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Critical Reviews™ in Biomedical Engineering
SJR: 0.26 SNIP: 0.375 CiteScore™: 1.4

ISSN Print: 0278-940X
ISSN Online: 1943-619X

Critical Reviews™ in Biomedical Engineering

DOI: 10.1615/CritRevBiomedEng.2017021073
pages 397-410

Posture and Loading in the Pathomechanics of Carpal Tunnel Syndrome: A Review

Nicolas Vignais
CIAMS, Univ. Paris-Sud, Université Paris-Saclay, 91405 Orsay Cedex, France; CIAMS, Université d'Orléans, 45067, Orléans, France; McMaster Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
Justin Weresch
McMaster Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
Peter J. Keir
McMaster Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada

ABSTRACT

Carpal tunnel syndrome is a neuropathy of the median nerve at the wrist, and represents the most common peripheral neuropathy. It has long been an issue in the workplace because of healthcare costs and loss of productivity. The two main pathomechanisms of carpal tunnel syndrome include increased hydrostatic pressure within the carpal tunnel (carpal tunnel pressure) and contact stress (or impingement). As most cases of carpal tunnel syndrome in the workplace are labelled "idiopathic", a clear understanding of the physical parameters that may act as pathomechanisms is critical for its prevention. The aim of this review is to examine and quantify the influence of posture and loading factors on the increase of carpal tunnel pressure and median nerve contact stress. Forearm, wrist, and finger postures, as well as fingertip force have significant effects on carpal tunnel pressure. Contact stress on the median nerve is mainly a product of wrist posture and musculotendinous loading. Anatomical and musculoskeletal sources have been proposed to explain these effects. This critical review provides an improved understanding of pathomechanisms and etiology underlying carpal tunnel syndrome.


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