ANATOMICAL STRUCTURES IN THE RABBIT CARPAL TUNNEL: COMPARISON WITH HUMAN

Rabbit Carpal Tunnel

Authors

  • Firuze Turker Yavas Department of Anatomy, Faculty of Veterinary Medicine, Aydin Adnan Menderes University, Isikli, 09020, Efeler / Aydin, Turkey https://orcid.org/0000-0001-8651-945X
  • Ilknur Dabanoglu * Department of Anatomy, Faculty of Veterinary Medicine, Aydin Adnan Menderes University, Isikli, 09020, Efeler / Aydin, Turkey, idabanoglu@adu.edu.tr
  • Ayse Nur Akkoc Department of Pathology, Faculty of Veterinary Medicine, Aydin Adnan Menderes University, Isikli, 09020, Efeler / Aydin, Turkey https://orcid.org/0000-0003-4862-013X

DOI:

https://doi.org/10.26873/SVR-1870-2023

Keywords:

carpal canal, morphometry, histology, median nerve, ulnar nerve, flexor retinaculum

Abstract

In this study, it was aimed to reveal the morphological and morphometric changes of anatomical structures passing through the carpal tunnel, which is an en­trapment neuropathy location for the median nerve. It was also aimed to evaluate the potential of rabbits as an animal model for carpal tunnel research. New Zealand rabbit cadavers were enrolled, and their wrists were investigated using the histological method in this study. ImageJ was used to measure histological sections stained with hemox­ylin-eosin. The carpal tunnel was examined at three levels: entrance, inside, and exit. Flexor retinaculum comprises two layers, encircling the carpal tunnel from the palmar side. The deep and superficial digital flexor tendons, and radial carpal flexor tendon were observed within the carpal tunnel but not the flexor pollicis longus tendon. The median and ulnar vascular nerve bundles reside between two layers of flexor retinaculum in the carpal tunnel. The areas of these anatomical structures were measured from images at three levels. Since the flexor retinaculum was located at the entrance and inside, the carpal tunnel area was measured at both levels.
The narrowing in the area from the carpal tunnel entrance to the inside of the carpal tunnel in rabbits and the decrease in connective tissue bring the anatomical structures here closer together. This clearly demonstrates that the carpal tunnel is an entrapment neuropathy area, particularly for the median nerve. Upon comparing rabbit and dog car­pal tunnel anatomy, it has been shown that rabbits exhibit a greater resemblance to humans, particularly with regard to the flexor retinaculum. This study emphasizes the importance of using the rabbit model to gain insights into carpal tunnel syndrome. It demonstrates similarities between rabbit and human anatomy, underscoring the value of this animal model for future research.

Anatomske strukture v karpalnem kanalu kunca: primerjava s človekom

Izvleček: Cilj te raziskave je bil raziskati spremembe v morfologiji in morfometriji anatomskih struktur v karpalnem kanalu, natančneje na mestu ukleščenja medianega živca. Poleg tega smo želeli oceniti primernost kuncev kot živalskega mod­ela za študije karpalnega kanala. V ta namen smo uporabili trupla novozelandskih kuncev in opravili histološki pregled njihovih zapestij. Histološke rezine, obarvane s hematoksilinom in eozinom, smo analizirali s programom ImageJ za pridobitev meritev. Naš pregled je bil osredotočen na tri nivoje karpalnega kanala: vhod, notranjost in izhod. Karpalni kanal je obdan z dvema plastema flektornega retinakuluma na palmarni strani. Znotraj karpalnega kanala smo opazovali globoke in površinske kite upogibalk prstov in radialnih upogibalk zapestja, ne pa tudi tetiv dolge upogibalke. Žilni živčni snopi medianega in ulnarnega živca se nahajata med obema plastema flektornega retinakuluma znotraj karpalnega kanala. Da bi ocenili velikost teh anatomskih struktur, smo izmerili njihove površine na podlagi slik, posnetih na treh prej omenjenih ravneh.
Ob upoštevanju prisotnosti flektornega retinakuluma smo meritev površine karpalnega kanala izvedli tako na vhodu kot znotraj kanala. Pri kuncih zožitev območja od vhoda do notranjosti karpalnega kanala skupaj z zmanjšanjem vezivnega tkiva povzroči, da se anatomske strukture približajo. To zagotavlja jasen dokaz, da je karpalni kanal mesto, kjer se pojavi utesnitvena nevropatija, ki posebej vključuje mediani živec. S primerjavo anatomije karpalnega kanala pri kuncih in psih je bilo ugotovljeno, da so kunci bolj podobni ljudem, zlasti v smislu flektornega retinakuluma. Ta raziskava poudarja po­men uporabe kunčjega modela za preučevanje sindroma karpalnega kanala, saj prikazuje podobnosti med kunčjo in človeško anatomijo ter poudarja pomen tega živalskega modela za prihodnje preiskave.

Ključne besede: karpalni kanal; morfometrija; histologija; mediani živec; ulnarni živec; flektorni retinaculum

References

1. Ettema AM, Zhao C, An KN, Amadio PC. Comparative anatomy of the subsynovial connective tissue in the carpal tunnel of the rat, rabbit, dog, baboon, and human. Hand (N Y) 2006; 1(2): 78–84. doi: 10.1007/ s11552-006-9009-z DOI: https://doi.org/10.1007/s11552-006-9009-z

2. Craige EH. Bensley`s practical anatomy of the rabbit. 5th ed. Philadelphia: The Blakiston Company, 1948.

3. Schrier VJMM, Vrieze A, Amadio PC. Subsynovial connective tissue development in the rabbit carpal tunnel. Vet Med Sci 2020; 6(4): 1025– 33. doi: 10.1002/vms3.281 DOI: https://doi.org/10.1002/vms3.281

4. Bower JA, Stanisz GJ, Keir PJ. An MRI evaluation of carpal tunnel dimensions in healthy wrists: implications for carpal tunnel syndrome. Clin Biomech (Bristol, Avon). 2006; 21(8), 816–25. doi: 10.1016/j. clinbiomech.2006.04.008 DOI: https://doi.org/10.1016/j.clinbiomech.2006.04.008

5. Diao E, Shao F, Liebenberg E, Rempel D, Lotz JC. Carpal tunnel pressure alters median nerve function in a dose-dependent manner: a rabbit model for carpal tunnel syndrome. J Orthop Res 2005; 23(1): 218–23. doi: 10.1016/j.orthres.2004.05.014 DOI: https://doi.org/10.1016/j.orthres.2004.05.014

6. Kamolz LP, Schrögendorfer KF, Rab M, Girsch W, Gruber H, Frey M . The precision of ultrasound imaging and its relevance for carpal tunnel syndrome. Surg Radiol Anat 2001; 23(2): 117–21. doi:10.1007/ s00276-001-0117-8 DOI: https://doi.org/10.1007/s00276-001-0117-8

7. Stapleton MJ. Occupation and carpal tunnel syndrome. ANZ J Surg 2006; 76(6): 494–6. doi:10.1111/j.1445-2197.2006.03770.x DOI: https://doi.org/10.1111/j.1445-2197.2006.03770.x

8. Wright AR, Atkinson RE. Carpal tunnel syndrome: an update for the primary care physician. Hawaii J Health Soc Welf 2019; 78(11, suppl. 2): 6–10.

9. Zuniga AF, Keir PJ. Diagnostic and research techniques in carpal tunnel syndrome. Crit Rev Biomed Eng 2019;4 7(6): 457-71. doi: 10.1615/ CritRevBiomedEng.2020030827 DOI: https://doi.org/10.1615/CritRevBiomedEng.2020030827

10. Aleksenko D, Varacallo M. Guyon canal syndrome. In: StatPearls. StatPearls Publishing, 2023. https://www.ncbi.nlm.nih.gov/books/ NBK431063/

11. Georgiew F, Maciejczak A, Florek J, Kotela, I. Ulnar and median nerve abnormalities in carpal tunnel syndrome. Ortop Traumatol Rehabil 2020; 22(5): 311–8. doi: 10.5604/01.3001.0014.4214 DOI: https://doi.org/10.5604/01.3001.0014.4214

12. Levy SM, Reid M, Montgomery AM, et al. Do magnetic resonance imaging abnormalities of the non-dominant wrist correlate with ulnar-sided wrist pain in elite tennis players?. Skeletal Radiol 2020; 49(3): 407–15. doi: 10.1007/s00256-019-03285-y DOI: https://doi.org/10.1007/s00256-019-03285-y

13. Vij N, Traube B, Bisht R, et al. An update on reatment modalities for ulnar nerve entrapment: a literature review. Anesth Pain Med 2020; 10(6): e112070. doi: 10.5812/aapm.112070 DOI: https://doi.org/10.5812/aapm.112070

14. Yamamoto R, Izumida M, Sakuraya T, Emura K, Arakawa T. The ulnar nerve is surrounded by the tendon expansion of the flexor carpi ulnaris muscle at the wrist: an anatomical study of Guyon's canal. Anat Sci Int 2021; 96(3): 422–6. doi: 10.1007/s12565-021-00607-w DOI: https://doi.org/10.1007/s12565-021-00607-w

15. Moriya T, Zhao C, Cha SS, Schmelzer JD, Low PA, An KN, Amadio PC. Tendon injury produces changes in SSCT and nerve physiology similar to carpal tunnel syndrome in an in vivo rabbit model. Hand ( NY) 2011; 6(4): 399–407. doi: 10.1007/s11552-011-9356-2 DOI: https://doi.org/10.1007/s11552-011-9356-2

16. Werthel JD, Zhao C, An KN, Amadio PC. Carpal tunnel syndrome pathophysiology: role of subsynovial connective tissue. J Wrist Surg 2014; 3(4): 220–6. doi: 10.1055/s-0034-1394133 DOI: https://doi.org/10.1055/s-0034-1394133

17. Tung WL, Zhao C, Yoshii Y, Amadio PC, Su FC, An KN. . A comparative study of carpal tunnel compliance in the human, dog, rabbit, and rat. J Orthop Res 2014; 28(5), 652–6. doi: 10.1002/jor.21037 DOI: https://doi.org/10.1002/jor.21037

18. Yoshii Y, Zhao C, Schmelzer JD, Low PA, An KN, Amadio PC. Effects of multiple injections of hypertonic dextrose in the rabbit carpal tunnel: a potential model of carpal tunnel syndrome development. Hand (N Y) 2014;9(1): 52–7. doi: 10.1007/s11552-013-9599-1 DOI: https://doi.org/10.1007/s11552-013-9599-1

19. Oh S, Ettema AM, Zhao C, et al. Dextrose-induced subsynovial connective tissue fibrosis in the rabbit carpal tunnel: A potential model to study carpal tunnel syndrome?. Hand 2008; 3(1): 34–40. doi: 10.1007/ s11552-007-9058-y DOI: https://doi.org/10.1007/s11552-007-9058-y

20. Yamaguchi T, Osamura N, Zhao C, Zobitz ME, An KN, Amadio PC. The mechanical properties of the rabbit carpal tunnel subsynovial connective tissue. J Biomech 2008; 41(16): 3519–22. doi: 10.1016/j. jbiomech.2007.06.004 DOI: https://doi.org/10.1016/j.jbiomech.2007.06.004

21. Luna LG. Manual of histologic staining methods of the armed forces Institue of pathology. 3rd ed., Mc Graw - Hill Book Campany, New York: Blakiston Division McGraw-Hill, 1968.

22. Park JS, Won HC, Oh JY, Kim DH, Hwang SC, Yoo JI. Value of crosssectional area of median nerve by MRI in carpal tunnel syndrome. Asian J Surg 2020; 43(6): 654–59. doi: 10.1016/j.asjsur.2019.08.001 DOI: https://doi.org/10.1016/j.asjsur.2019.08.001

23. Presazzi A, Bortolotto C, Zacchino M, Madonia L, Draghi F. Carpal tunnel: normal anatomy, anatomical variants and ultrasound technique. J Ultrasound 2011; 14(1): 40–6. doi: 10.1016/j.jus.2011.01.006 DOI: https://doi.org/10.1016/j.jus.2011.01.006

24. Sora MC, Genser‐Strobl B. The sectional anatomy of the carpal tunnel and its related neurovascular structures studied by using plastination. Eur J Neurol 2005; 12(5): 380–4. doi: 10.1111/j.1468-1331.2004.01034.x DOI: https://doi.org/10.1111/j.1468-1331.2004.01034.x

25. Turan E, Erden H. Computed tomography and morphometry of the carpal canal in the dog. Ann Anat 2003; 185(2): 173–8. doi: 10.1016/ S0940-9602(03)80084-5 DOI: https://doi.org/10.1016/S0940-9602(03)80084-5

26. Deak N, Black AC, Bordoni B. Anatomy, shoulder and upper limb, wrist flexor retinaculum. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2024. https://www.ncbi.nlm.nih.gov/books/NBK545198/ (12. 2. 2024)

27. Ekim O, Oto C, Algin O. Magnetic resonance (MR) imaging of the carpal tunnel and related structures in New Zealand Rabbit (Oryctolagus cuniculus): an anatomic and radiologic evaluation on an animal model. Ankara Univ Vet Fak Derg 2014; 61(1): 1–7. doi: 10.1501/ Vetfak_0000002597 DOI: https://doi.org/10.1501/Vetfak_0000002597

28. Rodríguez P, Casado A, Potau JM. Quantitative anatomical analysis of the carpal tunnel in women and men. Ann Anat 2022; 243: 151956. doi: 10.1016/j.aanat.2022.151956 DOI: https://doi.org/10.1016/j.aanat.2022.151956

29. Potuznik P, Hosek P, Kotas R. Median nerve ultrasonography examination correlates with electrodiagnostic studies for the diagnosis of moderate to severe carpal tunnel syndrome. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2023; 167(2): 192–8. doi:10.5507/ bp.2021.068 DOI: https://doi.org/10.5507/bp.2021.068

30. Ulaşli AM, Duymuş M, Nacir B, Rana Erdem H, Koşar U. Reasons for using swelling ratio in sonographic diagnosis of carpal tunnel syndrome and a reliable method for its calculation. Muscle Nerve 2013; 47(3): 396–402. doi:10.1002/mus.23528 DOI: https://doi.org/10.1002/mus.23528

31. Asghar A, Naaz S, Ansari S, Kumar A, Singh V. The cross-sectional morphology of median nerve in carpal tunnel of healthy, adult population: a systematic review and meta-analysis. Morphologie 2023; 107(356): 99–115. doi: 10.1016/j.morpho.2022.05.005 DOI: https://doi.org/10.1016/j.morpho.2022.05.005

32. Fu T, Cao M, Liu F, et al. Carpal tunnel syndrome assessment with ultrasonography: value of inlet-to-outlet median nerve area ratio in patients versus healthy volunteers. PloS One 2015; 10(1): e0116777. doi: 10.1371/journal.pone.0116777 DOI: https://doi.org/10.1371/journal.pone.0116777

33. Bueno-Gracia E, Malo-Urriés M, Ruiz-de-Escudero-Zapico A, et al. Reliability of measurement of the carpal tunnel and median nerve in asymptomatic subjects with ultrasound. Musculoskeletal Sci Pract 2017; 32: 17–22. doi: 10.1016/j.msksp.2017.08.001 DOI: https://doi.org/10.1016/j.msksp.2017.08.001

34. Kerasnoudis A, Pitarokoili K, Behrendt V, Gold R, Yoon MS. Cross sectional area reference values for sonography of peripheral nerves and brachial plexus. Clin Neurophysiol 2013; 124(9): 1881–8. doi: 10.1016/j. clinph.2013.03.007 DOI: https://doi.org/10.1016/j.clinph.2013.03.007

35. Won SJ, Kim, BJ Park, Yoon JS, Choi H.. Reference values for nerve ultrasonography in the upper extremity. Muscle Nerve 2013; 47(6): 864–71. doi: 10.1002/mus.23691 DOI: https://doi.org/10.1002/mus.23691

36. Ginanneschi F, Mondelli M, Cioncoloni D, Rossi A. Impact of carpal tunnel syndrome on ulnar nerve at wrist: systematic review. J Electromyogr Kinesiol 2018; 40: 32–8. doi: 10.1016/j.jelekin.2018.03.004 DOI: https://doi.org/10.1016/j.jelekin.2018.03.004

37. Darwish HS, Habash WY, Kamel H. A. Ultrasound reference values estimation for the upper limb peripheral nerves in adult females; a hospital-based Study. Suez Canal Uni Med J 2022; 25(3): 48–55. doi: 10.21608/scumj.2022.261000 DOI: https://doi.org/10.21608/scumj.2022.261000

38. Bedewi MA, Abodonya A, Kotb M, et al. Estimation of ultrasound reference values for the upper limb peripheral nerves in adults: a cross-sectional study. Medicine(Baltimore) 2017; 96(50): e9306. doi: 10.1097/ MD.0000000000009306 DOI: https://doi.org/10.1097/MD.0000000000009306

39. Qrimli M, Ebadi H, Breiner A, et al. Reference values for ultrasonograpy of peripheral nerves. Muscle Nerve 2016; 53(4): 538–44. doi:10.1002/ mus.24888 DOI: https://doi.org/10.1002/mus.24888

40. Chatterjee S. Artefacts in histopathology. J Oral Maxillofac Pathol 2014; 18(suppl. 1): S111–6. Doi: 10.4103/0973-029X.14134 DOI: https://doi.org/10.4103/0973-029X.141346

Downloads

Published

2024-09-30

How to Cite

Turker Yavas , F., Dabanoglu, I., & Akkoc, A. N. (2024). ANATOMICAL STRUCTURES IN THE RABBIT CARPAL TUNNEL: COMPARISON WITH HUMAN: Rabbit Carpal Tunnel. Slovenian Veterinary Research, 61(3), 187–94. https://doi.org/10.26873/SVR-1870-2023

Issue

Section

Original Research Article