Ligament and Bone Arch Partition of the Carpal Tunnel by Three-Dimensional Ultrasonography.

The carpal tunnel is structurally complex and geometrically irregular due to the many intercalated carpal bones by numerous intercarpal ligaments. The purpose of the study was to investigate the relative contributions of the ligament and bone arches to carpal tunnel space at the proximal, middle, and distal tunnel regions. A catheter ultrasound probe acquired fan-like images inside cadaveric carpal tunnels for three-dimensional reconstruction of the tunnel. The total tunnel volume was 5367.6 +/- 940.1 mm3 with contributions of 12.0%, 6.9%, and 4.1% by proximal, middle, and distal ligament arches, respectively, and 27.0%, 25.3%, and 24.7% by proximal, middle, and distal bone arches, respectively. The bone arch occupied more tunnel space than the ligament arch at all regions (p<0.05). The ligament arch was largest at the proximal region of the tunnel and significantly decreased towards the distal region (p<0.05). However, the bone arch significantly decreased only from the proximal to middle region (p<0.05) but not from the middle to distal region (p=0.311). Consequently, it was observed that the ligament arch was the key contributor to the unequal carpal tunnel space across regions. The partitional tunnel morphometric knowledge provided in the study is valuable in understanding the regional abnormalities in tunnel morphology associated with various wrist pathological conditions. The developed framework of ultrasonography and data processing can be applied to other areas of interest in the musculoskeletal system.