An Anechoic Space at the Carpal Tunnel Inlet is a Consistent Ultrasonographic Entity which Accommodates Tendon Displacement during Finger Flexion

Abstract

Background: We consistently observed the presence of anechoic spaces on standard ultrasonographic imaging of the carpal tunnel inlet in normal subjects. These spaces change in size during finger flexion and have not been characterized in a large sample of normal individuals. Ultrasonographic quantification of these spaces may indicate the available space in the region of the carpal tunnel, which allows the normal motion of tendons and the median nerve. Methods: Transverse ultrasonographic images of the carpal tunnel inlet from 33 asymptomatic volunteers were obtained at Position A (fingers in extension) and B (fingers in flexion). Cross-sectional area (CSA), perimeter and position of anechoic space relative to median nerve were recorded. Results: Analysis showed a 75.4% prevalence rate of a single anechoic space. Two discrete patterns were observed. 89.1% had a decrease in CSA and perimeter of anechoic space from Position A to B while 10.9% exhibited an increase. Mean position of the anechoic space is ulnar (7.49 ± 3.57 mm) and dorsal (2.18 ± 1.28 mm) to the median nerve. Conclusions: A consistent anechoic space at the carpal tunnel inlet is seen in 75.4% of normal hands and can be quantified (cross sectional area 11.75 ± 7.36 mm2). It allows for the accommodation of flexor tendons during finger flexion.