Development of a musculoskeletal model of the wrist to predict frictional work dissipated due to tendon gliding resistance in the carpal tunnel

Abstract

Carpal tunnel syndrome is an entrapment neuropathy that has been associated with the aggravation of tendon gliding resistance due to forceful, high velocity, awkwardly angled, and repetitive wrist motions. Cadaveric and epidemiological studies have shown that combinations of these risk factors have a more than additive effect. The aim of the current study was to develop a musculoskeletal model of the wrist that could evaluate these risk factors by simulating frictional work dissipated due to the gliding resistance of the third flexor digitorum superficialis tendon. Three flexion angle zones, three extension angle zones, five levels of task repetitiveness, and five levels of task effort were derived from ergonomic standards. Of the simulations performed by systematically combining these parameters, the extreme wrist flexion zone, at peak task repetitiveness and effort, dissipated the most frictional work. This zone dissipated approximately double the amount of frictional work compared to its equivalent zone in extension. For all motions, a multiplicative effect of the combination of task repetitiveness and effort on frictional work was identified by the musculoskeletal model, corroborating previous epidemiological and experimental studies. Overall, these results suggest that the ergonomic standards for wrist flexion-extension may need to be adjusted to reflect equivalent biomechanical impact and that workplace tasks should be designed to minimise exposure to combinations of highly repetitive and highly forceful work, especially when the wrist is highly flexed.

Keywords:

• Musculoskeletal modelling
• carpal tunnel
• tendon gliding resistance
• frictional work
• ergonomic risk factors

Acknowledgements

The authors thank Marc Schneider for assistance with rig design; Petros Martirosian and Prof. Fritz Schick for assistance with MR data acquisition; Catharina Rebling for assistance with image processing; and Natalie Winter and Prof. Alexander Grimm for carpal tunnel anatomy consultation.

Disclosure statement

The authors report no conflicts of interest.

CRediT author statement

J.D Glenday: Methodology; Software; Validation; Formal Analysis; Investigation; Data Curation; Writing – Original Draft; Visualisation.

B. Steinhilber: Conceptualisation; Methodology; Resources; Writing – Review & Editing; Project Administration; Funding Acquisition.

F. Jung: Methodology; Investigation; Writing – Review & Editing.

D.F.B Haeufle: Conceptualisation; Methodology; Software; Validation; Resources; Writing – Review & Editing; Supervision; Project Administration; Funding Acquisition.

All the authors were fully involved in the study and the preparation of the manuscript.

Additional information

Funding

The research of JG and DH was supported by the Ministry of Science, Research and the Arts Baden-Württemberg (Az: 33-7533.-30-20/7/2). Furthermore, JG, DH, and BS were supported by the University of Tuebingen via research seed funding through the Exzellentzinitiative. The work of the Institute of Occupational and Social Medicine and Health Services Research Tuebingen is supported by an unrestricted grant of the Employers’ Association of the Metal and Electric Industry Baden-Wuerttemberg (Suedwestmetall). FJ acknowledges funding through the Hertie Institute for Clinical Brain Research, ‘Sigmund-Kiener Promotionsstipendium’.