Comparison of the Effects of Flexion and Extension of the Thumb and Fingers on the Position and Cross-Sectional Area of the Median Nerve

Objective: To assess the separate effects of thumb and finger extension/flexion on median nerve position and cross-sectional area. Methods: Ultrasonography was used to assess median nerve transverse position and cross-sectional area within the carpal tunnel at rest and its movement during volitional flexion of the individual digits of the hand. Both wrists of 165 normal subjects (11 men, 4 women, mean age, 28.6, range, 22 to 38) were studied. Results: Thumb flexion resulted in transverse movement of the median nerve in radial direction (1.2 +/- 0.6 mm), whereas flexion of the fingers produced transverse movement in ulnar direction, which was most pronounced during flexion of the index and middle fingers (3.2 +/- 0.9 and 3.1 +/- 1.0 mm, respectively). Lesser but still statistically significant movements were noted with flexion of the ring finger (2.0 +/- 0.8 mm) and little finger (1.2 +/- 0.5 mm). Flexion of the thumb or individual fingers did not change median nerve cross-sectional area (8.5 +/- 1.1 mm(2)). Conclusions: Volitional flexion of the thumb and individual fingers, particularly the index and middle fingers, produced significant transverse movement of the median nerve within the carpal tunnel but did not alter the cross-sectional area of the nerve. The importance of these findings on the understanding of the pathogenesis of the carpal tunnel syndrome and its treatment remains to be investigated.