteration of joint motion of the digits. Significance: Many fine manual tasks require accurate pulp-to-pulp positioning of the thumb to the index finger. Within the hand, the median nerve is critical to the fine sensorimotor function due to the motor supply and the sensory endings to the thumb and index finger. People with median neuropathies (for example, carpal tunnel syndrome) experience clumsiness while performing simple manual tasks. The current approach to the examination of precision pinch movement may be utilized to quantify the apparent hand clumsiness observed in individuals with peripheral neuropathy such as carpal tunnel syndrome. [Copyright &y& Elsevier]

The purposes of this study were to investigate the mechanical properties of the carpal tunnel and to examine carpal tunnel compliance as it related to gender difference. Twelve male and twelve female subjects without any neuromusculoskeletal disorders in the upper extremities participated in the study. Indentation testing was manually performed on the wrist volar to the transverse carpal ligament. Effective compliance was defined as the slope of the regression analyses of indentation force and displacement data. In the tested indentation force range (2.45–19.60 N), the displacement of females was 1.38 ± 0.25 mm, significantly smaller than that of the males, 1.82 ± 0.30 mm (p < 0.001). Regression analyses in the force range showed that the effective compliance for females, 0.075 ± 0.012 mm/N, was 26.3% lower than that for males, 0.101 ± 0.018 mm/N (p < 0.005). It was concluded that females have less compliant carpal tunnel than males. The gender difference in carpal tunnel mechanics may predispose females to detrimental compression of the median nerve and carpal tunnel syndrome. [ABSTRACT FROM AUTHOR]

Abstract: Background. Conventional wrist joint goniometry evaluates range of motion in isolated directions. The coupling between wrist flexion–extension and radial–ulnar deviation was investigated. Methods. Ten healthy young male subjects performed wrist flexion–extension, radial–ulnar deviation, and circumduction motions. Flexion–extension and radial–ulnar deviation angles were computed from the coordinates of surface markers attached to the forearm and hand. A motion analysis system recorded marker motion. Findings. During radial–ulnar deviation, the amount of accompanying flexion–extension movement was linearly related to the amount of radial–ulnar deviation. The secondary (flexion–extension) range of motion (48.3°) was about 75% of the primary (radial–ulnar deviation) range of motion (55.1°). During the flexion–extension task, the coupling was less linear. The motion range in radial–ulnar deviation (21.2°) was about 20% of the primary (flexion–extension) range of motion (108.3°). The radial–ulnar deviation and flexion–extension motions combined extension with radial deviation, and flexion with ulnar deviation. The convex hull of the flexion–extension and radial–ulnar deviation angles during circumduction was “egg-shaped” and asymmetric with respect to the anatomically defined flexion–extension and radial–ulnar deviation axes. Wrist position in one direction strongly influenced the range of motion in the other. Maximum range of motion in flexion–extension occurred with the wrist near the neutral radial–ulnar deviation position, and vice versa. Wrist deviation from neutral position in one direction diminished wrist range of motion in the other. Interpretation. Wrist movements in flexion–extension and radial–ulnar deviation are coupled. Maximal wrist range of motion is near the neutral position. To account for the naturally coupled wrist motion in work station design and rehabilitation, the wrist should be placed at a neutral position. [Copyright &y& Elsevier]

We developed an apparatus to measure maximal continuous circumferential forces of a digit in the transverse plane that is perpendicular to the longitudinal axis. Subjects with asymptomatic hands were asked to produce maximal forces in all directions at the proximal phalanx of the thumb. The force components during circumferential trials were used to construct a force envelope for each subject. The force envelope enlarged as the number of trials increased, and converged to a stable pattern after several trials. The shape of the force envelope was asymmetric and oblique, skewed towards the flexion/adduction direction. Maximal force (112.1±14.8 N) was generated in the direction combining flexion and adduction. The lowest force produced was only 50.3% of the maximal force in a direction combining extension and abduction. The forces in the direction of adduction, extension, abduction, and flexion were 60.1%. 61.9%, 51.5%, and 92.9% of the maximal force, respectively. The forces generated by circumferential exertions were comparable to the forces by focused directional exertions except in the flexion direction. Our methods have the potential to identify deviations from the normative force output pattern and help detect underlying impairments resulting from neuromuscular disorders. [Copyright &y& Elsevier]

Objective. The purpose of this study was to biomechanically evaluate the motor function of the index finger based on multi-directional strengths.Design. An experimental apparatus was developed to measure force production of a digit at various points of force application along the digit and in any direction of force application within the transverse plane of the longitudinal axis of the digit.Background. Most existing tests of hand motor function are subjective, semiquantitative, and/or non-specific.Methods. Eight normal subjects with asymptomatic hands were tested. Maximum voluntary isometric contraction forces were measured at the middle of the proximal phalanx of the index finger in 16 directions that were evenly distributed within 360°.Results. The highest force, 110.7 (SD 9.0) N, was generated in flexion, while the lowest force was generated in extension. The forces in extension, abduction and adduction were 37.6%, 97.9% and 79.3% of the flexion force, respectively. The area of the force envelope was 25 739 (SD 3688) N–N. The average percentage quadrant areas, relative to the total force envelope area, for extension–adduction, extension–abduction, flexion–abduction, and flexion–adduction were 12.9%, 20.4%, 36.0%, and 30.8%, respectively. The average percentage quadrant areas for extension, abduction, flexion, and adduction were 9.1%, 33.3%, 35.6%, and 22.1%, respectively.Conclusion. The current study provides an advanced level of quantification of hand motor function.RelevanceThe methods may be used as a basis to detect changes in the motor function resulting from pathological conditions, disease progression, as well as rehabilitation and treatment of these disorders. [Copyright &y& Elsevier]

The current study investigated inter-digit co-ordination and object-digit interaction during sustained object holding tasks by using five, six-component force/torque sensors. The sum of the individual finger normal forces and the thumb normal force showed a parallel variation with a mean median correlation coefficient of 0.941. The normal force traces demonstrated the lowest coefficient of variation (about 9% as averaged across digits) as compared with other force/torque traces. The sum for the variances of the normal forces of the index, middle, ring, and little fingers was about 50% of the variance of the summed normal force of the four fingers. Of the five digits, the thumb, index, middle, ring and little fingers accounted for 50.0, 15.4, 14.6, 11.7 and 7.3% of the total normal force; and 39.4, 9.9, 19.3, 14.0 and 17.5% of the total vertical shear force (i.e. the load), respectively. The ratios of the normal force to the resultant shear force were 2.6, 4.5, 1.8, 2.2 and 1.3 for the thumb, index, middle, ring and little finger, respectively. The centre of pressure migration area of a single digit at the object-digit surface during object holding ranged from 0.30 to 1.21 mm[sup 2]. The current study reveals a number of detailed object-digit mechanics and multiple digits co-ordination principle. The results of this study may help to improve ergonomic designs that involve the usage of multiple digits. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study was to investigate precision grip impairment caused by a lower median nerve block at the wrist. The median nerve block was achieved by injecting bupivacaine hydrochloride into the carpal tunnel, which acutely simulated a median neuropathy. Seven healthy male subjects were instructed to grip, lift, and hold an instrumented handle within 60s using precision grip. The same tasks were performed before and after the nerve block. Force and torque data were recorded using two miniature 6-component force/torque transducers. The precision grip was quantified by the safety margin (i.e. the difference between the actual grip force and the minimal grip force to keep the object from dropping), the variation of grip force, and the migration area of center of pressure (i.e. the area defined by the center of pressure at a digit-transducer surface while holding the handle). Two subjects were unable to complete the precision grip tasks after the nerve block, and their data were excluded from the analyses. The median nerve block caused significant increases (P <0.05) in the safety margin of the grip force (>50%), the grip force variation (>80%), and the area of center of pressure migration (>250%). Median nerve block at the wrist impairs the fine motor control during precision grip. Our results corroborate the important role played by sensory function in hand fine motor control. Clinically, the measures related to precision grip have the potential to quantify impairment of hand function caused by neuromuscular disorders, to monitor the progress of a hand disorder, and to evaluate the efficacy of a treatment or rehabilitation procedure. [Copyright &y& Elsevier]

Abstract: Background. Repetitive motion of the hand has been suggested as a major factor of pathogenesis of cumulative trauma disorders (e.g., carpal tunnel syndrome). The purpose of this study was to investigate the 3D displacement of the median nerve and extrinsic finger flexor tendons (flexor digitorum superficialis; flexor digitorum profundus) as a function of flexion/extension of metacarpophalangeal joints of the index and middle fingers. Methods. Shim markers were placed on the median nerve, flexor digitorum superficialis, and flexor digitorum profundus tendons at the wrist region of seven cadaveric specimens for the purpose of digitization of tendon and nerve locations. The metacarpophalangeal joint of the index or middle finger was moved from 15° extension to 75° of flexion while the markers were digitized at increments of 15°. Marker displacements were determined in the longitudinal, radial–ulnar, and dorsal–palmar directions. Findings. Movement of metacarpophalangeal joint of the index or middle finger caused tendon and nerve displacements in the longitudinal, radial–ulnar, and dorsal–palmar directions. The longitudinal displacements of the median nerve and the flexor tendons were linearly correlated with angular movement of the metacarpophalangeal joint. The maximum longitudinal displacements of the flexor digitorum superficialis tendon, flexor digitorum profundus tendon, and median nerve were, on average, 14.7mm, 11.9mm, and 3.0mm, respectively, for the index finger; and 18.4mm, 14.5mm, and 4.0mm, respectively, for the middle finger. The radial–ulnar and dorsal–palmar displacements were irregular and relatively small. The maximum displacements in these transverse directions fell in the range of 1.4–5.1mm for the median nerve and 1.9–7.3mm for the flexor tendons. Interpretations. Finger flexor tendons and median nerve move not only concurrently, but also differentially, in all anatomical directions. Tendon and nerve movement during prolonged repetitive hand movement may cause hand disorders such as carpal tunnel syndrome. [Copyright &y& Elsevier]